Ultrasonography Findings of the Carpal Tunnel after Endoscopic Carpal Tunnel Release for Carpal Tunnel Syndrome

ObjectiveTo investigate changes in the median nerve, retinaculum, and carpal tunnel on ultrasound after successful endoscopic carpal tunnel release (ECTR).Materials and MethodsThis prospective study involved 37 wrists in 35 patients (5 male, 30 female; mean age ± standard deviation [SD], 56.9 ± 6.7 years) with primary carpal tunnel syndrome (CTS). An in-house developed scoring system (0–3) was used to gauge the clinical improvement after ECTR. Ultrasound was performed before ECTR, and at 1, 3, and 12 months post-ECTR. Changes in the median nerve, flexor retinaculum, and carpal tunnel morphology on ultrasound after ECTR were analyzed. Ultrasound parameters for different clinical improvement groups were compared.ResultsAll patients improved clinically after ECTR. The average clinical improvement score ± SD at 12 months post-ECTR was 2.2 ± 0.7. The median nerve cross-sectional area proximal and distal to the tunnel decreased at all time intervals post-ECTR but remained swollen compared to normal values. Serial changes in the median nerve caliber and retinacular bowing after ECTR were more pronounced at the tunnel outlet than at the tunnel inlet. The flexor retinaculum had reformed in 25 (68%) of 37 wrists after 12 months.ConclusionPostoperative changes in median nerve and retinaculum parameters were most pronounced at the tunnel outlet. Even in patients with clinical improvement after ECTR, nearly all ultrasound parameters remain abnormal at one year post-ECTR. These ultrasound parameters should not necessarily be relied upon to diagnose persistent CTS after ECTR.     

腕管综合征的MRI诊断

研究腕管综合征（CTS）的MRI特征及应用价值。材料和方法：经临床及手术证实的CTS12例，行MRI检查，以横断面为主。结果：12例CTS的MRI表现为：正中神经进入腕管时肿胀增粗12例，正中神经肿胀率（MNSR）为2．25：1。正中神经腕管内受压变扁12冽，正中神经扁平率（MNFR）为3．4。腕横韧带向掌侧膨隆10例，腕横韧带膨隆率（BR）为15．8％。T2WI像正中神经信号增高12例。结论：MRI对CTS的诊断、治疗方式的选择及疗效观察有重要的价值。     

实时动态超声检查在诊治腕管综合征中的作用

目的:初步探讨实时动态超声检查在诊断腕管综合征(CTS)中的作用.材料和方法:20只具CTS症状的手腕,在屈指过程中观察正中神经的位移、断面形态变化,记录下屈指前后神经的厚度差.结果:与对照组相比CTS组当屈指时神经移动较少,断面形状的改变不明显,豌豆骨水平神经厚度未见明显增加.结论:实时动态检查作为超声独具的优势,它可以直观地显示屈指过程中腕管内正中神经的移位,断面形状上的改变,可能根据神经前后径在屈指前后的增加值,判断病变神经及病变程度,为手术方式选择提供帮助.     

The value of power and pulsed Doppler in the diagnosis of CTS: Is a solution in sight

Objective

To evaluate the value of power and pulsed Doppler in diagnosis of CTS and compare it with median nerve cross-sectional area (CSA) measured by gray-scale US and nerve conduction studies.

Patients and methods

Forty patients with definite clinical evidence of CTS and 20 healthy cases were enrolled in the study. All patients and controls underwent nerve conduction studies, gray-scale US (for measurement of CSA) and color Doppler (for assessment of vasomotor activity).

Results

Twenty eight patients (70%) had confirmed diagnosis by NCS while 12 patients (30%) were not detected by the NCS. The CSA ranged from 0.06 to 0.78 cm² with a mean of 0.19 + 0.12. Comparison between patients and controls as regards CSA showed highly statistically significant difference (P < 0.001). There was a significant difference between patients and controls as regards PS, ED & PI. Also there was a significant correlation between median nerve hypervascularization and the parameters of spectral Doppler and the severity of CTS by NCS and also with CSA.

Conclusion

Color Doppler imaging of the median nerve is a readily accessible and practical method for determining the degree of vasomotor impairment in CTS patients that may be valuable in evaluation and follow up of CTS patients in clinical practice.     

Detection of occult metastatic lymph nodes in the neck with gray-scale and power Doppler US

Purpose: To determine the most accurate criterion for predicting malignancy of small cervical lymph nodes with gray-scale ultrasound (GSUS) and power Doppler ultrasound (PDUS).Material and Methods: Findings of 69 pathologically verified cervical nodes (38 benign, 31 malignant) in 57 patients without wide echogenic hilum on GSUS that measured less than 10 mm in minimal axial diameter were prospectively studied. Minimal and maximal axial diameters, ratios of minimal to maximal axial diameters, and presence or absence of calcification or necrosis of the nodes were assessed. On PDUS, vascularity in the node was classified into 4 pattern groups. A logistic model was used to evaluate the significant factors for predicting malignancy.Results: The logistic model revealed that the minimal axial diameter and vascularity patterns were the only significant factors for malignancy. Using the minimal axial diameter, a node larger than 8 mm showed the highest accuracy (73%) with 45% sensitivity and 93% specificity. Of the vascularity patterns, spotted or peripheral pattern had the highest accuracy (80%) with 61% sensitivity and 93% specificity. A combined criterion of the minimal axial diameter larger than 8 mm and spotted or peripheral pattern increased the accuracy to 82% and sensitivity to 77% but specificity decreased to 86%.Conclusion: A combined criterion of minimal axial diameter and vascular patterns was most accurate for diagnosing occult metastatic lymph nodes in the neck.     

Gray scale and color Doppler sonography in the diagnosis of carpal tunnel syndrome

Purpose

To determine the diagnostic accuracy of gray scale and color Doppler sonography in the diagnosis of patients with carpal tunnel syndrome.

Patients and methods

A total of 53 wrists in 41 consecutive patients with clinical suspicion of carpal tunnel syndrome, referred from the Department of Physical medicine, Rheumatology & Rehabilitation were examined with ultrasonography using a 12 MHz linear array transducer. The presence of median nerve edema, swelling, and bowing of the flexor retinaculum was evaluated by gray scale sonography, while intraneural hypervascularity was evaluated by color Doppler sonography. Sensitivity and specificity were calculated for each sonographic feature and compared with electrodiagnostic test (EDT) results.

Results

Electrodiagnostic tests confirmed carpal tunnel syndrome in 48 wrists. A median nerve cross sectional area (CSA) of 11 mm² was calculated as a definition of median nerve swelling. In comparison with electrodiagnostic tests, median nerve swelling showed the highest accuracy (89%) among the gray scale sonographic criteria, and the presence of median nerve hypervascularization showed the highest accuracy (94%) among all sonographic criteria. Median nerve edema and bowing of the flexor retinaculum showed accuracies of 81% and 77% respectively.

Conclusion

Median nerve intraneural hypervascularity detected by color Doppler sonography is more accurate in detection of median nerve involvement than gray scale sonography criteria in patients with suspected carpal tunnel syndrome.     

Power Doppler imaging in acute renal vein occlusion and recanalization: a canine model.

OBJECTIVE: To evaluate the dynamic changes of the power Doppler (PD) in acute renal vein occlusion and recanalization in a canine model. MATERIALS AND METHODS: We performed a PD of the kidney during graded renal vein occlusion and recanalization induced by balloon inflation and deflation in nine dogs. The PD images were transferred to a personal computer, and the PD signals were quantified. RESULTS: We observed the temporal change of the PD signal during renal vein occlusion and recanalization, with a decrease in the PD signal during occlusion and an increase during recanalization. The mean PD signal decreased gradually as the renal vein was occluded, and conversely increased gradually with sequential relief of occlusion. The sequential change of the mean value of the PD signal was statistically significant. CONCLUSION: The PD can detect a change in renal blood flow during acute renal vein occlusion and recanalization in a canine model. The PD may be used as a helpful tool for the early detection of acute renal vein thrombosis and the monitoring of renal perfusion.     

彩色多普勒诊断锁骨下动脉窃血征

目的:探讨锁骨下动脉窃血征的彩色多普勒特征,评价不同程度的椎动脉返流与锁骨下动脉起始部或无名动脉狭窄的关系.材料和方法:回顾性分析32例锁骨下动脉窃血征患者的超声影像资料,并与血管造影结果进行对照分析.结果:左侧病变24例,右侧8例,其中隐性窃血3例,早期短暂性窃血6例,晚期短暂性窃血8例,完全窃血15例.超声对窃血征患者病变部位狭窄情况直接显示率较低,为25%(8/32).患侧椎动脉返流程度与病变部位动脉狭窄程度呈正相关(r=0.8).结论:锁骨下动脉窃血征的重要特征是病变侧椎动脉返流,根据椎动脉返流程度可以推测锁骨动脉起始部或无名动脉狭窄程度.     

肾重复畸形的CT诊断价值及与IVP、B超的比较

目的：提高肾重复畸形的影像学诊断水平。材料和方法：对12例经手术证实的肾重复畸形的CT、IVP和B超表现进行回顾性分析。结果：CT对全部6只积水型肾作出诊断，而9只发育型肾中5只作出诊断，2例发育不全型中1例作出诊断。B超的诊断结果与CT相似。IVP对全部9只发育型肾作出诊断，明显优于CT和B超。而对积水型主要依赖下极肾盂的位置和形态改变，对发育不全型无诊断价值。结论：对肾重复畸形的影像学诊断，单项检查容易漏诊，两种以上检查方法结合进行能明显提高诊断准确率。     

经阴道彩色多普勒超声诊断子宫切口妊娠的临床价值

目的探讨经阴道彩色多普勒超声诊断子宫切口妊娠的应用价值。资料与方法分析30例经手术及病理证实为子宫切口妊娠病例的彩色多普勒超声表现。结果 20例彩色多普勒超声表现为单纯孕囊型,其中漏诊1例;9例为混合性包块型;1例为蜂窝型;29例前壁峡部或前壁肌层内均测得低阻血流信号。结论经阴道彩色多普勒超声检查是诊断子宫切口妊娠简便、准确、可靠的方法。     

高频彩色多谱勒超声在眼内异物诊断中的临床价值

目的探讨高频超声及彩色多普勒(彩超)血流显像对眼内异物的诊断价值。资料和方法运用高频超声及彩色多普勒血流显像技术探查伤眼,回顾性分析2003～2008年经随访手术证实的33只眼内异物的声像图特征。结果 33只伤眼经彩色多谱勒检查发现异物28只,异物检出率为84.85%(28/33),其中眼内异物24只(72.7%),眼球壁异物3只(9.1%),眼眶内异物1只(3%)。结论彩超对于眼内异物的检查具有特异性的诊断价值。     

Carpal tunnel syndrome assessed with diffusion tensor imaging: Comparison with electrophysiological studies of patients and healthy volunteers

The main goal of this study was to investigate the applicability of parameters derived from diffusion tension imaging (DTI) in diagnosing carpal tunnel syndrome (CTS). Forty subjects were recruited, of which 19 were normal controls and 21 belonged to the CTS group. DTI of median nerves evaluated at 4 levels of the wrist (distal radius, pisiform bone, middle portion of the carpal tunnel, and hamate bone) and conventional MRI of the wrist was performed in normal and CTS subjects in two finger postures (extension and flexion). Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were derived from DTI, and parameters related to abnormal hyperintensity of the median nerve were derived from conventional MRI. Electrophysiological tests, including nerve conduction velocity and F wave were also performed for comparison. The results of FA and ADC measurements did not depend on the measuring location and finger posture. Mean FA was decreased while mean ADC was increased by CTS. FA and ADC at the middle portion of the carpal tunnel was 0.47±0.05 and 1.37±0.12 (×10(-3)mm(2)/s) for the control group and 0.42±0.04 and 1.50±0.15 (×10(-3)mm(2)/s) for the CTS group, respectively. The linear correlations of FA and ADC versus electrophysiological indicators of CTS were significant (R(2) ranged from 0.09 to 0.36), indicating FA and ADC from DTI had significant correlation with the existence and severity of CTS.     

彩色多普勒超声内镜、CT和腹部超声术前定位诊断胰岛细胞瘤

目的:比较彩色多普勒超声内镜(ECDUS)与螺旋CT和腹部超声(US)术前定位诊断胰岛细胞瘤的价值.材料和方法:对经内科检查定性诊断胰岛细胞瘤并准备手术切除的9例患者行术前ECDUS、US和胰腺螺旋CT增强扫描(CT)检查,并与手术和病理检查对照.结果:9例患者共发现12个病灶,均为良性,ECDUS检出10/12,US未检出,CT检出1/12,ECDUS检出病灶部位与手术所见一致,ECDUS漏诊的2个病灶,直径分别为0.4cm和0.5cm.结论:ECDUS对胰岛细胞瘤定位准确优于US、CT.但对直径小于0.5cm的病灶,定位诊断仍有困难.     

阑尾炎的彩超检查附200例报告

目的：探讨彩超对阑尾炎的临床诊断价值。方法：回顾性分析200例行彩超检查的阑尾炎患者的声像图特征,并与手术及病理对照分析。结果：200例中急性单纯性阑尾炎81例（40．5％）,急性化脓性阑尾炎72例（36%）,急性坏疽穿孔性阑尾炎41例（20．5％）,慢性阑尾炎6例（3％）,其中27例伴阑尾周围脓肿,有5例合并右侧卵巢及右侧输卵管积脓,慢性阑尾炎急性发作4例,有3例为胆囊术后并发阑尾炎,有35例阑尾腔内有粪石。急性阑尾炎彩超表现为：阑尾明显增粗,水肿,阑尾周围伴有渗出的低回声,合并脓肿时伴有低回声或者混合型回声团块,合并粪石时,阑尾腔内为强回声团块,后方伴声影;慢性阑尾炎为阑尾卷曲,折迭,管腔粗细不均匀,部分合并狭窄、管腔闭塞或者粪石阻塞。结论：彩超对阑尾炎的检查方便快捷,同时有易接受及可重复性等优点,可为急性阑尾炎的诊断提供依据,在临床外科手术中具有较高的实用性。     

经阴道彩色多普勒超声诊断11～14孕周胎儿心脏结构异常的价值

目的探讨经阴道彩色多普勒超声(TVCDS)诊断11～14孕周胎儿心脏结构异常的方法和价值。资料和方法对125例11～14孕周、有高危妊娠病史或经腹检查不满意的孕妇进行经阴道彩色多普勒超声检查,并与胎儿引产结果及产后超声心动图进行对照。结果 125例中发现胎儿心脏异常5例。除外1例室间隔小缺损,随访均与阴道彩色多普勒超声心动图检查结果相符。结论经阴道彩色多普勒超声心动图对早期诊断胎儿心脏结构异常有重要的临床应用价值。     

彩色多普勒超声血流阻力指数结合CA125对卵巢肿瘤的诊断价值

目的探讨彩色多普勒超声血流阻力指数(RI)结合肿瘤标志物CA125判断卵巢肿瘤良恶性的价值.资料与方法107例卵巢肿瘤患者采用Finkler 超声评分系统进行评分,经彩色多普勒超声检查测定 RI,同时测定患者血清 CA125判断卵巢肿瘤良恶性,并与术后病理进行对照.结果恶性卵巢肿瘤患者 Finkler 超声评分明显高于良性卵巢肿瘤患者,RI 值低于良性卵巢肿瘤患者,CA125明显高于良性卵巢肿瘤患者(P <0.01、P <0.05).Finkler超声评分、RI 结合 CA125对卵巢肿瘤良恶性诊断的敏感性及特异性分别为94.59%、89.47%,均高于单一检查方法.结论彩色多普勒超声、RI 及肿瘤标志物 CA125联合应用对提高卵巢肿瘤良恶性的诊断有一定临床价值.     

Color Doppler, power Doppler and B-flow ultrasound in the assessment of ICA stenosis: Comparison with 64-MD-CT angiography

The purpose of this study is to investigate the diagnostic potential of color-coded Doppler sonography (CCDS), power-Doppler (PD) and B-flow ultrasound in assessing the degree of extracranial internal carotid artery (ICA) stenosis in comparison to CT-angiography (MD-CTA). Thirty-two consecutive patients referred for CTA with 41 ICA-stenoses were included in this prospective study. MD-CTA was performed using a 64 row scanner with a CTDIvol of 13.1 mGy/cm. In CTA, CCDS, PD and B-flow, the degree of stenosis was evaluated by the minimal intrastenotic diameter in comparison to the poststenotic diameter. Two radiologists performed a quantitative evaluation of the stenoses in consensus blinded to the results of ultrasound. These were correlated to CTA, CCDS, PD and B-flow, intraoperative findings and clinical follow-up. Grading of the stenoses in B-flow ultrasound outperformed the other techniques in terms of accuracy with a correlation coefficient to CTA of 0.88, while PD and CCDS measurements yield coefficients of 0.74 and 0.70. Bland-Altman analysis additionally shows a very little bias of the three US methods between 0.5 and 3.2 %. There is excellent correlation (coefficient 0.88, CI 0.77–0.93) with 64-MD-CTA and B-flow ultrasound in terms of accuracy for intrastenotic and poststenotic diameter. Duplex sonography is useful for screening purposes. Clevert D.–A. and Johnson T. contributed equally to this study.