目的

评估HRUS和SWE对CTS的诊断价值，并探讨HRUS、SWE参数与CTS严重程度的相关性。

方法

本研究连续收集2018年8月至2018年12月在北京协和医院神经内科因手麻、疼痛就诊且EDT检查结果符合临床CTS诊断标准的37例患者（68根病变MN）。同期选取年龄及性别相匹配的37例健康志愿者（74根MN）。选择前臂远端腕管近端距离腕管入口约0.5~1.0cm（1组）及腕管内部紧邻豌豆骨水平以远（2组）两个不同平面测量正中神经CSA、YM和SWV。通过构建ROC曲线评价HRUS及SWE所得参数对CTS的诊断效能，计算相应的曲线下面积（areas under the curves，AUCs），获取各参数诊断CTS的最佳临界值、敏感度及特异度。分析HRUS、SWE参数与CTS严重程度的相关性以及YM、SWV与一般资料、HRUS参数的相关性。均以P＜0.05为差异有统计学意义。

结果

CTS组MN的CSA、YM和SWV均显著高于对照组（p＜0.05），1组中CSA1、E1mean、V1mean及2组中CSA2、E2min、V2min六个参数的诊断效能较高，AUC分别为0.990、0.748、0.740、0.949、0.859、0.859。当MN的CSA1、E2min和V2min分别为8.5mm²、173.60kPa和7.59m/s时，诊断CTS的敏感性（100%、85%、85%）和特异性（89%、76%、76%）最高。

2. HRUS与SWE相结合的诊断效能高于单一技术，AUC为0.992，但差异无统计学意义（p＞0.05）。

3. CSA在轻-中度与重度组之间有显著的统计学差异（p＜0.05）。

结论

HRUS及SWE是一种高效、无创、快速诊断CTS的方法，CSA诊断CTS的最佳测量切面为腕管近端，而SWE测量的最佳切面为腕管内部；并可应用CSA作为严重程度分级的辅助诊断指标，在临床应用中具有可行性。HRUS与SWE相结合的诊断效能高于单一技术，但仍需更多样本量进一步探究其诊断效能。

OBJECTIVE:

To evaluate the role of high-resolution ultrasonography (HRUS) and shear wave elastography(SWE) in carpal tunnel syndrome (CTS) compared to electrodiagnostic testing(EDT) and to explore the correlation between indexes of the HRUS and SWE and the severity of electrophysiological.

METHODS:

This study enrolled 37 patients with idiopathic CTS (68 CTS hands) and 37 healthy subjects (74 normal hands). Median nerve cross-sectional area (CSA) , Young’s Modulus(YM) and shear wave velocity(SWV) at two different levels, the interior of carpal tunnel closed to pisiform bone level(Group 2) and on forearm area away from tunnel inlet of 0.5~1.0cm(Group 1), were measured. Receiver operating characteristic (ROC) curves were plotted for the optimal cut-off values as well as the sensitivity and specificity. Then, comparisons among HRUS、SWE and EDT were made.

RESULTS

1. The CSA , YM and SWV of MN in the CTS group are significantly higher than those of the control group (p＜0.05). The results show that six parameters — CSA1, E1mean, V1mean of Group1 and CSA2, E2min, V2min of Group2, have high diagnostic efficiency, AUC was 0.990, 0.748, 0.740, 0.949, 0.859 and 0.859 respectively. When CSA1, E2min and V2min of MN were 8.5mm², 173.60 kPa and 7.59m/s respectively, the sensitivity (100%, 85%, 85%) and specificity (89%, 76%, 76%) of diagnosing CTS were the highest.

2. The efficiency of the combination of HRUS and SWE (AUC=0.992) is higher than that of single technology, but there was no significant statistical difference (p> 0.05).

3. There are significant statistical differences in the CSA of MN between mild to moderate and severe groups, which can be used to judge the severity of CTS patients (p＜0.05).

CONCLUSIONS:

HRUS and SWE are effective and noninvasive methods for the diagnosis of CTS. CSA can also be used as auxiliary diagnostic index for severity classification, and is feasible in clinical application. The best measurement section of CSA in the diagnosis of CTS is the proximal end of carpal tunnel, while the best measurement section of SWE is the internal part of carpal tunnel, and there is no significant difference between SWV and YM in the diagnosis efficiency of CTS, the hardness of MN is related to the degree of swelling. The diagnostic efficiency of combination of HRUS and SWE is higher than that of single technology, which may provide reliable basis for CTS diagnosis.