European Radiology

, Volume 22, Issue 6, pp 1310–1319 | Cite as

Pre- and post-operative diffusion tensor imaging of the median nerve in carpal tunnel syndrome

  • Jaana Hiltunen
  • Erika Kirveskari
  • Jussi Numminen
  • Nina Lindfors
  • Harry Göransson
  • Riitta Hari
Magnetic Resonance



To use pre- and post-operative diffusion tensor imaging (DTI) to monitor median nerve integrity in patients suffering from carpal tunnel syndrome (CTS).


Diffusivity and anisotropy images along the median nerve were compared among 12 patients, 12 age-matched and 12 young control subjects and correlated with electrophysiological neurography results. Slice-wise DTI parameter values were calculated to focus on local changes.


Results of pre-operative patients and age-matched control subjects differed only in the distal nerve. Moreover, pre-operative patients differed significantly from young controls and post-operative patients. The main abnormalities were increased diffusivity and decreased anisotropy in the carpal tunnel and distal median nerve. Post-operative clinical improvement was reflected in diffusivity, but not in anisotropy. Slice-wise analysis showed high pre-operative diffusivity at the distal nerve. All groups had relatively large inter-subject variation in both diffusivity and anisotropy.


DTI can provide information complementary to clinical examination, electrophysiological recordings and anatomical MRI of diseases and injuries of peripheral nerves. However, similar age-related changes in diffusivity and anisotropy may weaken DTI specificity. Slice-wise analysis is necessary for detection of local changes in nerve integrity.

Key Points

• Diffusion tensor magnetic resonance imaging provides information complementary to conventional diagnostic methods.

• Age caused similar changes to diffusivity and anisotropy as carpal tunnel syndrome.

• Post-operative clinical improvement was reflected in diffusivity, but not in anisotropy.

• Inter-subject variation in diffusivity and anisotropy was considerable.


Diffusion tensor imaging DTI Carpal tunnel syndrome CTS Fractional anisotropy Mean diffusivity 



This study was financially supported by the Academy of Finland (National Center of Excellence Program 2006-2011), the EVO of Helsinki and Uusimaa Hospital District, Instrumentarium Foundation (JH), Paulo Foundation (EK), Louis-Jeantet Foundation (Switzerland) and Jenny Antti Wihuri Foundation (Finland). We gratefully acknowlegde the DTI sequence and recon code from Drs. Roland Bammer, Michael Moseley and Gary Glover, supported by the NIH NCRR grant “Stanford Center for Advanced Magnetic Resonance Technology”, P41 RR09784 (PI: G. Glover). We thank Ms. Marita Kattelus and Dr. Nuutti Vartiainen for help in MRI recordings.


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Copyright information

© European Society of Radiology 2012

Authors and Affiliations

  • Jaana Hiltunen
    • 1
    • 2
  • Erika Kirveskari
    • 1
    • 3
  • Jussi Numminen
    • 1
    • 4
  • Nina Lindfors
    • 5
  • Harry Göransson
    • 5
  • Riitta Hari
    • 1
    • 2
    • 3
  1. 1.Brain Research Unit, Low Temperature LaboratoryAalto University School of ScienceAaltoFinland
  2. 2.Advanced Magnetic Imaging CentreAalto University School of ScienceAaltoFinland
  3. 3.Department of Clinical NeurophysiologyHelsinki University Central HospitalHelsinkiFinland
  4. 4.Helsinki Medical Imaging CenterUniversity of HelsinkiHelsinkiFinland
  5. 5.Department of Hand SurgeryHelsinki University Central HospitalHelsinkiFinland

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