肘管综合征行高频超声检查的价值

目的探讨高频超声检查技术对肘管综合征(CUTS)的诊断价值。方法选择31例肘管综合征患者的患侧手臂尺神经作为CUTS组,健侧手臂尺神经作为对照组,应用高频超声成像技术观察尺神经的连续性、内部结构、回声、有无局限性膨大及比邻结构关系,取横断面测量所有患者患侧尺神经与健侧尺神经的横截面积(CSA)。结果尺神经受压明显时神经局段变细,变细处回声明显减低,束状结构欠清晰,卡压近端及远端神经增粗;尺神经卡压瘢痕粘连时,神经增粗回声减低,外膜及束膜回声增强,与周围组织界限模糊;个别患者未见明显卡压段,仅见肘管内尺神经全程肿胀。31例肘管综合征患者患侧肘管尺神经与健侧肘管尺神经比较,患侧尺神经横截面积较健侧明显增大并存在统计学差异(P<0.05)。结论高频超声能动态观察尺神经卡压征象及其周围结构损伤情况,对肘管综合征的诊断有着重要的应用价值。     

计算机辅助定量分析灰阶超声在腕管综合征诊断中的应用

【摘要】目的：采用计算机辅助定量分析腕管综合征（CTS）的灰阶超声图像,探讨其在定量分析CTS中的应用价值。方法：搜集60例CTS患者（77个异常手腕）和30例正常志愿者（60个正常手腕）,其中17例为双侧卡压,在豌豆骨水平保留正中神经图像,共得到137组图像,并且在二维图像上对正中神经进行勾勒,提取正中神经卡压的客观数据,为CTS的诊断提供依据。结果：CTS患者病灶区域像素的均值、标准差、变异系数、偏度、峰度均比正常组大;CTS患者直方图熵较正常组大;正常组亮度熵较CTS组大;而CTS患者整个灰阶区域像素中的均值、中值较正常组低;CTS患者所有表示对比度的参数均高于正常组;CTS患者病灶的厚度、长度、面积、长轴、短轴、周长等参数均较正常组大。表明在CTS患者中,图像分布较正常对照组欠均匀,且CTS患者正中神经较正常肿胀,横截面积增大。结论：计算机辅助定量分析在CTS中表现良好,可定量分析正中神经卡压时图像的均匀性和对比度。     

肘关节畸形致肘管综合征肌电图特征分析

目的 对肘关节畸形致肘管综合征（CTS）患者肌电图特征进行分析,并与颈椎病、胸出口综合征等疾病相鉴别.方法 对82例肘关节一侧或双侧畸形患者,分别采用运动神经传导速度（MCV）、感觉神经传导速度（SCV）、针电极肌电图方法,对双侧尺神经、正中神经、桡神经进行检测.对仅有尺神经的MCV、SCV异常,并有肘管传导速度减慢,且有明显神经传导阻滞点,而正中神经、桡神经不受累患者,确诊为CTS.结果 在测定的82例164条尺神经中,腕-肘下3 cm处MCV减慢的共56条（34.3%）,腕部测定SCV减慢45条（27.4%）、未引出41条（25%）;36例双侧、46例单侧共118条尺神经肘管传导速度均不同程度减慢,并伴有波幅降低,卡压部位均位于肘正中或上、下1 cm左右处.82例正中神经MCV与SCV均正常;针电极肌电图检测第一背侧骨间肌、小指展肌及尺侧屈腕肌异常48例（58%）,拇短展肌及桡侧屈腕肌均未见异常.82例中,最后明确诊断为CTS单侧46例、双侧36例,均可见确定的肘管内卡压点.结论 对有肘关节畸形的患者均应作神经肌电图检测,尽早明确CTS诊断,以便及时治疗.     

基于改进U-Net深度网络在定量评估腕管综合征正中神经卡压中的应用

【摘要】目的：运用改进U-Net深度网络学习定量评价腕管综合征正中神经的超声图像,确定基于改进U-Net深度网络学习的卷积神经网络模型,探讨其在定量评估腕管综合征正中神经卡压中的应用价值。方法：搜集213例经肌电图确诊的腕管综合征正中神经卡压患者及104例健康志愿者,213例正中神经卡压患者中60例为双侧卡压。对317例受检者行超声检查,在腕管处保存超声图像,共得到正中神经图像377组。由擅长肌骨超声的医师对377组图像进行勾勒。应用基于改进U-net深度网络学习的卷积神经网络模型,分割腕管综合征卡压的正中神经超声图像,定量分析提取横切以及纵切的正中神经超声图像的影像组学量化特征。结果：改进的U-Net深度网络可以很好地识别切割正中神经;改进的U-Net深度网络可以定量表示CTS中卡压的正中神经回声减低,区域明暗参数A、明暗参数I、对比明暗参数RI以及纹理参数Homo、纹理不均匀参数Cont差异均有统计学意义（P=0.000）。结论：改进的U-Net模型在超声正中神经图像自动分割方面表现良好,可以定量分析腕管综合征正中神经卡压时灰度以及神经纹理均匀性。     

超声在腕管综合征中的诊断价值

目的:探讨超声诊断腕管综合征(CTS)的准确性。方法:对37例腕管综合征患者的44只手腕和40例无CTS志愿者的80只手腕行动态超声检查,在腕管桡尺关节、豌豆骨及钩骨水平测量正中神经的截面积及其扁平率(长径与短径之比),两组结果进行相关性的对比研究,由ROC曲线评价超声诊断腕管综合征标准值的准确性。结果:CTS患者的正中神经在腕豆骨的截面积明显大于正常对照组,两组比较差异有统计学意义,正中神经的截面积增大对于诊断腕管综合征最有预测价值。以正中神经在豌豆骨水平的截面积9.5cm2为阈值,其诊断准确性为87%,诊断敏感度为88%,诊断特异度为87.5%。结论:超声测量正中神经的截面积是诊断腕管综合征的可靠方法。     

高频超声技术诊断肘管综合征的价值

目的：探讨超声技术诊断肘管综合征（CTS）的准确性。方法：对30例肘管综合征患者的30只手和50例无CTS志愿者的100只手肘部行动态超声检查,测量并比较两组尺神经的上下径、横径及截面积,并用ROC曲线评价超声诊断肘管综合征标准值的准确性。结果：CTS患者的尺神经在内上髁水平的截面积、上下径及左右径明显大于正常对照组,两组比较差异有统计学意义,尺神经的截面积增大对于诊断肘管综合征最有预测价值。以尺神经在内上髁水平的截面积7.5mm2为阈值,诊断敏感度为93%,诊断特异性为91%。结论：超声测量尺神经的截面积是诊断肘管综合征的可靠方法。     

高频超声对老龄腕管综合征的诊断价值

目的 :探讨高频超声对老龄腕管综合征(CTS)的诊断价值。方法 :选择125例(140只腕)老龄CTS患者(CTS组)按肌电图检测的感觉/运动传导参数分为轻、中、重度3组,另选择匹配的45例健康志愿者为对照组,行高频超声检测正中神经横截面积(CSA),以及腕管入口和出口正中神经面积比(R-CSA)和面积差(△CSA),比较2组正中神经形态参数的差异及其不同平面的正中神经参数的ROC曲线。结果:高频超声检测的腕管入口R-CSA和△CSA的敏感度和特异度优于腕管出口的CSA。结论:高频超声所测腕管入口的R-CSA、△CSA是诊断老龄CTS的良好指标。     

高频超声对糖尿病并发腕管综合征的临床诊断研究

目的探讨高频超声诊断糖尿病(DM)并发腕管综合征(CTS)的临床应用价值。方法选取2014年1月～2017年12月在我院就诊的CTS患者共72例,其中非DM(non-DM)CTS患者40例,DM合并CTS患者32例。所有病例均经临床查体及电生理检查证实。DM者64只手腕中患有CTS手腕的为36只,non-DM中患有CTS手腕的为46只。将同期来我院进行健康体检的人共20例(40只手腕)设为A组,B组为non-DM合并CTS的手腕(共46只)、C组为DM无CTS的手腕(共28只)、D组为DM合并CTS的手腕(共36只)。高频超声测量每位受试者腕管入口(腕豆骨水平)与腕管出口(钩骨钩水平)正中神经(MN)的CSA值,并计算两者的比值,即肿胀率(SR)。单因素方差分析比较4组间各测值是否存在统计学差异。结果 1)各组腕管入口正中神经的CSA值分别为(8.78±0.76)mm~2(A组)、(13.36±0.18)mm~2(B组)、(10.37±0.30)mm~2(C组)以及(13.96±0.75)mm~2(D组)。各组腕管入口处正中神经CSA统计学差异显著(F=87.79,P0.001,多重比较结果显示B组与D组无差异,但是与A、C两组差异显著,而A、C两组测值差异亦显著。腕管入口正中神经的CSA值为B组=D组C组A组;2)各组腕管出口处正中神经的CSA值分别为(7.82±0.66)mm~2(A组)、(11.52±0.86)mm~2(B组)、(9.43±0.40)mm~2(C组)以及(13.12±0.74)mm~2(D组)。各组腕管出口处正中神经CSA统计学差异显著(F=90.429,P0.001),多重比较结果显示该处各CSA值均存在差异,其中以D组最大,其次为B组,然后为C组,最小者为A组;3)各组腕管SR值分别为1.12±0.07(A组)、1.17±0.11(B组)、1.10±0.06(C组)及1.07±0.07(D组)。各组SR值差异显著(F=9.850,P0.001),多重比较结果显示B组SR值A组=C组D组。结论高频超声诊断CTS和DM合并CTS具有一定的临床价值,值得推广应用。     

腕管综合征的MRI诊断

研究腕管综合征（CTS）的MRI特征及应用价值。材料和方法：经临床及手术证实的CTS12例，行MRI检查，以横断面为主。结果：12例CTS的MRI表现为：正中神经进入腕管时肿胀增粗12例，正中神经肿胀率（MNSR）为2．25：1。正中神经腕管内受压变扁12冽，正中神经扁平率（MNFR）为3．4。腕横韧带向掌侧膨隆10例，腕横韧带膨隆率（BR）为15．8％。T2WI像正中神经信号增高12例。结论：MRI对CTS的诊断、治疗方式的选择及疗效观察有重要的价值。     

特发性腕管综合征患者正中神经硬度与神经传导的相关性研究

目的 :探讨声触诊成像定量(VTIQ)技术所测特发性腕管综合征(CTS)患者正中神经硬度与神经传导指标是否存在相关性。方法:对37例(61只腕)特发性CTS患者行VTIQ及神经传导检查,分析其正中神经剪切波速度(SWV)、近豌豆骨水平正中神经横截面积(CSA)、末端运动潜伏期(DML),以及SWV与CSA、DML的相关性。结果:正中神经的SWV与DML、CSA均呈正相关(r=0.357,P0.05;r=0.690,P0.001)。结论:特发性CTS患者SWV值与CSA及DML的相关性提示神经硬度的增加与神经形态学改变及神经传导的异常有关。VTIQ技术可为CTS的诊治提供更丰富的定量影像学证据。     

Grey-scale sonography and sonoelastography for diagnosing carpal tunnel syndrome

Carpal tunnel syndrome (CTS) is a common peripheral entrapment neuropathy of the median nerve at wrist level, and is thought to be caused by compression of the median nerve in the carpal tunnel. There is no standard quantitative reference for the diagnosis of CTS. Grey-scale sonography and sonoelastography (SEL) have been used as diagnostic tools. The most commonly agreed findings in grey-scale sonography for the diagnosis of CTS is enlargement of the median nerve cross-sectional area (CSA). Several authors have assessed additional parameters. “Delta CSA” is the difference between the proximal median nerve CSA at the pronator quadratus and the maximal CSA within the carpal tunnel. The “CSA ratio” is the ratio of CSA in the carpal tunnel to the CSA at the mid forearm. These additional parameters showed better diagnostic accuracy than CSA measurement alone. Recently, a number of studies have investigated the elasticity of the median nerve using SEL, and have shown that this also has diagnostic value, as it was significantly stiffer in CTS patients compared to healthy volunteers. In this review, we summarize the usefulness of grey-scale sonography and SEL in diagnosing CTS.     

Ultrasonographic assessment of mild and moderate idiopathic carpal tunnel syndrome

AIM: To investigate the diagnostic value of ultrasonography in mild and moderate idiopathic carpal tunnel syndrome (CTS). MATERIALS AND METHODS: Cross-sectional areas (CSA), flattening ratios at three different levels, swelling ratio, and palmar displacement were analysed in 26 patients (14 with bilateral and 12 with unilateral disease, 40 wrists in total) for the presence and the severity of CTS. Twenty had normal nerve conduction studies (NCS) defined as "mild", and 20 of them had abnormal NCS defined as "moderate". The control group consisted of 20 healthy participants. RESULTS: All parameters were significantly different between patient and control groups. Palmar displacement, swelling ratio, CSA at all levels and distal flattening ratio had the highest significance (p < 0.0001). The criterion with the highest sensitivity was the swelling ratio > or = 1.3 (72.5%), followed by the middle CSA > 9 mm2 and the palmar displacement > 2.5 mm. All of these criteria had a higher sensitivity in diagnosing moderate cases (85-100%) than diagnosing mild cases (30-55%). There was a significant difference between normal and mild CTS groups regarding palmar displacement, distal flattening ratio, middle CSA and swelling ratio (p < 0.0001 for all) and between normal and moderate groups regarding all parameters (p < 0.01 - 0.0001) When combined middle CSA, palmar displacement and swelling ratio had an overall discriminatory accuracy of 83.8%. CONCLUSION: Additional diagnostic confirmation can be provided by ultrasonography and may be preferred as the initial step instead of electrophysiological studies. Detection of at least two of the three criteria (median nerve CSA > 9 mm2 at pisiform level, swelling ratio > or = 1.3, and palmar displacement > 2.5 mm) may be helpful for the verification of the diagnosis.     

Contribution of power Doppler and gray-scale ultrasound of the median nerve in evaluation of carpal tunnel syndrome

Aim of the work

To assess the role of gray-scale and power Doppler ultrasound (US) of the median nerve at the wrist in evaluating carpal tunnel syndrome (CTS).

Materials and methods

Seventy-one wrists in 51 patients with CTS in addition to 50 healthy volunteers that served as the control group were enrolled in this study. The following sonographic parameters were evaluated in both patients and controls: cross sectional area of the median nerve just proximal to the tunnel inlet (CSA1), at the pisiform bone level (CSA2), the CSA difference (ΔCSA), flattening ratio of the median nerve and bowing of the flexor retinaculum. The power Doppler US was used to assess the number of nerve vessels with estimation of the vascularity score.

Results

The ΔCSA revealed an excellent discriminative ability (AUC = 0.988) in differentiating patients with CTS at an optimal cut-off value of 3.9 mm². Intraneural hypervascularization was significantly correlated with the ΔCSA of the median nerve (P < 0.001), while not significantly correlated with the age of patients, median nerve flattening ratio and bowing of flexor retinaculum.

Conclusion

The ΔCSA and vascularity score of the median nerve are important and useful sonographic parameters in evaluation of CTS.     

The value of power and pulsed Doppler in the diagnosis of CTS: Is a solution in sight

Objective

To evaluate the value of power and pulsed Doppler in diagnosis of CTS and compare it with median nerve cross-sectional area (CSA) measured by gray-scale US and nerve conduction studies.

Patients and methods

Forty patients with definite clinical evidence of CTS and 20 healthy cases were enrolled in the study. All patients and controls underwent nerve conduction studies, gray-scale US (for measurement of CSA) and color Doppler (for assessment of vasomotor activity).

Results

Twenty eight patients (70%) had confirmed diagnosis by NCS while 12 patients (30%) were not detected by the NCS. The CSA ranged from 0.06 to 0.78 cm² with a mean of 0.19 + 0.12. Comparison between patients and controls as regards CSA showed highly statistically significant difference (P < 0.001). There was a significant difference between patients and controls as regards PS, ED & PI. Also there was a significant correlation between median nerve hypervascularization and the parameters of spectral Doppler and the severity of CTS by NCS and also with CSA.

Conclusion

Color Doppler imaging of the median nerve is a readily accessible and practical method for determining the degree of vasomotor impairment in CTS patients that may be valuable in evaluation and follow up of CTS patients in clinical practice.     

环孢素联合糖皮质激素治疗Vogt-小柳原田病的临床研究

目的：探讨环孢素联合糖皮质激素治疗VKH病的临床疗效。方法：选择07年1月至08年2月哈尔滨242医院眼科眼底病病房VKH病患者36例（72只眼）,患病年龄18～60岁,平均39.53岁;男21例,女15例;视力4.0-4.1有29只眼,4.2-4.3有15只眼,≥4.4有28只眼;随机分为对照组和治疗组,前者20例（40只眼）应用环孢素联合糖皮质激素治疗,后者16例（32只眼）常规应用糖皮质激素的治疗,对两组患者治疗前和治疗后一个月的视力、多焦视网膜电图及眼底荧光血管造影等方面的变化情况进行比较。结果：（1）视力方面,治疗组治疗前后视力比较,差异有统计学意义（p〈0.01）,对照组治疗前后比较,差异有统计学意义（p〈0.05）,治疗组与对照组治疗后视力比较,差异有统计学意义（p〈0.05）,治疗组优于对照组;（2）多焦视网膜电图（mfERG）：两组治疗前后Pl波振幅密度增加,潜伏时缩短,差异均有统计学意义（p〈0.05）,治疗后治疗组与对照组P1波振幅密度和潜伏时变化比较,差异有统计学意义（p〈0.05）,治疗组优于对照组;（3）眼底荧光血管造影方面：两组视网膜荧光素渗漏改善情况比较,差异有统计学意义（p〈0.05）,治疗组优于对照组。结论：环孢素联合糖皮质激素治疗VKH病可取得良好疗效。     

三维平衡式快速场梯度回波和时间飞跃法血管造影技术对三叉神经的对比研究

目的:探讨MR扫描三叉神经与周围血管的最佳序列。方法:对16例三叉神经痛患者行三叉神经3D BTFE和3D TOF MRA扫描。测量双侧三叉神经与桥前池的CNR、椎-基底动脉与桥前池CNR、三叉神经与桥前池对比度。根据三叉神经图像质量、周围血管显示、神经与血管的关系进行评分。结果:3D BTFE组三叉神经与桥前池CNR、对比度较3D TOF MRA组高〔22.94±4.18(左)and 21.68±5.51(右)vs 5.92±3.01(左)and 6.37±3.86(右)〕、〔1834±294(左)and 1968±351(右)vs 572±42(左)and 468±55(右)〕。3D BTFE组椎-基底动脉与桥前池CNR较3D TOFMRA低〔2.47±1.17 vs 6.21±2.87〕(P0.01)。3D BTFE组三叉神经图像质量较好。3D TOF MRA组血管显示较好、血管与神经关系较清晰(P0.05,Kappa0.75)。结论:3D BTFE和3D TOF MRA序列联合应用,可以清晰观察到三叉神经解剖学改变及神经与周围血管关系,对设计和优化MVD具有重要意义。     

磁共振3D-TSE序列和3D-VIBE序列在诊断血管压迫性三叉神经痛中的价值

目的探讨磁共振3 D-TSE序列和3 D-VIBE序列对于血管压迫性三叉神经痛的诊断价值。方法采用3 DTSE序列和3 D-VIBE序列扫描28例临床拟诊为血管压迫性三叉神经痛的患者。经3 DMRP、MIP、min-MIP后处理图像,观察三叉神经与周围血管的关系。结果 28例患者手术证实26例存在血管神经接触或压迫,3 D-VIBE、3 D-TSE序列综合判断血管压迫性三叉神经痛的阳性预测值、阴性预测值、敏感性、手术符合率分别为92.0%(23/25)、33.3%(1/3)、92.0%(23/25)、85.7%(24/28)。而且MRI所显示的责任血管与神经的相对位置关系与术中所见具有高度的一致性(K=0.81)。结论 3 D-TSE序列和3 D-VIBE序列结合可以清楚显示脑池内血管和三叉神经的空间关系并辨认责任血管的来源,对血管压迫性三叉神经痛的术前评估具有较高的价值。     

The ultrasonographic correlates of carpal tunnel syndrome in patients with normal electrodiagnostic tests

Purpose

The diagnosis of carpal tunnel syndrome (CTS) is established by electrodiagnostic testing (EDT). Nonetheless, in a portion of patients complaining of the typical signs and symptoms of CTS, the EDT is negative, and yet no paraclinical tool has been acknowledged for confirming the diagnosis. The aim of this study was to investigate the value of ultrasound imaging in diagnosing clinically suspicious patients with normal EDT findings.

Materials and methods

Thirty-four patients, with clinical evidence of CTS but without abnormal findings on electromyography, and 41 healthy controls were enrolled. Ultrasonography was performed in all participants, and cross-sectional area (CSA), hypoechogenicity and hypervascularity of the median nerve were evaluated. Multivariate logistic regression analysis was used to formulate a prediction model for CTS.

Results

CSA of the median nerve in the wrist and wrist-to-forearm ratio were significantly higher in patients compared with controls. Patients had significantly higher hypoechogenicity [odds ratio (OR) 4.317; 95% confidence interval (CI) 1.23?C15.11) and hypervascularity (OR 5.004,; 95% CI 1.02?C21.15) in the median nerve. Clinical evidence of CTS was predicted using a model comprising three ultrasonographic determinant factors, including hypoechogenicity, hypervascularity and wrist CSA of the median nerve. The probability of clinical evidence of CTS in a person with one, two, or three ultrasonographic signs of CTS was estimated to be 35%, 70%, and 90%, respectively.

Conclusions

Ultrasound imaging is a useful technique in diagnosing CTS patients when EDT results are not confirmatory and the patient is suspected of having neuropathy.