Skip to main content

Advertisement

SpringerLink
Log in

The efficiency of acoustic radiation force impulse (ARFI) elastography in the diagnosis and staging of carpal tunnel syndrome

  • Original Article
  • Published:
Journal of Medical Ultrasonics Aims and scope Submit manuscript

Abstract

Objectives

The aim of the present study was to quantify the stiffness of the median nerve (MN) at the carpal tunnel inlet by acoustic radiation force impulse (ARFI) elastography and to evaluate whether ARFI can be used in diagnosis and staging of carpal tunnel syndrome (CTS).

Methods

Sonographic examinations of 96 wrists in 50 patients were included in the study. The cross-sectional area and stiffness of the MN were quantitatively measured by B-mode ultrasonography (USG) and ARFI. The findings of CTS were assigned to four groups: (I) normal (n = 21), (II) mild (n = 39), (III) moderate (n = 38), and (IV) severe (n = 19). The differences between CTS patients and controls and the differences in electrodiagnostic tests among subgroups were statistically compared. ROC analysis was performed to determine the cut-off values between subgroups.

Results

Bilateral CTS was present in 46 patients (92 wrists) and unilateral CTS in four patients. Of the 96 nerves in the 50 symptomatic “idiopathic CTS” patients (48 women, 2 men; mean age 45.9 years, range 23–73 years), 39 (40.4%) were mild, 38 (39.8%) were moderate, and 19 (19.8%) were severely affected. When compared to controls, MN stiffness was significantly higher in the CTS group (P < 0.001); furthermore, it was higher in the severe or extreme severity group than the mild or moderate severity group (P < 0.001). A 3.250 m/s cut-off value on ARFI revealed sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 81, 82, 95.1, 50, and 82%, respectively.

Conclusion

The MN stiffness measured by ARFI elastography is significantly higher in patients with CTS then in controls. ARFI elastography appears to be a highly efficient imaging modality for the diagnosis and staging of these patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Bianchi S, Martinoli C, Sureda D, et al. Ultrasound of the hand. Eur J Ultrasound. 2001;14:29–34.

    Article  PubMed  CAS  Google Scholar 

  2. Peetrons PA, Derbali W. Carpal tunnel syndrome. Semin Musculoskelet Radiol. 2013;17:28–33.

    Article  PubMed  Google Scholar 

  3. Andreisek G, Crook DW, Burg D, et al. Peripheral neuropathies of the median, radial, and ulnar nerves: MR imaging features. Radiographics. 2006;26:1267–87.

    Article  PubMed  Google Scholar 

  4. Barcelo C, Faruch M, Lapegue F, et al. 3-T MRI with diffusion tensor imaging and tractography of the median nerve. Eur Radiol. 2013;23:3124–30.

    Article  PubMed  Google Scholar 

  5. Tasdelen N, Gurses B, Kilickesmez O, et al. Diffusion tensor imaging in carpal tunnel syndrome. Diagn Interv Radiol. 2012;18:60–6.

    PubMed  Google Scholar 

  6. Wong SM, Griffith JF, Hui AC, et al. Carpal tunnel syndrome: diagnostic usefulness of sonography. Radiology. 2004;232:93–9.

    Article  PubMed  Google Scholar 

  7. Bamber J, Cosgrove D, Dietrich CF, et al. EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 1: basic principles and technology. Ultraschall Med. 2013;34:169–84.

    Article  PubMed  CAS  Google Scholar 

  8. Botanlioglu H, Kantarci F, Kaynak G, et al. Shear wave elastography properties of vastus lateralis and vastus medialis obliquus muscles in normal subjects and female patients with patellofemoral pain syndrome. Skelet Radiol. 2013;42:659–66.

    Article  Google Scholar 

  9. Park GY, Kim SK, Park JH. Median nerve injury after carpal tunnel injection serially followed by ultrasonographic, sonoelastographic, and electrodiagnostic studies. Am J Phys Med Rehabil. 2011;90:336–41.

    Article  PubMed  Google Scholar 

  10. Orman G, Ozben S, Huseyinoglu N, et al. Ultrasound elastographic evaluation in the diagnosis of carpal tunnel syndrome: initial findings. Ultrasound Med Biol. 2013;39:1184–9.

    Article  PubMed  Google Scholar 

  11. Kantarci F, Ustabasioglu FE, Delil S, et al. Median nerve stiffness measurement by shear wave elastography: a potential sonographic method in the diagnosis of carpal tunnel syndrome. Eur Radiol. 2014;24:434–40.

    Article  PubMed  Google Scholar 

  12. Padua L, Padua R, Lo Monaco M, et al. Multiperspective assessment of carpal tunnel syndrome: a multicenter study. Italian CTS Study Group. Neurology. 1999;53:1654–9.

    Article  PubMed  CAS  Google Scholar 

  13. Jablecki CK, Andary MT, Floeter MK, et al. Practice parameter for electrodiagnostic studies in carpal tunnel syndrome: summary statement. American Association of Electrodiagnostic Medicine, American Academy of Neurology, American Academy of Physical Medicine and Rehabilitation. Muscle Nerve. 1993;16:1390–1.

    Article  Google Scholar 

  14. Padua L, LoMonaco M, Gregori B, et al. Neurophysiological classification and sensitivity in 500 carpal tunnel syndrome hands. Acta Neurol Scand. 1997;96:211–7.

    Article  PubMed  CAS  Google Scholar 

  15. Martinoli C, Bianchi S, Gandolfo N, et al. US of nerve entrapments in osteofibrous tunnels of the upper and lower limbs. Radiographics. 2000;20:S199–213 (discussion S-7).

    Article  PubMed  Google Scholar 

  16. Coppieters MW, Schmid AB, Kubler PA, et al. Description, reliability and validity of a novel method to measure carpal tunnel pressure in patients with carpal tunnel syndrome. Man Ther. 2012;17:589–92.

    Article  PubMed  Google Scholar 

  17. Wang Y, Qiang B, Zhang X, et al. A non-invasive technique for estimating carpal tunnel pressure by measuring shear wave speed in tendon: a feasibility study. J Biomech. 2012;45:2927–30.

    Article  PubMed  Google Scholar 

  18. Rempel D, Dahlin L, Lundborg G. Pathophysiology of nerve compression syndromes: response of peripheral nerves to loading. J Bone Joint Surg Am. 1999;81:1600–10.

    Article  PubMed  CAS  Google Scholar 

  19. Xin H, Hu HY, Liu B, et al. Ultrasound elastographic evaluation of the median nerve in hemodialysis with carpal tunnel syndrome. J Med Ultrason. 2001;2017:123–31.

    Google Scholar 

  20. Kang S, Kwon HK, Kim KH, et al. Ultrasonography of median nerve and electrophysiologic severity in carpal tunnel syndrome. Ann Rehabil Med. 2012;36:72–9.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, Medical Faculty, Van Yuzuncu Yil University, 65100, Van, Turkey

    Harun Arslan, Alpaslan Yavuz, Mesut Ozgokce, Hüseyin Akdeniz & Abdussamet Batur

  2. Department of Neurology, Van Training and Research Hospital, Van, Turkey

    Ferda İlgen

  3. Department of Neurosurgery, Medical Faculty, Van Yuzuncu Yil University, Van, Turkey

    Abdurrahman Aycan

Authors
  1. Harun Arslan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alpaslan Yavuz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ferda İlgen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Abdurrahman Aycan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mesut Ozgokce
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hüseyin Akdeniz
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Abdussamet Batur
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Harun Arslan.

Ethics declarations

Ethical statements

This study was approved by the Yuzuncu Yil University ethics committee. Written informed consent was obtained from all individuals included in the study. This manuscript has not been published and is not under consideration for publication elsewhere. There is no overlap of our present work with any previously published studies.

Conflict of interest

The authors declare that they have no conflicts of interest or industry support to disclose.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Arslan, H., Yavuz, A., İlgen, F. et al. The efficiency of acoustic radiation force impulse (ARFI) elastography in the diagnosis and staging of carpal tunnel syndrome. J Med Ultrasonics 45, 453–459 (2018). https://doi.org/10.1007/s10396-017-0857-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10396-017-0857-7

Keywords

Search

Navigation