| Objective: By analyzing the acoustic image characteristics of the Cubital Tunnel Syndrome(CuTS)patients with regular high-frequency ultrasound and coustic radiation force pulse imaging(ARFI),the feasibility and diagnostic value of ARFI in the assessment of elbow ulnar neuropathy were discussed.Method: 30 patients who underwent surgical treatment of ulnar nerve compression in our hospital from October 2017 to December 2018 were enrolled.All patients underwent electrophysiological examination before surgery,and all patients had unilateral ulnar neuropathy.Ulnar nerve on the affected side was the experimental group,while ulnar nerve on the uninjured side was the control group.Patients with peripheral neuropathy caused by diabetes and connective tissue disease were excluded.All patients underwent routine high frequency ultrasound,ARFI and ulna nerve electrophysiological examination before operation.The patients with CuTS were examined by routine bilateral ulna nerve contrast scan,and the morphological changes of ulna nerve were observed at the proximal and distal 10 cm of the inner epigondyle to determine whether there was entrapment and entrapment site.The anterior and right diameters of the ulnar nerve were measured in transverse section,and the anterior and right diameters of ulnar nerve,left and left diameters,and cross-sectional area were measured in the transverse section near the area of clamping point.ARFI mode was activated to observe and record the sonographic features of ulna nerve ARFI in the experimental group of CuTS patients.The transverse shear wave velocity(shear wave velocity,SWV)of ulna nerve was measured at the longitudinal section of the proximal 2cm of the medial epicondyle.The sonographic features of ulna nerve in the control group were observed by high frequency ultrasound and ARFI.Measurement of anterior and posterior diameter,left and right diameter and cross section area of ulna nerve at medial epicondyle.Measurement of SWV of ulna nerve in proximal 2cm of medial epicondyle by longitudinal section.The parameters of conventional high frequency ultrasound,SWV and neuroelectrophysiological examination were compared and analyzed,and the differences between the experimental group and the control group were compared.Draw the ROC curve,and get the diagnostic boundary point of CuTS diagnosis by ARFI technique.Evaluation of the accuracy of ARFI in the diagnosis of CuTS.Results:1.Results of conventional high frequency ultrasonic imaging: In the experimental group of CuTS,the transverse section of ulna nerve showed that the internal structure of the nerve was not clear,and the "ethmoidal foramen" structure in the ulna nerve was blurred or disappeared.The longitudinal section showed that the ulna nerve was compressed and flattened at the entrapment,the ulna nerve was obviously swollen and thickened,the echo inside the nerve decreased and the blood flow inside the nerve increased.2.Comparison of conventional high frequency ultrasonic measurement indicators:The anteroposterior diameter of the ulnar nerve of the experimental group of CuTS was 2.18±0.77 mm,which was less than 2.33±0.27 mm of the control group.The difference between the two groups was statistically significant(P<0.05).In the experimental group of CuTS patients,the left and right diameter of the ulnar nerve was 6.25±1.95 mm,which was greater than that of the control group3.28±0.63 mm.The difference between the two groups was statistically significant(P<0.001).The anterior and posterior diameter of the ulnar nerve swelling in the experimental group of CuTS patients was 3.89±0.97 mm,which was larger than that of the controlgroup 2.33±0.27 mm.The difference between the two groups was statistically significant(P<0.001).In the CuTS patients,the most obvious left and right diameter of the ulnar nerve swelling in the experimental group was 7.36±3.15 mm,which was 3.28±0.63 mm higher than that in the control group.The difference between the two groups was statistically significant(P<0.001).The most obvious cross-sectional area of the ulnar nerve swelling in the experimental group was 18.67±6.14 mm2,which was greater than that of the control group(5.87±0.82 mm2).The difference between the two groups was statistically significant(P<0.001).From the ROC curve analysis,the best cutoff values of CuTS indicators are:anteroposterior diameter <2.15 mm,sensitivity 73.3%,specificity 66.7%;left and right diameter >3.95 mm,sensitivity 93.3%,specificity 80% The cross-sectional area is >8mm2,the sensitivity is 100%,and the specificity is 100%.3.ARFI findings of ulna nerve:The sound radiation force pulse imaging quality control mode shows that all the images of the subject are of good quality and the color of the image in the sampling frame is evenly filled.The acoustic radiation force pulse imaging speed mode showed that the ulnar nerves of the experimental group showed blue-green phase,the proportion was similar,or a little yellow and red mixed,while the ulnar nerve of the control group showed blue color and a little green edge.Acoustic radiation force pulse imaging technique was used to measure the transverse shear wave velocity.The SWV value of the ulnar nerve at the proximal 2 cm of the upper iliac crest was 3.85±1.39 m/s in the experimental group,and the SWV value of the control group was 2.42±0.38 m/s.SWV was significantly greater than the control group,and the difference between the two groups was statistically significant(P< 0.001).According to the analysis of ROC curve,the ulnar nerve SWV>2.95m/s at theproximal end of the inner upper iliac crest was 83.3%,and the specificity was 90%.Conclusion:1.High-frequency ultrasound can clearly show the morphological features of the ulnar nerve,clear the ulnar nerve compression site,and help to determine the cause of nerve compression,which has a high value in the diagnosis of CuTS.Compared with conventional high-frequency ultrasound,ARFI technology can evaluate the mechanical properties of the tissue non-invasively,quantitatively evaluate the ulnar nerve stiffness,and can be used for the diagnosis of CuTS patients,and has a high diagnostic value.3.The application of ARFI technology in CuTS provides a new method for clinical diagnosis of CuTS. |
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