Evaluation of median nerve by shear wave elastography and diffusion tensor imaging in carpal tunnel syndrome

Abstract

PurposeThe aim of the current study is to investigate the diagnostic role of shear-wave elastography and diffusion tensor imaging in patients with carpal tunnel syndrome. Material and methodsThe study included a total of 77 wrists; 18 normal, 35 wrists with mild, 9 wrists with moderate and 15 wrists with severe carpal tunnel syndrome. Elastography of the median nerve was performed by defining the boundaries of a segment of the nerve at sagittal plane at the level of proximal carpal row. Additionally, the cross-sectional area of the median nerve was evaluated. Fractional anisotropy and apparent diffusion coefficient measurements were carried out by placing region-of-interest at three levels: at pisiform bone (carpal tunnel inlet), mid carpal tunnel, and hook of hamate (carpal tunnel outlet). ResultsPatients with carpal tunnel syndrome had higher elasticity values of median nerve (53.0 kPa; IQR 40.8–77.0 kPa) compared to control subjects. (36.8 kPa; IQR 31.0–39.9 kPa) Patients with moderate-severe carpal tunnel syndrome had higher elasticity values (82 kPa; IQR 64.0–95.5 kPa) compared to patients with mild carpal tunnel syndrome. (44 kPa; IQR 32.5–59.5 kPa)Patients with carpal tunnel syndrome had lower fractional anisotropy at mid-carpal level (0.382; IQR 0.330–0.495) compared to the control group. (0.494; IQR 0.434–0.537) Patients with moderate-severe carpal tunnel syndrome had lower fractional anisotropy values (0.366; IQR 0.331–0.407) and higher apparent diffusion coefficient values (1.509 mm2/s; IQR 1.374–1.733 mm2/s) compared to patients with mild carpal tunnel syndrome. (0,423; IQR 0.324–0.526 and 1.293 mm2/s; IQR 0.967–1.514 mm2/s) ConclusionShear-wave elastography and diffusion tensor imaging are helpful imaging modalities in diagnosing carpal tunnel syndrome and assessing its severity.