A Novel Ultrasonographic Anthropometric-Independent Measurement of Median Nerve Swelling in Carpal Tunnel Syndrome: The “Nerve/Tendon Ratio” (NTR)
Background: There is little consensus on ultrasound (US) normative values of cross-sectional area of median nerve (MN-CSA) in carpal tunnel syndrome (CTS) because of its dependency on anthropometric parameters. We aim to propose a novel anthropometric-independent US parameter: MN-CSA/flexor radialis...
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| Format: | Article |
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MDPI AG
2022-10-01
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| Series: | Diagnostics |
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| Online Access: | https://www.mdpi.com/2075-4418/12/11/2621 |
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| author | Paolo Falsetti Edoardo Conticini Caterina Baldi Emilio D’Ignazio Suhel Gabriele Al Khayyat Marco Bardelli Stefano Gentileschi Roberto D’Alessandro Miriana D’Alessandro Caterina Acciai Federica Ginanneschi Luca Cantarini Bruno Frediani |
| author_facet | Paolo Falsetti Edoardo Conticini Caterina Baldi Emilio D’Ignazio Suhel Gabriele Al Khayyat Marco Bardelli Stefano Gentileschi Roberto D’Alessandro Miriana D’Alessandro Caterina Acciai Federica Ginanneschi Luca Cantarini Bruno Frediani |
| author_sort | Paolo Falsetti |
| collection | DOAJ |
| description | Background: There is little consensus on ultrasound (US) normative values of cross-sectional area of median nerve (MN-CSA) in carpal tunnel syndrome (CTS) because of its dependency on anthropometric parameters. We aim to propose a novel anthropometric-independent US parameter: MN-CSA/flexor radialis carpi CSA (FCR-CSA) ratio (“Nerve Tendon Ratio”, NTR), in the diagnosis of clinically and electrodiagnostic (EDS)-defined CTS. Methods: 74 wrists of 49 patients with clinically defined CTS underwent EDS (scored by the 1–5 Padua Scale of electrophysiological severity, PS) and US of carpal tunnel with measurement of MN-CSA (at the carpal tunnel inlet), FCR-CSA (over scaphoid tubercle) and its ratio (NTR, expressed as a percentage). US normality values and intra-operator agreement were assessed in 33 healthy volunteers. Results: In controls, the mean MN-CSA was 5.81 mm<sup>2</sup>, NTR 64.2%. In 74 clinical CTS, the mean MN-CSA was 12.1 mm<sup>2</sup>, NTR 117%. In severe CTS (PS > 3), the mean MN-CSA was 15.9 mm<sup>2</sup>, NTR 148%. In CTS, both MN-CSA and NTR correlated with sensitive conduction velocity (SCV) (<i>p</i> < 0.001), distal motor latency (DML) (<i>p</i> < 0.001) and PS (<i>p</i> < 0.001), with a slight superiority of NTR vs. MN-CSA when controlled for height, wrist circumference and weight. In CTS filtered for anthropometric extremes, only NTR maintained a correlation with SCV (<i>p</i> = 0.023), DML (<i>p</i> = 0.016) and PS (<i>p</i> = 0.009). Diagnostic cut-offs were obtained with a binomial regression analysis. In those patients with a clinical diagnosis of CTS, the cut-off of MN-CSA (AUROC: 0.983) was 8 mm<sup>2</sup> (9 mm<sup>2</sup> with highest positive predictive value, PPV), while for NTR (AUROC: 0.987), the cut-off was 83% (100% with highest PPV). In patients with EDS findings of severe CTS (PS > 3), the MN-CSA (AUROC: 0.876) cut-off was 12.3 mm<sup>2</sup> (15.3 mm<sup>2</sup> with highest PPV), while for NTR (AUROC: 0.858) it was 116.2% (146.0% with highest PPV). Conclusions: NTR can be simply and quickly calculated, and it can be used in anthropometric extremes. |
| first_indexed | 2024-03-09T19:09:40Z |
| format | Article |
| id | doaj.art-bda03cdb4cb846f6877c5774d6e4a662 |
| institution | Directory Open Access Journal |
| issn | 2075-4418 |
| language | English |
| last_indexed | 2024-03-09T19:09:40Z |
| publishDate | 2022-10-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Diagnostics |
| spelling | doaj.art-bda03cdb4cb846f6877c5774d6e4a6622023-11-24T04:18:13ZengMDPI AGDiagnostics2075-44182022-10-011211262110.3390/diagnostics12112621A Novel Ultrasonographic Anthropometric-Independent Measurement of Median Nerve Swelling in Carpal Tunnel Syndrome: The “Nerve/Tendon Ratio” (NTR)Paolo Falsetti0Edoardo Conticini1Caterina Baldi2Emilio D’Ignazio3Suhel Gabriele Al Khayyat4Marco Bardelli5Stefano Gentileschi6Roberto D’Alessandro7Miriana D’Alessandro8Caterina Acciai9Federica Ginanneschi10Luca Cantarini11Bruno Frediani12Rheumatology Unit, Department of Medical, Surgical Sciences and Neurosciences, University Hospital of Siena, 53100 Siena, ItalyRheumatology Unit, Department of Medical, Surgical Sciences and Neurosciences, University Hospital of Siena, 53100 Siena, ItalyRheumatology Unit, Department of Medical, Surgical Sciences and Neurosciences, University Hospital of Siena, 53100 Siena, ItalyRheumatology Unit, Department of Medical, Surgical Sciences and Neurosciences, University Hospital of Siena, 53100 Siena, ItalyRheumatology Unit, Department of Medical, Surgical Sciences and Neurosciences, University Hospital of Siena, 53100 Siena, ItalyRheumatology Unit, Department of Medical, Surgical Sciences and Neurosciences, University Hospital of Siena, 53100 Siena, ItalyRheumatology Unit, Department of Medical, Surgical Sciences and Neurosciences, University Hospital of Siena, 53100 Siena, ItalyRheumatology Unit, Department of Medical, Surgical Sciences and Neurosciences, University Hospital of Siena, 53100 Siena, ItalyUnit of Respiratory Diseases and Lung Transplantation, Department of Medical, Surgical Sciences and Neurosciences, University Hospital of Siena, 53100 Siena, ItalyNeurorehabilitation Unit, San Donato Hospital, 52100 Arezzo, ItalyNeurology Unit, Department of Medical, Surgical Sciences and Neurosciences, University Hospital of Siena, 53100 Siena, ItalyRheumatology Unit, Department of Medical, Surgical Sciences and Neurosciences, University Hospital of Siena, 53100 Siena, ItalyRheumatology Unit, Department of Medical, Surgical Sciences and Neurosciences, University Hospital of Siena, 53100 Siena, ItalyBackground: There is little consensus on ultrasound (US) normative values of cross-sectional area of median nerve (MN-CSA) in carpal tunnel syndrome (CTS) because of its dependency on anthropometric parameters. We aim to propose a novel anthropometric-independent US parameter: MN-CSA/flexor radialis carpi CSA (FCR-CSA) ratio (“Nerve Tendon Ratio”, NTR), in the diagnosis of clinically and electrodiagnostic (EDS)-defined CTS. Methods: 74 wrists of 49 patients with clinically defined CTS underwent EDS (scored by the 1–5 Padua Scale of electrophysiological severity, PS) and US of carpal tunnel with measurement of MN-CSA (at the carpal tunnel inlet), FCR-CSA (over scaphoid tubercle) and its ratio (NTR, expressed as a percentage). US normality values and intra-operator agreement were assessed in 33 healthy volunteers. Results: In controls, the mean MN-CSA was 5.81 mm<sup>2</sup>, NTR 64.2%. In 74 clinical CTS, the mean MN-CSA was 12.1 mm<sup>2</sup>, NTR 117%. In severe CTS (PS > 3), the mean MN-CSA was 15.9 mm<sup>2</sup>, NTR 148%. In CTS, both MN-CSA and NTR correlated with sensitive conduction velocity (SCV) (<i>p</i> < 0.001), distal motor latency (DML) (<i>p</i> < 0.001) and PS (<i>p</i> < 0.001), with a slight superiority of NTR vs. MN-CSA when controlled for height, wrist circumference and weight. In CTS filtered for anthropometric extremes, only NTR maintained a correlation with SCV (<i>p</i> = 0.023), DML (<i>p</i> = 0.016) and PS (<i>p</i> = 0.009). Diagnostic cut-offs were obtained with a binomial regression analysis. In those patients with a clinical diagnosis of CTS, the cut-off of MN-CSA (AUROC: 0.983) was 8 mm<sup>2</sup> (9 mm<sup>2</sup> with highest positive predictive value, PPV), while for NTR (AUROC: 0.987), the cut-off was 83% (100% with highest PPV). In patients with EDS findings of severe CTS (PS > 3), the MN-CSA (AUROC: 0.876) cut-off was 12.3 mm<sup>2</sup> (15.3 mm<sup>2</sup> with highest PPV), while for NTR (AUROC: 0.858) it was 116.2% (146.0% with highest PPV). Conclusions: NTR can be simply and quickly calculated, and it can be used in anthropometric extremes.https://www.mdpi.com/2075-4418/12/11/2621carpal tunnel syndromemedian nerveultrasoundelectrodiagnosticsneuropathy |
| spellingShingle | Paolo Falsetti Edoardo Conticini Caterina Baldi Emilio D’Ignazio Suhel Gabriele Al Khayyat Marco Bardelli Stefano Gentileschi Roberto D’Alessandro Miriana D’Alessandro Caterina Acciai Federica Ginanneschi Luca Cantarini Bruno Frediani A Novel Ultrasonographic Anthropometric-Independent Measurement of Median Nerve Swelling in Carpal Tunnel Syndrome: The “Nerve/Tendon Ratio” (NTR) Diagnostics carpal tunnel syndrome median nerve ultrasound electrodiagnostics neuropathy |
| title | A Novel Ultrasonographic Anthropometric-Independent Measurement of Median Nerve Swelling in Carpal Tunnel Syndrome: The “Nerve/Tendon Ratio” (NTR) |
| title_full | A Novel Ultrasonographic Anthropometric-Independent Measurement of Median Nerve Swelling in Carpal Tunnel Syndrome: The “Nerve/Tendon Ratio” (NTR) |
| title_fullStr | A Novel Ultrasonographic Anthropometric-Independent Measurement of Median Nerve Swelling in Carpal Tunnel Syndrome: The “Nerve/Tendon Ratio” (NTR) |
| title_full_unstemmed | A Novel Ultrasonographic Anthropometric-Independent Measurement of Median Nerve Swelling in Carpal Tunnel Syndrome: The “Nerve/Tendon Ratio” (NTR) |
| title_short | A Novel Ultrasonographic Anthropometric-Independent Measurement of Median Nerve Swelling in Carpal Tunnel Syndrome: The “Nerve/Tendon Ratio” (NTR) |
| title_sort | novel ultrasonographic anthropometric independent measurement of median nerve swelling in carpal tunnel syndrome the nerve tendon ratio ntr |
| topic | carpal tunnel syndrome median nerve ultrasound electrodiagnostics neuropathy |
| url | https://www.mdpi.com/2075-4418/12/11/2621 |
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