Emrah KARATAY, Ozlem TURKOGLU, Başak MANSIZ-KAPLAN

Karpal tünel sendromunda median sinir sertliği ölçümlerini kullanarak real-time strain elastografinin tanısal etkinliğinin değerlendirilmesi

Amaç: Karpal tünel sendromu(KTS) tanılı olgularda real -time strain elastografisinin tanısal değerini ve median sinire yönelik EMG (elektromiyografi) bulguları ile sonografik parametrelerin (sinir kesit alanı ölçümü) arasındaki korelasyonu göstermeyi amaçladık. Gereç ve Yöntem: Çalışmaya median sinirin trasesinde en az 3 ay süren parestezisi olan hastalar dahil edildi. KTS tespit edilen toplam 23 kadın hasta ve 25 sağlıklı kadın kontrol gruplarının el bileği incelenirken bifid median sinir ekarte edilerek toplamda 36 KTS ve 46 sağlıklı median sinire el bileği trasesinde 3 farklı noktada; radyoulnar eklem, skafoidpsiform bileşke ve hamat kemik olmak üzere real time strain elastografisi uygulandı. Hastaların klinik belirtileri vardı ve EMG testleri tanıyı doğruladı Bulgular: KTS mevcut olgularda EMG bulguları ile sonografik median sinir kesit alanı ölçümü ve strain elastografi oran değerleri korele olarak tespit edildi. KTS olgularında median sinir elastografi strain oran değeri kontrol grubuna göre anlamlı olarak artmıştı . Sonuç: Sonoelastografi KTS tanısı için yararlı bir yöntem olarak umut verici sonuçlar vermektedir.

Assessment of diagnostic efficiency of real-time strain elastography by using the median nerve stiffness at females with carpal tunnel syndrome

elastography in relation to carpal tunnel syndrome (CTS) and to show the relationship between electromyography (EMG) and sonographic cross-sectional area measurements. Materials and Methods: The patients with paresthesia of the median nerve distrubition lasting at least for 3 months were included. A total of 23 female patients’s of CTS and 25 healthy female volunteers’ wrist in which one median nerve existed included that of 36 CTS and 46 healthy wrists. The patients had clinical signs and their EMG test confirmed the diagnosis. The patients median nerve along its course on the wrist was applied strain elastography at three points of the radioulnar joint, scaphoidpsiform junction and hamate bone. Results: The EMG findings, strain elastogragraphy ratios and the CSA of the median nerve were found to be correlated significantly. The median nerve strain ratio in elastography was significantly increased in the CTS patients compared to the control group. Conclusion: Sonoelastography promises to be a useful method for the diagnosis of CTS.

Keywords:

electromyography carpal tunnel syndrome, strain elastography, elasticity,

PDF

___

1. Martyn CN, Hughes RA. Epidemiology of peripheral neuropathy. J Neurol Neurosurg Psychiatry. 1997;62:310–18.
2. Moran L, Perez M, Esteban A, Bellon J, Arranz B, del Cerro M. Sonographic measurement of cross- sectional area of the median nerve in the diagnosis of carpal tunnel syndrome: Correlation with nerve conduction studies. J Clin Ultrasound. 2009;37:125– 31.
3. Ozben S, Acar H, Gunaydin S, Genc F, Ozer F, Ozben H. The second lumbrical–interosseous latency comparison in carpal tunnel syndrome. J Clin Neurophysiol. 2012;29:263–67.
4. Atroshi I, Gummesson C, Johnsson R, Ornstein E. Diagnostic properties of nerve conduction tests in population based carpal tunnel syndrome. BMC Musculoskelet Disord. 2003;4:9.
5. Gomes I, Becker J, Ehlers JA, Nora DB. Prediction of the neurophysiological diagnosis of carpal tunnel syndrome from the demographic and clinical data. Clin Neurophysiol. 2006;117:964–71.
6. Witt JC, Hentz JG, Stevens JC. Carpal tunnel syndrome with normal nerve conduction studies. Muscle Nerve. 2004;29:515–22.
7. Mathew RP, Venkatesh SK. Imaging of hepatic fibrosis. Curr Gastroenterol Rep. 2018;20:45.
8. Hari S, Paul SB, Vidyasagar R, Dhamija E, Adarsh AD, Thulkar S et al. Breast mass characterization using shear wave elastography and ultrasound. Diagn Interv Imaging. 2018;99:699-707.
9. Tyloch DJ, Tyloch JF, Adamowicz J, Juszczak K, Ostrowski A, Warsiński P et al. Elastography in prostate gland imaging and prostate cancer detection. Med Ultrason. 2018;20:515-23.
10. Feng YN, Li YP, Liu CL, Zhang ZJ. Assessing the elastic properties of skeletal muscle and tendon using shearwave ultrasound elastography and MyotonPRO. Sci Rep. 2018;8:17064.
11. Miyamoto H, Halpern EJ, Kastlunger M, Gabl M, Arora R, Bellmann-Weiler et al. Carpal tunnel syndrome: diagnosis by means of median nerve elasticity--improved diagnostic accuracy of US with sonoelastography. Radiology. 2014;270:481 86.
12. Gunes O, Serkan O, Nergiz H, Mahmut D, Keziban G. Ultrasound elastographic evaluation in the diagnosis of carpal tunnel syndrome: initial findings. Ultrasound Med Biol. 2013;39: 1184–189.
13. Emara DM, El Shafei MM, Naby HMA. Utility of ultrasound elastography in a cohort of patients with idiopathic carpal tunnel syndrome. The Egypt J of Radiol Nucl Med. 2018; 49:408-14.
14. de Krom MC, Knipschild PG, Kester AD, Thijs CT, Boekkooi PF, Spaans F. Carpal tunnel syndrome: Prevalence in the general population. J Clin Epidemiol. 1992;45:373–76.
15. Szabo RM, Chidgey LK. Stress carpal tunnel pressures in patients with carpal tunnel syndrome and normal patients. J Hand Surg Am. 1989;14:624-27.
16. Mackinnon SE, Dellon AL, Hudson AR, Hunter DA. A primate model for chronic nerve compression. J Reconstr Microsurg. 1985;1:185–95.
17. Rempel D, Evanoff B, Amadio PC, De Krom M, Franklin G, Franzblau A et al. Consensus criteria for the classification of carpal tunnel syndrome in epidemiologic studies. Am J Public Health. 1998;88:1447–451.
18. Dinarvand V, Abdollahi I, Ahmad SR, Bandpei MAM, Babaee M, Talimkhani A. The effect of scaphoid and hamate mobilization on treatment of patients with carpal tunnel syndrome. Anesth Pain Med. 2017;7.e14621.
19. Demirkol A, Uludag M, Soran N, Aksoy N, Gun K, Incebıyık S et al. Total oxidative stress and antioxidant status in patients with carpal tunnel syndrome. Redox Rep. 2012;7:234 38.
20. Kim JK, Koh YD, Kim JS, Hann HJ, Kim MJ. Oxidative stress in subsynovial connective tissue of idiopathic carpal tunnel syndrome. J Orthop Res. 2010;28:1463 468.
21. Asadov R, Erdal A, Buğdaycı O, Gündüz OH, Ekinci G. The effectiveness of ultrasonography and ultrasonographic elastography in the diagnosis of carpal tunnel syndrome and evaluation of treatment response after steroid injection. Eur J Radiol. 2018;108:172 76.
22. Dehghan F, Haghighat S, Ramezanian H, Karami M, Rezaei MR. Ultrasonography predictive factors of response to local steroid injection in patients with carpal tunnel syndrome. Adv Biomed Res. 2018;7:22.
23. Tezcan S, Ulu Ozturk F, Uslu N, Nalbant M, Umit Yemisci O. Carpal tunnel syndrome: evaluation of the effects of low-level laser therapy with ultrasound strain imaging. J Ultrasound Med. 2019;38:113 122.
24. Shiri R, Pourmemari MH, Falah-Hassani K, Viikari- Juntura E. The effect of excess body mass on the risk of carpal tunnel syndrome: a metaanalysis of 58 studies. Obes Rev. 2015;16:1094–1104.
25. Mansoor S, Siddiqui M, Mateen F, Saadat S, Khan ZH, Zahid M et al. Prevalence of obesity in carpal tunnel syndrome patients: A cross-sectional survey. Cureus. 2017;9:e1519.
26. Uzar E, İlhan A, Ersoy A. Association between carpal tunnel syndrome and abdominal obesity. Turk J Neurol. 2010;16:187-92.
27. Kurt S, Kisacik B, Kaplan Y, Yildirim B, Etikan I, Karaer H. Obesity and carpal tunnel syndrome: is there a causal relationship? Eur Neurol. 2008;59:253 57.
28. Martin MJ, Cartwright MS. A pilot study of strain elastography in the diagnosis of carpal Tunnel Syndrome. J Clin Neurophysiol. 2017;34:114–18.
29. Miyamoto H, Morizaki Y, Kashiyama T, Tanaka S. Grey-scale sonography and sonoelastography for diagnosing carpal tunnel syndrome. World J Radiol. 2016;8:281–87.
30. Liao YY, Lee WN, Lee MR,Chen WS, Chiou HJ, Kuo TT et al. Carpal tunnel syndrome: US strain imaging for diagnosis. Radiology. 2015;75:205 14.
31. Lin CP, Chen IJ, Chang KV, Wu WT, Özçakar L. Utility of ultrasound elastography in evaluation of carpal tunnel syndrome: A systematic review and meta-analysis. Ultrasound Med Biol. 2019;45:2855 865.