实时弹性定量成像技术在腕管综合征正中神经病变中应用及与MRI正中神经扁平率相关性研究

[目的]评估VTIQ的剪切波速度(shear wave velocity,SWV)在CTS患者中的应用,同时分析与MRI钩骨钩水平正中神经扁平率(median nerve flattening ratio MNFR) 相关性,以探讨SWV在诊断CTS中的临床应用价值。[方法]对临床诊断为CTS 40例患者(67只腕关节)及20例健康对照组(40只腕关节)进行VTIQ检测及二维超声检测。评估指标是SWV及CSA。比较两指标CTS组与对照组组间差异。绘制两指标诊断CTS的ROC曲线。回顾性分析临床诊断CTS患者MRI资料,测量MNFR。评估SWV及CSA与MNFR相关性。[结果]CTS组SWV、CSA与对照组比较差异有统计学意义(P＜0.05)。正中神经SWV诊断CTS最佳截值3.30m/s,计算SWV的灵敏度、特异度和准确率高于CSA。两指标联合诊断效能灵敏度,准确率高于单一指标。SWV、CSA与MNFR之间存在相关性。[结论] CSA及SWV两指标的改变反映了CTS患者正中神经形态学增粗,组织学变硬。VTIQ技术与MRI测量结果有较好一致性。遵照规范及指南条件下应用VTIQ技术在诊断CTS患者正中神经病变中有较好的可行价值。VTIQ技术及正中神经横截面积联合应用可以减少漏诊率,可为患者正确规范化治疗CTS提供更丰富的影像诊断依据。

Correlation real-time quantitative elastography measurement of median nerve neuropathy and MRI median nerve flatness ratio in carpal tunnel syndrome patients

[Objectives] To evaluate the application of the VTIQ and to analysisSthe correlation among SWV,CSA and MNFR,to evaluate the diagnostic value of the VTIQ in the diagnosis of CTS. [Methods] The study included 40 patients (67 wrists) and 20 healthy volunteers (40wrists). The median nerve(MN)CSA, SWV and MNFR were studied. The differences between CTS patients and controls were studied by independent sampleST-test.ROC analysis was performed. The correlations were analyzed among SWV, CSA and MNFR. [Results] There was significant differences of the MN SWV, CSA between CTS group and healthy control (P<0.01). The cut-off value of SWV for diagnosing CTS was 3.30m/s, and the sensitivity, specificity and accuracy of SWV were better than that of CSA. The combined diagnostic performance sensitivity and accuracy of the two indexes is higher than that of the single index. There is a positive correlations among the SWV,CSA and MNFR.[Conclusions] The changes of CSA and SWV reflected the thickening of MN morphology and the hardening of histology in CTS patients.VTIQ technique was in good agreement with MRI results.The application of VTIQ in the diagnosis of CTS has a good practical value under the premise of following the clinical guidelines and recommendations of elastic imaging.The combined application of VTIQ technology and CSA can reduce the rate of missed diagnosis and provide more abundant imaging diagnostic basis for patients with correct standardized treatment of CTS.