말초신경초음파검사를 이용한 흔한 신경포착부위 검사; 단면적기준치와 정상변이
Ultrasonographic Findings of the Normal Nerves in Common Entrapment Site; Cross-Sectional Area Reference Value and Normal Variant
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초록
Background: Neuromuscular ultrasound has emerged over the last decade as a useful tool for diagnosing peripheral neuropathy. Because nerve enlargement is the most important diagnostic marker of an abnormal nerve, quantification of nerve size is essential. Methods: We included 80 healthy volunteers aged 21–60 years. The nerve cross-sectional area (CSA) was measured in all participants at the following common compressive sites: bilateral median nerve at the carpal tunnel and forearm, ulnar nerve at the wrist and medial epicondyle, radial nerve at the spiral groove, peroneal nerve at the fibular head and popliteal fossa, and tibial nerve at the popliteal fossa. Anatomical variants were also evaluated, including a bifid median nerve and persistent median artery. Results: The CSAs were 9.58±1.55, 6.87±1.61, 4.72±0.91, 6.64±1.33, 6.48±1.68, 12.35±3.55, and 26.98±6.92 mm2 (mean±SD) for the median nerve at the carpal tunnel and forearm, ulnar nerve at the wrist and medial epicondyle, radial nerve at the spiral groove, peroneal nerve at the fibular head, and tibial nerve at the popliteal fossa, respectively. The nerve CSA was significantly larger in men than in women and was correlated with body mass index, weight, and height. A bifid median nerve and persistent median artery were seen in 12 (7.5%) and 4 (2.5%) of 160 hands, respectively. Conclusions: The information produced in this study can serve as reference data when evaluating these nerve sites using ultrasound.
Abstract
Background: Neuromuscular ultrasound has emerged over the last decade as a useful tool for diagnosing peripheral neuropathy. Because nerve enlargement is the most important diagnostic marker of an abnormal nerve, quantification of nerve size is essential. Methods: We included 80 healthy volunteers aged 21–60 years. The nerve cross-sectional area (CSA) was measured in all participants at the following common compressive sites: bilateral median nerve at the carpal tunnel and forearm, ulnar nerve at the wrist and medial epicondyle, radial nerve at the spiral groove, peroneal nerve at the fibular head and popliteal fossa, and tibial nerve at the popliteal fossa. Anatomical variants were also evaluated, including a bifid median nerve and persistent median artery. Results: The CSAs were 9.58±1.55, 6.87±1.61, 4.72±0.91, 6.64±1.33, 6.48±1.68, 12.35±3.55, and 26.98±6.92 mm2 (mean±SD) for the median nerve at the carpal tunnel and forearm, ulnar nerve at the wrist and medial epicondyle, radial nerve at the spiral groove, peroneal nerve at the fibular head, and tibial nerve at the popliteal fossa, respectively. The nerve CSA was significantly larger in men than in women and was correlated with body mass index, weight, and height. A bifid median nerve and persistent median artery were seen in 12 (7.5%) and 4 (2.5%) of 160 hands, respectively. Conclusions: The information produced in this study can serve as reference data when evaluating these nerve sites using ultrasound.
참고문헌 (17)
- Wiesler ER, "The use of diagnostic ultrasound in carpal tunnel syndrome", J Hand Surg Am, 31, pp.726~732 (2006)
- Cartwright MS, "Cross-sectional area reference values for nerve ultrasonography", Muscle Nerve, 37, pp.566~571 (2008)
- Duncan I, "Sonography in the diagnosis of carpal tunnel syndrome", AJR Am J Roentgenol, 173, pp.681~684 (1999)
- Beekman R, "Ultrasonography in ulnar neuropathy at the elbow: a critical review", Muscle Nerve, 43, pp.627~635 (2011)
- Roll SC, "Diagnostic accuracy of ultrasonography vs. electromyography in carpal tunnel syndrome: a systematic review of literature", Ultrasound Med Biol, 37, pp.1539~1553 (2011)
- Won SJ, "Reference values for nerve ultrasonography in the upper extremity", Muscle Nerve, 47, pp.864~871 (2013)
- Seok HY, "Cross-sectional area reference values of nerves in the lower extremities using ultrasonography", Muscle Nerve, 50, pp.564~570 (2014)
- 조정모, "한국인의 수근관 증후군에서 정중신경 단면적 비의 유용성", Annals of Rehabilitation Medicine, 33(5), pp.627~631 (2009), 대한재활의학회
- Bathala L, "Normal values of median nerve cross-sectional area obtained by ultrasound along its course in the arm with electrophysiological correlations, in 100 Asian subjects", Muscle Nerve, 49, pp.284~286 (2014)
- Cartwright MS, "Ultrasonographic findings of the normal ulnar nerve in adults", Arch Phys Med Rehabil, 88, pp.394~396 (2007)
- Tagliafico A, "Reliability of side-to-side sonographic cross-sectional area measurements of upper extremity nerves in healthy volunteers", J Ultrasound Med, 32, pp.457~462 (2013)
- Kerasnoudis A, "Cross sectional area reference values for sonography of peripheral nerves and brachial plexus", Clin Neurophysiol, 124, pp.1881~1888 (2013)
- Bayrak IK, "Bifid median nerve in patients with carpal tunnel syndrome", J Ultrasound Med, 27, pp.1129~1136 (2008)
- Granata G, "Prevalence of bifid median nerve at wrist assessed through ultrasound", Neurol Sci, 32, pp.615~618 (2011)
- Khashaba A, "Carpal tunnel syndrome from thrombosed persistent median artery", J Emerg Med, 22, pp.55~57 (2002)
- Feldkamp MM, "A persistent median artery causing carpal tunnel syndrome in a patient with chronic renal failure: case report", Neurosurgery, 37, pp.140~143 (1995)
- Walker FO, "Prevalence of bifid median nerves and persistent median arteries and their association with carpal tunnel syndrome in a sample of Latino poultry processors and other manual workers", Muscle Nerve, 48, pp.539~544 (2013)