A Comparison of Diagnostic Usefulness of Sonography and Electrophysiologic Study in Patients with Carpal Tunnel Syndrome
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Objective To compare the diagnostic accuracy of ultrasonography(US) and electrophysiologic study in patients with carpal tunnel syndrome (CTS). Method Two hundred twenty-seven hands in patients and 40 hand in healthy control group were used. Patients were diagnosed clinically with CTS. All groups had nerve conduction study (NCS) and sonographic measurement of the cross-sectional area (CSA) of the median nerve. Using the receiver operating characteristic curve, the optimal cutoff value was obtained and the sensitivity and specificity was evaluated. The correlation between the Hi-Ob score and the electrophysiologic severity, Hi-Ob score and CSA of the median nerve, and between the electrophysiologic severity and CSA were assessed. Results The cutoff value of the difference of median sensory latency (DMSL) was 1.55 ms with a sensitivity and specificity of 94.7% and 92.3% respectively. The cutoff value of CSA was 9.5 mm2, had a sensitivity of 85.5% and a specificity of 92.3%. In mild CTS, NCS showed a sensitivity of 92.1% and CSA showed a sensitivity of 81.2%. The electrophysiologic severity and Hi-Ob score appeared to show a significant positive correlation (r=0.34, p＜0.01), and as the Hi-Ob score increased, the CSA was increased (r=0.54, p＜0.01). The increase in electrophysiologic severity and the CSA also showed a significant correlation (r=0.33, p＜0.01) There was bifurcation of the nerve in 9 hands, persistent median artery in 4 hands and cyst in 1 hands. And tenosynovitis was observed in 1 hands. Conclusion In clinical CTS, electrophysiologic study showed higher sensitivity than US. But US can give us anatomical informations.
Abstract
Objective To compare the diagnostic accuracy of ultrasonography(US) and electrophysiologic study in patients with carpal tunnel syndrome (CTS). Method Two hundred twenty-seven hands in patients and 40 hand in healthy control group were used. Patients were diagnosed clinically with CTS. All groups had nerve conduction study (NCS) and sonographic measurement of the cross-sectional area (CSA) of the median nerve. Using the receiver operating characteristic curve, the optimal cutoff value was obtained and the sensitivity and specificity was evaluated. The correlation between the Hi-Ob score and the electrophysiologic severity, Hi-Ob score and CSA of the median nerve, and between the electrophysiologic severity and CSA were assessed. Results The cutoff value of the difference of median sensory latency (DMSL) was 1.55 ms with a sensitivity and specificity of 94.7% and 92.3% respectively. The cutoff value of CSA was 9.5 mm2, had a sensitivity of 85.5% and a specificity of 92.3%. In mild CTS, NCS showed a sensitivity of 92.1% and CSA showed a sensitivity of 81.2%. The electrophysiologic severity and Hi-Ob score appeared to show a significant positive correlation (r=0.34, p＜0.01), and as the Hi-Ob score increased, the CSA was increased (r=0.54, p＜0.01). The increase in electrophysiologic severity and the CSA also showed a significant correlation (r=0.33, p＜0.01) There was bifurcation of the nerve in 9 hands, persistent median artery in 4 hands and cyst in 1 hands. And tenosynovitis was observed in 1 hands. Conclusion In clinical CTS, electrophysiologic study showed higher sensitivity than US. But US can give us anatomical informations.
참고문헌 (30)
- Dumitru D, "Focal peripheral neuropathies In Electrodiagnostic medicine", pp.1058~1070 (2002), Hanly & Belfus Inc
- Brahme SK, "Dynamic MR imaging of carpal tunnel syndrome", Skeletal Radiol, 26, pp.482~487 (1997)
- Buchberger W, "Radiologic imaging of the carpal tunnel", Eur J Radiol, 25, pp.112~117 (1997)
- Swen WA, "Carpal tunnel sonography by the rheumatologist versus nerve conduction study by the neurologist", J Rheumatol, 28, pp.62~69 (2001)
- El Miedany YM, "Ultrasonography versus nerve conduction study in patients with carpal tunnel syndrome: substantive or complementary tests?", Rheumatology Oxford, 43, pp.887~895 (2004)
- Nakamichi K, "Ultrasonographic measurement of median nerve cross-sectional area in idiopathic carpal tunnel syndrome: diagnostic accuracy", Muscle Nerve, 26, pp.798~803 (2002)
- American Academy of Neurology, "Practice parameter for carpal tunnel syndrome (summary statement). Report of the quality standards subcommittee of the american academy of neurology. Practice parameter for carpal tunnel syndrome (summary statement)", Neurology, 43, pp.2406~2409 (1993)
- Mondelli M, "Diagnostic utility of ultrasonography versus nerve conduction studies in mild carpal tunnel syndrome", Arthritis Rheum, 59, pp.357~366 (2008)
- Giannini F, "A new clinical scale of carpal tunnel syndrome: validation of the measurement and clinical-neurophysiological assessment", Clin Neurophysiol, 113, pp.71~77 (2002)
- Stevens JC, "AAEM minimonograph #26: the electrodiagnosis of carpal tunnel syndrome", Muscle Nerve, 20, pp.1477~1486 (1997)
- Koyuncuoglu HR, "The value of ultrasonographic measurement in carpal tunnel syndrome in patients with negative electrodiagnostic tests", Eur J Radiol, 56, pp.365~369 (2005)
- Shivde AJ, "The carpal tunnel syndrome. A clinical-electrodiagnositic analysis", Electromyogr Clin Neurophysiol, 21, pp.143~153 (1981)
- Kimura J, "A method for determining median nerve conduction velocity across the carpal tunnel", J Neurol Sci, 38, pp.1~10 (1978)
- Jonson EW, "Sensory latencies to the ring finger: normal values and relation to carpal tunnel syndrome", Arch Phys Med Rehabil, 62, pp.206~208 (1981)
- Jonhson EW, "Median and radial sensory latencies to digit I: normal values and usefulness in carpal tunnel syndrome", Arch Phys Med Rehabil, 68, pp.140~141 (1987)
- 윤준식, "정상과 수근관 증후군에서 손목위치에 따른 정중신경 초음파 소견 변화", Annals of Rehabilitation Medicine, 28(4), pp.337~342 (2004), 대한재활의학회
- 박지영, "한국 정상 성인의 나이와 성별에 따른 수근관내 정중신경의 초음파 소견", Annals of Rehabilitation Medicine, 32(5), pp.564~569 (2008), 대한재활의학회
- Werner RA, "Carpal tunnel syndrome: pathophysiology and clinical neurophysiology", Clin Neurophysiol, 113, pp.1373~1381 (2002)
- Yoon SR, "Usefulness of median-radial latency difference to the thumb in the diagnosis of mild carpal tunnel syndrome", J Korean Assoc EMG-Electrodiagn Med, 1, pp.19~25 (1999)
- Girlanda P, "Electrophysiological studies in mild idiopathic carpal tunnel syndrome", Electroencephalogr Clin Neurophysiol, 109, pp.44~49 (1998)
- Preston DC, "The median-ulnar latency difference studies are comparable in mild carpal tunnel syndrome", Muscle Nerve, 17, pp.1469~1471 (1994)
- 이승엽, "수근관증후군에서 전기생리학적 척도들의 민감도 비교", 대한신경과학회지, 20(1), pp.54~59 (2002), 대한신경과학회
- Duncan I, "Sonography in the diagnosis of carpal tunnel syndrome", Am J Roentgenol, 173, pp.681~684 (1999)
- Yesildag A, "The role of ultrasonographic measurements of the median nerve in the diagnosis of carpal tunnel syndrome", Clin Radiol, 59, pp.910~915 (2004)
- Padua L, "Carpal tunnel syndrome: ultrasound, neurophysiology, clinical and patient-oriented assessment", Clin Neurophysiol, 119, pp.2064~2069 (2008)
- Boonyapisit K, "Lumbrical and interossei recording in severe carpal tunnel syndrome", Muscle Nerve, 25, pp.102~105 (2002)
- Gupta R, "Chronic nerve compression induces concurrent apoptosis and proliferation of Schwann cells", J Comp Neurol, 461, pp.174~186 (2003)
- Gupta R, "Chronic nerve compression induces local demyelination and remyelination in a rat model of carpal tunnel syndrome", Exp Neurol, 187, pp.500~508 (2004)
- Pierre-Jerome C, "MRI of the median nerve and median artery in the carpal tunnel: prevalence of their anatomical variations and clinical significance", Surg Radiol Anat, 32, pp.315~322 (2010)
- Lindley SG, "Prevalence of anatomic variations encountered in elective carpal tunnel release", J Hand Surg Am, 28, pp.849~855 (2003)