Study On The Diagnostic Value Of Real-Time Shear Wave Elastography For Different Degrees Of Carpal Tunnel Syndrome

Objective: This study mainly explored the feasibility of real-time shear wave elastography(SWE)technology in assessing the clinical application of median nerve stiffness,and further explored the diagnostic significance of this technology for patients with different degrees of carpal tunnel syndrome.Methods: A total of 100 median nerves were collected from 76 patients with carpal tunnel syndrome diagnosed by electrophysiological examination in the Department of Hand and Foot Surgery of the Affiliated Hospital of Jining Medical College from September 2018 to December 2019.According to the severity of the disease,it is divided into three groups: mild,moderate and severe.During the same period,22 healthy volunteers were selected as the control group.AixPlorer type ultrasonic elastography diagnostic instrument,SL10-2 linear array probe produced by French acoustics SuperSonic Imagine company was used.The frequency was 2 ~ 10 MHz.MSK conditions were selected.First perform a conventional two-dimensional ultrasound scan to display the median nerve cross-section,then rotate the probe 90 degrees to display the median nerve long-axis section,observe the movement of the median nerve and the surrounding anatomy;switch to the shear wave elastic imaging mode,and place the probe At the desired measurement position,keep the probe perpendicular to the nerve running.After the color image completely fills the sampling frame and stabilizes,turn on the quantitative measurementfunction,and measure the carpal tunnel entrance,the carpal tunnel,and the carpal tunnel exit at the transverse and longitudinal sections,respectively.And the median nerve shear wave elastic modulus at the level of the upper edge of the forearm muscle at the forearm and the level of the superior flexor muscle at the upper edge of the forearm.Eentrance,Einner,Eexport,Eforearm,and Emuscle.Calculate the ratio of the elastic modulus of the median nerve at the upper edge of the anterior rotator muscle to the same plane,Fratio.Calculate the average value of each group of data and record it.SPSS software was used to compare the differences in elastic modulus between the groups,and the ROC curve was plotted to obtain the diagnostic critical value of the elastic modulus to determine its diagnostic efficacy.Results: The color of Q-BOX in the median nerve of all subjects was well filled,and the image quality was clear.In the control group,the elastic color-coded maps were mostly blue and blue-green in the nerve area;in the carpal tunnel syndrome group,the neural areas were mostly yellowish or reddish.The measured values of the patients in each group are as follows: The cross-sectional measured values in the control group are Eentrance: 52.76 ±5.48 kPa,Einner: 98.47 ± 5.12 kPa,Eexport: 93.14 ± 4.98 kPa,Eforearm: 45.61± 3.52 kPa,Fraction: 0.98 ± 0.08;longitudinally The cut value is Eentrance:63.56 ± 5.95 kPa,Einner: 113.54 ± 3.61 kPa,Eexport: 108.91 ± 3.96 kPa,Eforearm: 53.07 ± 3.59 kPa,Fratio: 0.97 ± 0.10;the measured value of the cross section of the mild group is Eentrance: 60.19 ± 3.73 kPa,Einner: 102.04 ±3.85 kPa,Eexport: 98.19 ± 5.02 kPa,Eforearm: 51.05 ± 6.38 kPa,Fraction: 1.02± 0.19;the longitudinal section measurement value is Eentrance 77.15 ±7.59 kPa,Einner: 119.24 ± 6.33 kPa,Eexport : 114.10 ± 6.55 kPa,Eforearm:57.29 ± 5.36 kPa,Fratration: 1.03 ± 0.12;the measured value of the cross section of the middle group is Eentrance: 72.35 ± 6.70 kPa,Einner: 107.72 ±3.84 kPa,Eexport: 103.41 ± 5.21 kPa,Eforearm: 59.37 ± 4.88 kPa,Fratio: 1.29 ±0.11;longitudinal section measured values are Eentrance: 95.74 ± 6.52 kPa,Einner: 131.20 ± 6.12 kPa,Eexport: 127.23 ± 7.78 kPa,Eforearm72.74 ±5.30 kPa,Fraction: 1.33 ± 0.11;severe group The measured value of the cross section is Eentrance: 88.31 ± 6.3kPa,Einner: 116.47 ± 7.68 kPa,Eexport 110.19± 6.4kPa,Eforearm: 66.78 ± 4.47 kPa,Fratio: 1.48 ± 0.13;longitudinal section measurement values are Eentrance: 112.97 ± 6.9kPa,Einner: 140.08 ± 7.5kPa,Eexport: 136.37 ± 6.0kPa,Eforearm: 80.59 ± 4.80 kPa,Fratio: 1.45 ± 0.22.Compared with the control group,the elastic modulus values of the patients in the light,medium and heavy groups of the cross-section and longitudinal sections were compared with the control group,and the differences in the values of the elastic modulus were statistically significant(P <0.05).Compared with the mild group,the elastic modulus values of various parts of the moderate and severe patients were statistically significant(P <0.05).Compared with the moderate group,the elastic modulus values of the patients in the severe group were statistically significant(P<0.05).The cross-section and longitudinal section measured the ratio of the elastic modulus ratio Fratio at the level of theupper edge of the anterior rotator muscle between the groups and the median nerve in the same plane was also statistically significant(P<0.05).Among them,the AUC value corresponding to the ROC curve of Eentrance is the highest in the cross-section and longitudinal section groups;the AUC value corresponding to the ROC curve in each group of the longitudinal section and the cross-section group are higher.Conclusion: The median nerve elastic modulus of patients with different degrees of carpal tunnel syndrome is higher than that of the healthy control group.Both the cross-section measurement and the longitudinal section measurement are significant.And the diagnosis efficiency of the longitudinal section value is higher,and the diagnosis efficiency of the entrance of the carpal tunnel is higher than that of other parts.Shear wave elastography has important clinical application value in the diagnosis of carpal tunnel syndrome with different degrees.And the diagnosis efficiency of the longitudinal section value is higher,and the diagnosis efficiency of the entrance of the carpal tunnel is higher than that of other parts.