Carpal tunnel syndrome: Diagnostic usefulness of sonography
Carpal tunnel syndrome: Diagnostic usefulness of sonography
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DOI：
10.1148/radiol.2321030071
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发表时间：
2004-07-01
期刊：
影响因子：
19.7
通讯作者：
Wong, KS
中科院分区：
文献类型：
--
作者：
Wong, SM;Griffith, JF;Wong, KS
目的：为了。前瞻性评估超声检查对临床怀疑一只手或双手患有腕管综合征 (CTS) 的患者的诊断准确性。 材料和方法：2001 年 10 月至 2002 年 6 月期间，由 133 名疑似患有 CTS 的患者组成的前瞻性队列被转诊至教学医院进行电诊断研究。 120 名患者（98 名女性，22 名男性；平均年龄，49 岁；范围，19-83 岁）在电诊断研究后 1 周内接受了超声检查。放射科医生对电诊断研究结果不知情。 75 名患者有双侧症状； 23 名患者有右手症状，22 名患者有左手症状（总共 195 只有症状的手）。在三个水平测量正中神经的横截面积：紧邻腕管入口、腕管入口和腕管出口。屈肌支持带被用作腕管边缘的标志。隧道入口附近和隧道出口处区域的最佳阈值水平（通过分类和回归树分析确定）用于区分患有疾病的患者和未患病的患者。敏感性、特异性以及假阳性和假阴性率是根据最终诊断得出的，最终诊断以临床病史和电诊断研究结果为参考标准。结果：对于右手，超声检查的敏感性为 94%（70 中的 66）；对于右手，超声检查的敏感性为 94%（70 中的 66）；特异性，65%（26 中的 17）；假阳性率，12%（75 个中的 9 个）；假阴性率为 19%（21 个中的 4 个）（截止值，隧道入口附近 0.09 cm(2)，隧道出口 0.12 cm(2)）。对于左手，敏感度为 83%（64 人中的 53 人）；特异性，73%（33 中的 24）；假阳性率，15%（62 个中的 9 个）；假阴性率为 31%（35 例中的 11 例）（截止值，接近隧道入口 0.10 cm(2)）。结论：超声检查在诊断 CTS 方面与电诊断研究相当，应被视为疑似患有 CTS 的患者的首选测试。
PURPOSE: To. prospectively evaluate accuracy of sonography for diagnosis of carpal tunnel syndrome (CTS) in patients clinically suspected of having the disease in one or both hands.MATERIALS AND METHODS: A prospective cohort of 133 patients suspected of having CTS were referred to a teaching hospital between October 2001 and June 2002 for electrodiagnostic study. One hundred twenty patients (98 women 22 men; mean age, 49 years; range, 19-83 years) underwent sonography within 1 week after electrodiagnostic study. Radiologist was blinded to electrodiagnostic study results. Seventy-five patients had bilateral symptoms; 23 patients, right-hand symptoms and 22 patients, left-hand symptoms (total, 195 symptomatic hands). Cross-sectional area of median nerve was measured at three levels: immediately proximal to carpal tunnel inlet, at carpal tunnel inlet, and at carpal tunnel outlet. Flexor retinaculum was used as a landmark to margins of carpal tunnel. Optimal threshold levels (determined with classification and regression tree.-analysis) for areas proximal to and at tunnel inlet and at tunnel outlet were used to discriminate between patients with and patients without disease. Sensitivity, specificity, and false-positive and false-negative rates were derived on the basis of final diagnosis, which was determined with clinical history and electrodiagnostic study results as reference standard.RESULTS: For right hands, sonography had sensitivity of 94% (66 of 70); specificity, 65% (17 of 26); false-positive rate, 12% (nine of 75); and false-negative rate, 19% (four of 21) (cutoff, 0.09 cm(2) proximal to tunnel inlet and 0.12 cm(2) at tunnel outlet). For left hands, sensitivity was 83% (53 of 64); specificity, 73% (24 of 33); false-positive rate, 15% (nine of 62); and false-negative rate, 31% (11 of 35) (cutoff, 0.10 cm(2) proximal to tunnel inlet).CONCLUSION: Sonography is comparable to electrodiagnostic study in diagnosis of CTS and should, be considered as initial test of choice for patients suspected of having CTS.