超音波诊断是一项精确且便宜的腕隧道症候群诊断法


  June 13, 2005 (维也纳) - 在欧洲风湿医学年度大会中,波兰的研究人员发表指出,除了核磁共振造影(MRI)及肌电图(EMG)以外,超音波也可以用来诊断腕隧道症候群(CTS)。
  
  主研究员Anna Ciechomska医师表示,核磁共振造影及肌电图都会让患者感到不舒服,也很耗时、昂贵、不容易取得;超音波比较便宜,患者也比较容易接受;Ciechomska在波兰华沙的军医研究院,担任内科医学及风湿病学的教授一职。
  
  Ciechomska和她的研究同僚于是对超音波进行研究,确定超音波是否可以正确的侦测出腕隧道症候群患者受到压迫的神经;研究人员从52位患者处获取了126个手腕超音波造影,这些患者皆经肌电图证实患有腕隧道症候群;同时,研究人员也取得了22位健康者的腕部超音波造影以为对照;所使用的仪器为Aspen (Acuson公司,位于加州Aliso Viejo市),配备一线性的宽频电能转换器,频率设定在6到11 MHz。
  
  Ciechomska的研究团队针对超音波回音、厚度,及正中神经的构造进行评估,并注意目视可及的神经压迫现象;在腕隧道的入口部位,研究人员对神经的横断面作面积测量;自身神经组织差异过大者,不论是试验组或对照组,研究人员都会将之排除于试验之外,如神经高度分叉者。
  
  研究人员发现,腕隧道症候群患者的手腕中,83%有著较弱的回音,靠近腕隧道的正中神经有著扩大的现象;腕隧道入口部位的正中神经之平均横切面面积,腕隧道症候群组为16.0 ± 6.0 mm2,对照组为8.3 ± 0.8 mm2;以肌电图作比较,对于神经横断面为9.3 mm2者,超音波对神经压迫的诊断敏感度为92%,特定度为98%,正确率则为97.8%。
  
  另外,腕隧道症候群患者中,92.1%有著神经平坦化的现象;43.4%的患者在腕隧道内的神经,构造出现模糊、无法辨别、增大的情形;44.7%在隧道远端处的回音趋弱;根据Ciechomska所述,在126个手腕中,20个(16%)无法单以超音波对神经压迫的可能原因作确认。
  
  Ciechomska医师和她的同僚们在结论时表示,在疑似腕隧道症候群时,可以先以超音波对患者作诊断,在需要更进一步的细节时,再使用肌电图或核磁共振造影作扫描。

Ultrasound Is Accurate, Inexpe

By Paula Moyer, MA
Medscape Medical News

June 13, 2005 (Vienna) — Ultrasound is a feasible alternative to magnetic resonance imaging (MRI) and electromyography (EMG) for diagnosing carpal tunnel syndrome (CTS), according to a team of Polish investigators whose findings were presented here at the Annual European Congress of Rheumatology.

"Both MRI and electromyogaphy are unpleasant for patients, as well as time-consuming, expensive, and not always available," said principal investigator Anna Ciechomska, MD, PhD, in a presentation. "Ultrasound may be a cheaper and more patient-friendly alternative." Dr. Ciechomska is a professor of internal medicine and rheumatology at the Military Medical Institute in Warsaw, Poland.

Therefore, Dr. Ciechomska and her coinvestigators wanted to see if ultrasound would accurately identify the features of nerve compression in patients with CTS. They obtained ultrasound images of 126 wrists in 52 patients who had been diagnosed as having CTS by EMG. They also obtained ultrasound images of the wrists of 22 healthy people. They used the Aspen unit (Acuson, Aliso Viejo, California), which was equipped with a linear, wideband transducer at 6 to 11 MHz.

Dr. Ciechomska and her team assessed the echogenicity, thickness, and structure of the median nerve and noted visible causes of the compression. They also measured the cross-sectional area of the nerve at the level of entrance to the carpal tunnel. They excluded subjects in both the CTS and control groups who had anatomic variations of the nerve, such as high nerve division.

The investigators found that 83% of wrists with CTS had less echogenicity and an enlargement of the median nerve proximal to the carpal tunnel. The average cross-sectional area of the median nerve at the entrance to the carpal tunnel was 16.0 ± 6.0 mm2 compared with an average of 8.3 ± 0.8 mm2 in the healthy patients (P > .000005). When the investigators used EMG as a reference, they found that the cross-sectional area of the nerve of the standard 9.3 mm2 had a sensitivity of 92% and a specificity of 98% and was 97.8% accurate in diagnosing the nerve compression.

Additionally, the investigators observed that in patients with CTS, 92.1% had flattening of the nerve and that in 43.4% of patients the nerve's structure was blurred within the carpal tunnel. Patients with CTS also had nerve enlargement and a 44.7% decrease in echogenicity distal to the tunnel. In 20 (16%) of the 126 wrists, ultrasound alone was able to identify possible causes of nerve compression, according to Dr. Ciechomska.

Therefore, Dr. Ciechomska and her coinvestigators concluded that ultrasound would be the imaging modality to use first in all patients with suspected CTS and to use MRI and EMG if further details were needed.

EULAR: Abstract OP0018. Presented June 9, 2005.

Reviewed by Gary D. Vogin, MD

    
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