The place of B-mode ultrasonography, shear-wave elastography and superb microvascular imaging in the diagnosis of Carpal Tunnel Syndrome

Öz

Aim: Carpal Tunnel Syndrome is the most common neuropathy of the upper extremity. Electrodiagnostic tests are used to determine the indication for surgery by assessing the severity of neuropathy. However, these evaluations have a margin of error of 10-25% for early cases. The aim of our study is to investigate whether the degree of median nerve neuropathy can be detected with higher sensitivity and specificity with relatively new ultrasonographic parameters that evaluate tissue stiffness and vascularity. Method: The patients' median nerve at both wrist levels, the thickness of the transverse carpal ligament, the distance between the transverse carpal ligament and the adjacent bone, and tissue stiffness (shear wave elastography) and vascularity (superb microvascular imaging) of these structures by ultrasonography. The consistency between ultrasonographically measured tissue thicknesses and surgically measured tissue thicknesses using a caliper was also examined. Results: SWE m/s and kPa values of the median nerve in wrists with Carpal Tunnel Syndrome were significantly higher than in wrists without Carpal Tunnel Syndrome (p=0.0003, p=0.01, respectively). There was an increase in microvascularity in superb microvascular imaging of the median nerve in wrists with Carpal Tunnel Syndrome (p=0.003).Conclusion: Our results showed that median nerve stiffness and microvascularity increased in cases with Carpal Tunnel Syndrome. These findings suggest that, in addition to electrodiagnostic tests in the diagnosis of Carpal Tunnel Syndrome, B-mode ultrasonography, Shear wave elastography and superb microvascular imaging examinations may help clinicians in the treatment decision-making process.

Anahtar Kelimeler

• Carpal tunnel syndrome
• Shear wave elastography
• Superb microvascular imaging
• Electrodiagnostic testing

Karpal Tünel Sendromu tanısında B-mod ultrasonografi, Shear-wave elastografi ve superb mikrovasküler görüntülemenin yeri

Öz

Amaç: Karpal Tünel Sendromu üst ekstremitenin en çok karşılaşılan nöropatisidir. Elektrodiagnostik testler nöropatinin şiddetini değerlendirerek cerrahi endikasyonu belirlemeye yarayan tanısal bir araçtır. Elektrodiagnostik değerlendirmeler tanı ve tedavi kararını belirlemede yaygın olarak kullanılsa da erken dönem vakalar için %10-25 oranında hata payına sahiptir. Bu sebeple çalışmamızın amacı doku sertliği ve doku vaskülariteyi değerlendiren nispeten yeni kabul edilen ultrasonografik parametreler ile median sinir nöropatisinin derecesini daha yüksek sensivite ve spesifite ile tespit edilip edilemeyeceğini araştırmaktır. Yöntem: Dokuz tek taraflı Karpal Tünel Sendromu tanısı olan (8 kadın, 1 erkek, 56.55±8.86 yaş) hasta çalışmaya dahil edildi. Hastaların sağlıklı taraf el bilekleri kontrol grubu olarak kabul edildi. Hastaların her iki el bileği düzeyinde median sinir, transvers karpal ligaman kalınlıkları, transvers karpal ligaman ile komşu kemik arasındaki mesafe ve bu yapıların doku sertliği (shear wave elastografi) ve vaskülaritesi (superb mikrovasküler görüntüleme) ultrasonografi ile iki farklı radyolog tarafından değerlendirildi. Radyologlar arasındaki uyumun yanı sıra ultrasonografik olarak ölçülen doku kalınlıkları ile cerrahi olarak kaliper ile ölçülen doku kalınlıkları arasındaki uyum da incelendi. Bulgular: Karpal Tünel Sendromu kliniği olan el bileklerinde Median sinirin SWE m/s ve kPa değerleri, kliniği olmayanlara göre belirgin derece yüksekti (sırasıyla 0.0003, 0.01). Karpal Tünel Sendromu kliniği olan el bileklerinde Median sinirin Superb mikrovasküler görüntülemesinde mikrovaskülaritede artış vardı (p:0.003). Sonuç: Sonuçlarımız Karpal Tünel Sendromlu olgularda Median sinirde sertliğin ve mikrovaskülaritenin arttığını gösterdi. Bu bulgular Karpal Tünel Sendromu tanısında Elektrodiagnostik testlere ek olarak B mode ultrasonografi, Shear wave elastografi ve Superb mikrovasküler görüntüleme incelemelerinin klinisyenlere tedaviye karar verme sürecinde yardımcı olabileceğini düşündürmektedir.

Anahtar Kelimeler

• Karpal tünel sendromu
• Shear wave elastografi
• Superb mikrovasküler görüntüleme
• Elektrodiagnostik testler

Kaynakça

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