Magnetic resonance imaging compared with electrodiagnostic studies in patients with suspected carpal tunnel syndrome: predicting symptoms, function, and surgical benefit at 1 year
Magnetic resonance imaging compared with electrodiagnostic studies in patients with suspected carpal tunnel syndrome: predicting symptoms, function, and surgical benefit at 1 year
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DOI：
10.3171/jns/2008/108/3/0541
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发表时间：
2008-03-01
影响因子：
4.1
通讯作者：
Franklin, Gary M.
中科院分区：
文献类型：
--
作者：
Jarvik, Jeffrey G.;Comstock, Bryan A.;Franklin, Gary M.
Object.本研究对临床腕管综合征（CTS）患者进行了研究，目的是比较磁共振（MR）成像与电诊断研究（EDS）在以下方面的有效性：1）预测1年预后; 2）识别可能从手术治疗中获益的患者。作者前瞻性入组了120例临床疑似CTS患者。参与者使用标准化的EDS，MR成像和一系列问卷进行测试，包括腕管综合征评估问卷，这是一种经过充分验证的症状和功能5分评分。EDS和MR图像各自独立解读。1年后对患者进行重新评估。保守治疗或腕管松解治疗的决定由个体外科医生做出，他们可以访问初始EDS，但不能访问MR成像结果。单变量和多变量分析用于确定1年预后和基线诊断测试之间的关系。作者在12个月时重新联系了120名参与者中的105名。其中，30名患者接受了手术，75名患者没有接受手术。接受手术的患者在1年时比未接受手术的患者表现出更大的改善。MRI上异常T2加权神经信号的长度和中尺感觉潜伏期差异是手术获益的最强预测因子。有一个明确的患者偏好的MR成像EDSs。结论。通过腕管MR成像获得的结果预测了独立于神经传导研究的手术获益。
Object. The goal in this study of patients with clinical carpal tunnel syndrome (CTS) was to compare the usefulness of magnetic resonance (MR) imaging with that of electrodiagnostic studies (EDSs) for the following purposes: 1) prediction of 1-year outcomes and 2) identification of patients who are likely to benefit from surgical treatment.Methods. The authors prospectively enrolled 120 patients with clinically suspected CTS. The participants were tested using standardized EDSs, MR imaging, and a battery of questionnaires, including the Carpal Tunnel Syndrome Assessment Questionnaire, a well-validated 5-point score of symptoms and function. The EDSs and MR images were each interpreted independently. Patients were reevaluated after 1 year. The decision to treat patients conservatively or by carpal tunnel release was made by the individual surgeon, who had access to the initial EDS but not MR imaging results. Univariate and multivariate analyses were used to determine associations between 1-year outcomes and baseline diagnostic tests.Results. The authors recontacted 105 of 120 participants at 12 months. Of these, 30 patients had had surgery and 75 had not. Patients who had undergone surgery showed greater improvement at 1 year than those who had not had surgery. The length of the abnormal T2-weighted nerve signal on MR imaging and median-ulnar sensory latency difference were the strongest predictors of surgical benefit. There was a clear patient preference for the MR imaging over EDSs.Conclusions. The findings obtained with MR imaging of the carpal tunnel predict surgical benefit independently of nerve conduction studies.