Diagnostic Value Of Preoperative Doppler Ultrasonography In Neurogenic Thoracic Outlet Syndrome

Objective:Thoracic outlet syndrome(TOS)is caused by the compression of brachial plexus and subclavian blood vessels,resulting in numbness,pain,swelling and other clinical symptoms of upper limbs.Neurogenic thoracic outlet syndrome(NTOS)is the most common type in clinic.There is no gold standard for the diagnosis of NTOS.With the development of ultrasound technology,more and more studies show that ultrasound can also help the diagnosis of NTOS.The purpose of this study is to evaluate the value of Doppler ultrasound in the diagnosis of NTOS by measuring the change of blood flow velocity in the distal segment of subclavian vessels in different postures.Methods:8 healthy volunteers and 64 patients with clinical symptoms of NTOS and undergoing surgical treatment were selected for analysis.Doppler ultrasound examination of subclavian artery and vein,Adson test and Roos test were performed in both groups.The spectrum shape and peak systolic velocity of distal segment of subclavian blood vessels were observed in supine,sitting and lifting arms respectively.The velocity changes of distal segment of subclavian vessels in different positions were compared.Fifty-two of the 64 patients also underwent MRI.Results:There was a significant difference in the blood flow velocity between the supine position and the sitting position(P < 0.05);there was no significant difference in the blood flow velocity between the supine position and the sitting position(P > 0.05).The diagnostic results of Doppler ultrasound are consistent with the results of clinical operation.In this study,the positive rate of Doppler ultrasound in the diagnosis of NTOS was higher than that of MRI.Conclusion:Doppler ultrasound combined with different abduction position of upper limb can provide a simple and effective imaging method for the diagnosis of NTOS,which can reduce the misdiagnosis of NTOS.In addition,when the clinical symptoms of patients with suspected nto are not improved by physical therapy,and the ultrasound results of patients are positive,it can prompt surgeons to carry out surgical treatment in time to avoid permanent nerve injury.