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Carpal tunnel syndrome assessment with ultrasonography: value of inlet-to-outlet median nerve area ratio in patients versus healthy volunteers.

Fu T, Cao M, Liu F, Zhu J, Ye D, Feng X, Xu Y, Wang G, Bai Y - PLoS ONE (2015)

Bottom Line: The mean IOR in healthy volunteers (1.0) was smaller than that in patients (1.6, P<0.001).An IOR cutoff value of ≥ 1.3 would yield 93% specificity and 91% sensitivity in the diagnosis of CTS.The IOR of median nerve area promises to be an effective means in the diagnosis of CTS.

View Article: PubMed Central - PubMed

Affiliation: Department of Rehabilitation Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.

ABSTRACT

Objective: To evaluate the diagnostic value of the Inlet-to-outlet median nerve area ratio (IOR) in patients with clinically and electrophysiologically confirmed carpal tunnel syndrome (CTS).

Methods: Forty-six wrists in 46 consecutive patients with clinical and electrodiagnostic evidence of CTS and forty-four wrists in 44 healthy volunteers were examined with ultrasonography. The cross-sectional area (CSA) of the median nerve was measured at the carpal tunnel inlet (the level of scaphoid-pisiform) and outlet (the level of the hook of the hamate), and the IOR was calculated for each wrist. Ultrasonography and electrodiagnostic tests were performed under blinded conditions. Electrodiagnostic testing combined with clinical symptoms were considered to be the gold standard test. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic value between the inlet CSA and IOR.

Results: The study population included 16 men and 30 women (mean age, 45.3 years; range, 18-83 years). The control population included 18 men and 26 women (mean age, 50.4 years; range, 18-79 years). The mean inlet CSA was 8.7 mm2 in healthy controls and 14.6mm2 in CTS group (P<0.001). The mean IOR in healthy volunteers (1.0) was smaller than that in patients (1.6, P<0.001). Receiver operating characteristic analysis revealed a diagnostic advantage to using the IOR rather than the inlet CSA (P<0.01). An IOR cutoff value of ≥ 1.3 would yield 93% specificity and 91% sensitivity in the diagnosis of CTS.

Conclusion: The IOR of median nerve area promises to be an effective means in the diagnosis of CTS. A large-scale, randomized controlled trial is required to determine how and when this parameter will be used.

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Related in: MedlinePlus

ROC curves for IOR and Inlet CSA.Solid diagonal broken line represents a hypothetical ROC curve from a test that yielded no diagnostic information.
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pone.0116777.g002: ROC curves for IOR and Inlet CSA.Solid diagonal broken line represents a hypothetical ROC curve from a test that yielded no diagnostic information.

Mentions: ROC curves were calculated to evaluate specificity and sensitivity of IOR and Inlet CSA in the CTS diagnosis (Fig. 2). The areas under the IOR curve and Inlet CSA curve were 0.98 (95% confidence interval 0.97, 1.00), 0.87 (95% confidence interval 0.79, 0.95), respectively. According to comparisons of the areas under the ROC curves, the discriminating performance of IOR was significantly superior to that of Inlet CSA (P<0.01). Table 5 shows that an IOR cutoff value of 1.3 yielded a specificity of 93% and a sensitivity of 91%. An IOR cutoff value of 1.1 yielded a sensitivity of 100% while a specificity of 64%. Conversely, an IOR cutoff value of 1.5 yielded a specificity of 100% but only a sensitivity of 61%. Table 5 also presents LRs for IOR values below (negative LR) and equal to or greater than a specific cutoff value (positive LR).


Carpal tunnel syndrome assessment with ultrasonography: value of inlet-to-outlet median nerve area ratio in patients versus healthy volunteers.

Fu T, Cao M, Liu F, Zhu J, Ye D, Feng X, Xu Y, Wang G, Bai Y - PLoS ONE (2015)

ROC curves for IOR and Inlet CSA.Solid diagonal broken line represents a hypothetical ROC curve from a test that yielded no diagnostic information.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4305299&req=5

pone.0116777.g002: ROC curves for IOR and Inlet CSA.Solid diagonal broken line represents a hypothetical ROC curve from a test that yielded no diagnostic information.
Mentions: ROC curves were calculated to evaluate specificity and sensitivity of IOR and Inlet CSA in the CTS diagnosis (Fig. 2). The areas under the IOR curve and Inlet CSA curve were 0.98 (95% confidence interval 0.97, 1.00), 0.87 (95% confidence interval 0.79, 0.95), respectively. According to comparisons of the areas under the ROC curves, the discriminating performance of IOR was significantly superior to that of Inlet CSA (P<0.01). Table 5 shows that an IOR cutoff value of 1.3 yielded a specificity of 93% and a sensitivity of 91%. An IOR cutoff value of 1.1 yielded a sensitivity of 100% while a specificity of 64%. Conversely, an IOR cutoff value of 1.5 yielded a specificity of 100% but only a sensitivity of 61%. Table 5 also presents LRs for IOR values below (negative LR) and equal to or greater than a specific cutoff value (positive LR).

Bottom Line: The mean IOR in healthy volunteers (1.0) was smaller than that in patients (1.6, P<0.001).An IOR cutoff value of ≥ 1.3 would yield 93% specificity and 91% sensitivity in the diagnosis of CTS.The IOR of median nerve area promises to be an effective means in the diagnosis of CTS.

View Article: PubMed Central - PubMed

Affiliation: Department of Rehabilitation Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.

ABSTRACT

Objective: To evaluate the diagnostic value of the Inlet-to-outlet median nerve area ratio (IOR) in patients with clinically and electrophysiologically confirmed carpal tunnel syndrome (CTS).

Methods: Forty-six wrists in 46 consecutive patients with clinical and electrodiagnostic evidence of CTS and forty-four wrists in 44 healthy volunteers were examined with ultrasonography. The cross-sectional area (CSA) of the median nerve was measured at the carpal tunnel inlet (the level of scaphoid-pisiform) and outlet (the level of the hook of the hamate), and the IOR was calculated for each wrist. Ultrasonography and electrodiagnostic tests were performed under blinded conditions. Electrodiagnostic testing combined with clinical symptoms were considered to be the gold standard test. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic value between the inlet CSA and IOR.

Results: The study population included 16 men and 30 women (mean age, 45.3 years; range, 18-83 years). The control population included 18 men and 26 women (mean age, 50.4 years; range, 18-79 years). The mean inlet CSA was 8.7 mm2 in healthy controls and 14.6mm2 in CTS group (P<0.001). The mean IOR in healthy volunteers (1.0) was smaller than that in patients (1.6, P<0.001). Receiver operating characteristic analysis revealed a diagnostic advantage to using the IOR rather than the inlet CSA (P<0.01). An IOR cutoff value of ≥ 1.3 would yield 93% specificity and 91% sensitivity in the diagnosis of CTS.

Conclusion: The IOR of median nerve area promises to be an effective means in the diagnosis of CTS. A large-scale, randomized controlled trial is required to determine how and when this parameter will be used.

Show MeSH
Related in: MedlinePlus