Intraneural Vascular Resistive Index of the Median Nerve as a Predictor of Severity of Carpal Tunnel Syndrome
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DOI:
https://doi.org/10.5152/eurjther.2020.20030Keywords:
Carpal tunnel syndrome, median nerve, pulsed doppler ultrasounography, resistive indexAbstract
Objective: There is a limited data about resistive index (RI) of median nerve (MN) in patients with carpal tunnel syndrome (CTS). In our study, we aimed to evaluate the relationship between CTS severity and MN-RI. Methods: A total of 115 CTS patient wrists, and 49 wrists of control subjects without CTS, were examined on ultrasonography (US) and color Doppler US (CDUS), pulsed Doppler ultrasonography (PDUS), and by electrophysiological evaluations. MN peak-systolic velocity (MN-PSV), MN end-diastolic velocity, MN-RI and MN pulsatility index (MN-PI) were measured by PDUS. Patients were divided into 3 groups according to electrophysiological examinations severity findings of CTS as mild (Group-I), moderate (Group-II), and severe (Group-III). Results: MN-PSV, MN-PI and MN-RI increased significantly from Group-I to Group-III and these parameters were significantly higher in Group-III than other two groups. MN-RI independently determines the patients to have severe CTS. Increased MN-RI (per-0.1) was found to increase the risk of having severe CTS by 3.45-times. In the ROC analysis, the area under the curve was 0.846 for MN-RI. When the MN-RI cut-off value was taken as 0.80, it determines patients to be severe CTS with 85.2% sensitivity and 78.2% specificity. Conclusion: The increase in MN-RI in CTS patients is independently associated with disease severity and may be used in the clinical follow-up of these patients.
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References
Evans KD, Volz KR, Hutmire C, Roll SC. Morphologic Characterization of Intraneural Flow Associated With Median Nerve Pathology. J Diagn Med Sonogr 2012; 28: 11-9.
de Krom MC, Knipschild PG, Kester AD, Thijs CT, Boekkooi PF, Spaans F. Carpal tunnel syndrome: prevalence in the general population. J Clin Epidemiol 1992; 45: 373-6.
Porth CM. Essentials of Pathophysiology. 3. Philadelphia: Lippincott Williams & Wilkins 2011.
Bianchi, S, Martinoli C. Ultrasound of the Musculoskeletal System. Berlin: Springer-Verlag 2007.
Özçakar L, Kara M, Chang KV, Çarl AB, Akkaya N, Tok F, et al. Nineteen reasons why physiatrists should do musculoskeletal ultrasound: EURO-MUSCULUS/USPRM recommendations. Am J Phys Med Rehabil 2015; 94: 45-9.
Vanderschueren GA, Meys VE, Beekman R. Doppler sonography for the diagnosis of carpal tunnel syndrome: a critical review. Muscle Nerve 2014; 50: 159-63.
Karahan AY, Arslan S, Ordahan B, Bakdik S, Ekiz T. Superb Microvascular Imaging of the Median Nerve in Carpal Tunnel Syndrome: An Electrodiagnostic and Ultrasonographic Study. J Ultrasound Med 2018; 37: 2855-61.
Wilder-Smith EP, Therimadasamy A. Nerve blood flow. J Ultrasound Med 2013; 32: 187-8.
Ghasemi-Esfe AR, Khalilzadeh O, Mazloumi M, Vaziri-Bozorg SM, Niri SG, Kahnouji H, et al. Combination of high-resolution and color Doppler ultrasound in diagnosis of carpal tunnel syndrome. Acta Radiol 2011; 52: 191-7.
Ghasemi-Esfe AR, Khalilzadeh O, Vaziri-Bozorg SM, Jajroudi M, Shakiba M, Mazloumi M, et al. Color and power Doppler US for diagnosing carpal tunnel syndrome and determining its severity: a quantitative image processing method. Radiology 2011; 261: 499-506.
Mohammadi A, Ghasemi-Rad M, Mladkova-Suchy N, Ansari S. Correlation between the severity of carpal tunnel syndrome and color Doppler sonography findings. AJR Am J Roentgenol 2012; 198: 181-4.
Bayrak IK, Bayrak AO, Tilki HE, Nural MS, Sunter T. Ultrasonography in carpal tunnel syndrome: comparison with electrophysiological stage and motor unit number estimate. Muscle Nerve 2007; 35: 344-8.
Kwon HK, Kang HJ, Byun CW, Yoon JS, Kang CH, Pyun SB. Correlation between Ultrasonography Findings and Electrodiagnostic Severity in Carpal Tunnel Syndrome: 3D Ultrasonography. J Clin Neurol 2014; 10: 348-53.
Sayed Z, Hazim T, Neven Fa, Manal A. The value of power and pulsed Doppler in the diagnosis of CTS: Is a solution in sight. The Egyptian Journal of Radiology and Nuclear Medicine 2013; 44: 589-96.
Ikeda M, Okada M, Toyama M, Uemura T, Takamatsu K, Nakamura H. Comparison of Median Nerve Cross-sectional Area on 3-T MRI in Patients With Carpal Tunnel Syndrome. Orthopedics 2017; 40: 77-81.
Wang CK, Jou IM, Huang HW, Chen PY, Tsai HM, Liu YS, et al. Carpal tunnel syndrome assessed with diffusion tensor imaging: comparison with electrophysiological studies of patients and healthy volunteers. Eur J Radiol 2012; 81: 3378-83.
Ninet S, Schnell D, Dewitte A, Zeni F, Meziani F, Darmon M. Doppler-based renal resistive index for prediction of renal dysfunction reversibility: A systematic review and meta-analysis. J Crit Care 2015; 30: 629-35.
Tanaka K, Numata K, Morimoto M, Shirato K, Saito S, Imada T, et al. Elevated resistive index in the hepatic artery as a predictor of fulminant hepatic failure in patients with acute viral hepatitis: a prospective study using Doppler ultrasound. Dig Dis Sci 2004; 49: 833-42.
Zhang L, Duan YY, Li JM, Yin JK. Hemodynamic features of Doppler ultrasonography in patients with portal hypertension: intraoperative direct measurement of portal pressure in the portal venous system. J Ultrasound Med 2007; 26: 1689-96.
Frauchiger B, Schmid HP, Roedel C, Moosmann P, Staub D. Comparison of carotid arterial resistive indices with intima-media thickness as sonographic markers of atherosclerosis. Stroke 2001; 32: 836-41.
Graham B, Peljovich AE, Afra R, Cho MS, Gray R, Stephenson J, et al. The American Academy of Orthopaedic Surgeons Evidence-Based Clinical Practice Guideline on: Management of Carpal Tunnel Syndrome. J Bone Joint Surg Am 2016; 98: 1750-4.
Padua L, LoMonaco M, Gregori B, Valente EM, Padua R, Tonali P. Neurophysiological classification and sensitivity in 500 carpal tunnel syndrome hands. Acta Neurol Scand 1997; 96: 211-7.
Bayrak IK, Bayrak AO, Kale M, Turker H, Diren B. Bifid median nerve in patients with carpal tunnel syndrome. J Ultrasound Med 2008; 27: 1129-36.
Altınkaya N, Leblebici B. Prevalence of persistent median artery in carpal tunnel syndrome: sonographic assessment. Surg Radiol Anat 2016; 38: 511-5.
Öztürk GT, Malas FÜ, Yildizgören MT, Baki AE, İnal EE, Batmaz İ, et al. Ultrasonographic Assessment of the Femoral Cartilage Thickness in Patients with Pes Planus: A Multicenter Study by TURK-MUSCULUS. Am J Phys Med Rehabil 2015; 94: 568-72.
Cartwright MS, Hobson-Webb LD, Boon AJ, Alter KE, Hunt CH, Flores VH, et al. Evidence-based guideline: neuromuscular ultrasound for the diagnosis of carpal tunnel syndrome. Muscle Nerve 2012; 46: 287-93.
Akcar N, Ozkan S, Mehmetoglu O, Calisir C, Adapinar B. Value of power Doppler and gray-scale US in the diagnosis of carpal tunnel syndrome: contribution of cross-sectional area just before the tunnel inlet as compared with the cross-sectional area at the tunnel. Korean J Radiol 2010; 11: 632-9.
Ozcan HN, Kara M, Ozcan F, Bostanoglu S, Karademir MA, Erkin G, et al. Dynamic Doppler evaluation of the radial and ulnar arteries in patients with carpal tunnel syndrome. AJR Am J Roentgenol 2011; 197: 817-20.
Ghasemi-Esfe AR, Morteza A, Khalilzadeh O, Mazloumi M, GhasemiEsfe M, Rahmani M. Color Doppler ultrasound for evaluation of vasomotor activity in patients with carpal tunnel syndrome. Skeletal Radiol 2012; 41: 281-6.
Yoshii Y, Tanaka T, Ishii T. Correlations of median nerve area, strain, and nerve conduction in carpal tunnel syndrome patients. Hand 2016; 11: 161-7.
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