engleski

Choosing an optimal ultrasound parameter for confirmation of carpal tunnel syndrome.

INTRODUCTION: Ultrasound (US) is becoming increasingly used as an additional tool for evaluation of carpal tunnel syndrome (CTS) in a routine clinical practice. Although a large number of studies have been done in order to find an optimal US parameter, to our knowledge, a possibility of constructing a complex US parameter with potentially improved diagnostic value has not yet been addressed. The aim of this research was to evaluate and compare existing simple and complex ultrasound parameters to find an optimal one for use in routine clinical practice. METHODS AND PATIENTS: Eighty eight patients with CTS and 78 asymptomatic participants were enrolled in the study. All participants went through clinical, neurophysiologic and ultrasound examination. During US examination, median nerve (MN) cross- sectional area and diameter were measured on 4 anatomical levels. Two- level parameters were derived from individual measures. Also, a multi- component index was constructed via regression analysis. Diagnostic values of all US parameters, as well as their reference values, were calculated by using ROC curves and AUC values. The evaluated parameters were compared based on their AUC values, sensitivity and specificity. RESULTS: Among the simple US parameters inlet cross- sectional area (CSA), inlet circumference and outlet cross-sectional area had the best AUCs (0.969, 0.958 i 0.934 ; p < 0.001), sensitivity (89, 8%, 90, 9% i 84, 1% ; p < 0.001) and specificity (96, 2%, 91% i 88, 5% ; p < 0.001). Analysis of two- level parameters resulted in highest AUC for inlet-outlet mean (0.984 ; p < 0.001) with very good sensitivity and excellent specificity (100%, p < 0.001). Complex, regression-based ultrasound index yielded marginaly higher AUC (0.989 ; p < 0.001) compared to previously mentioned parameters. CONCLUSION: According to results of our study, inlet-outlet mean CSA (IOM) may be a simple and a reliable parameter in confirmation of CTS. Complex multi- component regression-based index provided in our sample even better diagnostic characteristics compared to IOM. However, it is overly complicated to acquire and time-consuming, thus making the inlet-outlet mean CSA an optimal US parameter in routine CTS confirmation.

Carpal tunnel syndrome ; Ultrasound

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