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Sonographic cross-sectional area measurement in carpal tunnel syndrome patients: can delta and ratio calculations predict severity compared to nerve conduction studies?

  • Ultrasound
  • Published:
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Abstract

Objective

To evaluate the accuracy of two different sonographic median nerve measurement calculations in predicting carpal tunnel syndrome (CTS) severity in a study population with clinically and electrophysiologically confirmed CTS.

Methods

643 wrists of 427 patients (325 females and 102 males, age range: 17–90 years, mean ± SD: 57.9 ± 14.7) were included with CTS diagnosis based on clinical and nerve conduction studies (NCS). Cross-sectional area (CSA) measurement of the median nerve was performed at the carpal tunnel level (CSAc) and at the pronator quadratus muscle level (CSAp). Two parameters were calculated: delta (∆-CSA), which is the difference between proximal and distal measurements, and ratio (R-CSA), calculated by dividing distal over proximal measurements.

Results

Patients were classified into mild, moderate and severe CTS based upon NCS. The mean ∆-CSA (4.2 ± 2.6, 6.95 ± 2.2 and 10.7 ± 4.9 mm2) and mean R-CSA (1.5 ± 0.4, 1.95 ± 0.4 and 2.4 ± 0.7) values were significantly different between all groups (p < 0.001). Optimal cut-off values for ∆-CSA and R-CSA were 6 mm2 and 1.7, respectively, to distinguish mild from moderate disease, and 9 mm2 and 2.2, respectively, to distinguish moderate from severe disease.

Conclusion

Threshold values for the calculated sonographic parameters ∆-CSA and R-CSA are useful in predicting CTS severity compared to NCS.

Key Points

• Two proposed parameters were calculated (∆-CSA, R-CSA) and compared to NCS.

• A defined sonoanatomical proximal landmark was used for the calculation.

• Both parameters showed ability to detect CTS severity comparable to NCS.

• Cut-off values could be determined for both parameters.

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Abbreviations

CTS:

Carpal tunnel syndrome

NCS:

Nerve conduction studies

CSA:

Cross-sectional area

CSAc:

Cross-sectional area at the carpal tunnel

CSAp:

Cross-sectional area proximally

∆-CSA:

Delta cross-sectional area

R-CSA:

Ratio

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Acknowledgments

The scientific guarantor of this publication is Andrea S. Klauser. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors has significant statistical expertise: Dr. Ethan J. Halpern, Department of Radiology and Urology, Jefferson Prostate Diagnostic Center and Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Methodology: prospective, diagnostic or prognostic study, performed at one institution.

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Authors and Affiliations

  1. Department of Diagnostic Radiology, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria

    Andrea S. Klauser, Mohamed M. H. Abd Ellah, Christian Siedentopf, Thomas Auer, Gernot Eberle, Christian Kremser, Gudrun M. Feuchtner & Werner R. Jaschke

  2. Department of Radiology and Urology, Jefferson Prostate Diagnostic Center and Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA

    Ethan J. Halpern

  3. Department of Internal Medicine I, Clinical Immunology and Infectious Diseases, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria

    Rosa Bellmann-Weiler

  4. Department of Neurology, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria

    Martin Sojer & Wolfgang N. Löscher

  5. Department of Trauma Surgery, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria

    Markus F. Gabl

  6. Department of Diagnostic Radiology, South Egypt Cancer Institute, Assiut University, Almethaq street, 71111, Assiut, Egypt

    Mohamed M. H. Abd Ellah

Authors
  1. Andrea S. Klauser
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  2. Mohamed M. H. Abd Ellah
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  3. Ethan J. Halpern
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  4. Christian Siedentopf
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  5. Thomas Auer
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  6. Gernot Eberle
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  7. Rosa Bellmann-Weiler
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  8. Christian Kremser
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  9. Martin Sojer
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  10. Wolfgang N. Löscher
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  11. Markus F. Gabl
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  12. Gudrun M. Feuchtner
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  13. Werner R. Jaschke
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Corresponding author

Correspondence to Mohamed M. H. Abd Ellah.

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Klauser, A.S., Abd Ellah, M.M.H., Halpern, E.J. et al. Sonographic cross-sectional area measurement in carpal tunnel syndrome patients: can delta and ratio calculations predict severity compared to nerve conduction studies?. Eur Radiol 25, 2419–2427 (2015). https://doi.org/10.1007/s00330-015-3649-8

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  • DOI: https://doi.org/10.1007/s00330-015-3649-8

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