Median Nerve Cross-sectional Area In High Frequency Ultrasound Study Of Carpal Tunnel Syndrome Severity

Objective: Using high frequency ultrasound for carpal tunnel syndrome(CTS)the pisiform bone level in patients with median nerve cross-sectional area and forearm distal median nerve cross-sectional area of pronator quadratus muscle level,and two cross-sectional areas are calculated on the basis of two parameters,namely area increment and area ratio.To study whether can we according to cross-sectional area,Delta area and area ratio of median nerve of pisiform bone level to classify the severity of CTS and the reliability of its results.Method: Taking 87 cases patients as CTS group,total 98 wrists [female 73 cases with 9 cases is double side,male 14 cases with two cases of double side,age from 31 to 73 years old,(average is 55.10 ± 9.41 years old),who are diagnosed to CTS patients by clinical and the NCS confirmed,and selected 42 volunteers as control group,who are no upper limb numb,and pain etc.symptoms,are checked excluded CTS with neural electric physiological check(NSC).Using ultrasound to measure cross-sectional areas of median nerve of Pisiform bone level and median nerve of forearm distal spin ahead muscle level to calculate area increment,and area ratio based on these two areas: area increment is the different of these two areas,area ratio is the ratio of these two areas.Based on the NCS classification results,classify the cross-sectional area,area increment,area ratio of median nerve of Pisiform bone level.Then ANOVE variance analysis and the independent samples t-test of each group to prove that there are significant differences between these groups.And taking ROC curves analysis on two adjacent groups,calculate optimal threshold between each levels,and their sensitivity and specificity.At last,taking Kappa analysis of the gold standard of NCS results with ultrasound,which compared with cross-sectional area,area increment,area ratio of median nerve of Pisiform bone level specially.Results: According to the NCS classification result,CTS patients divided into normal,mild,moderate and severe group,ultrasonic level pisiform bone median nerve crosssectional area,area increment and area ratio,there were significant differences between the groups(P<0.05).The (?)±S of cross-sectional area of median nerve of Pisiform bone level in normal,mild,moderate,severe group was 0.07 ± 0.01cm~2,0.10± 0.02 cm~2,0.13 +0.01 cm~2,0.18 ± 0.03 cm~2 specially.About (?)±S of area increment of in normal,mild,moderate,severe group was 0.03 ± 0.01 cm~2,0.06 ± 0.01 cm~2,0.08 ± 0.01 cm~2,0.12 ± 0.03 cm~2 specially.About (?)±S of area ratio in normal,mild,moderate,severe group was 1.78 ± 0.27,2.34 ±0.26,2.71±0.31,3.13 ± 0.50 specially.Through making the adjacent group of ROC,pea bone level cross cut area in normal,mild,moderate,severe group restructuring of best threshold value was 0.09 cm~2,0.12 cm~2,and 0.15 cm~2 specially;area incremental in normal,mild,moderate,severe group restructuring of best threshold value was 0.05 cm~2,0.08 cm~2,and 0.10 cm~2 specially;area ratio in normal,mild,moderate,severe group restructuring of best threshold value was 2.1,2.5,2.9 specially.The Kappa value of cross-sectional area of median nerve of Pisiform bone level classification results and NCS classification results is 0.702,and that is of grading of the area increases results and NCS classification results is 0.823,and that is of area ratio classification results and NCS classification results is 0.580.Conclusion: Ultrasound measurement level of the pisiform bone median nerve crosssectional area,Delta area,and area than are help to CTS severity prediction.Area increment is strongest to diagnosis CTS and classify the severity of it.Area increase of grading higher consistency with the NCS classification results,the cross-sectional area of median nerve of pisiform bone level and the area ratio of the classification results is consistently to the electrophysiological results.Ultrasound for the diagnosis of CTS is an effective method of examination.