高频超声联合VTIQ诊断腕管综合征的临床应用
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摘要
目的探讨高频超声(HFUS)联合声触诊组织成像与定量(VTIQ)是否有助于提高腕管综合征(CTS)的诊断效能。方法以临床症状及神经肌电图结果,对35例CTS患者(45根神经)及23例(46根神经)健康对照者进行HFUS及VTIQ检测,作为制定标准。绘制两种不同方法诊断CTS的受试者工作特征(ROC)曲线,确定诊断阈值并比较这两种诊断方法的差异。比较上述两种方法联合诊断与HFUS诊断CTS的灵敏度及特异度的差别。结果 (1)CTS组正中神经腕管入口横截面积(CSA)较对照组显著增大(14.11±2.73)mm~2 vs (9.26±1.56)mm~2(P<0.01),而且横向剪切波速度均值(SWV_(mean))也显著增高(3.19±0.15)m/s vs (2.74±0.36)m/s,(P<0.01)。(2)分别以腕管入口CSA和SWV_(mean)比作ROC曲线,前者曲线下面积为0.94 (95%CI,0.89～0.98)。以CSA的诊断阈值为≥11.5mm~2,灵敏度为82.2%、特异度为91.3%,后者曲线下面积为0.84 (95%CI,0.76～0.93)。SWV_(mean)的诊断阈值为≥3.13m/s,灵敏度为75.6%、特异度为73.9%。VTIQ和HFUS检查的灵敏度相似(P=0.59),但特异度比HFUS检查显著降低(P=0.03)。(3)两种方法的串联实验诊断CTS,其灵敏度和特异度无显著改变(P>0.05);而并联试验时,特异度显著降低(P<0.05),灵敏度无显著改变(P>0.05)。结论在诊断CTS方面,VTIQ与HFUS检查有相似的灵敏度,但总的精确性不如HFUS检查;VTIQ和HFUS联合VTIQ检查未能提高CTS的诊断效能。
Objective To determine the diagnostic value of HFUS and VTIQ in the diagnosis of CTS and to assess the diagnostic value of HFUS with VTIQ in the diagnosis of CTS.Methods The neuropathic group consisted of35 patients(total 45 nerves)and the control group consisted of twenty-three healthy volunteers(total 46 nerves)were subiect to HFUS and VTIQ measurements using clinical diagnosis and neuroelectrophysiology as the reference standard,then the diagnostic value of different methods were compared.A receiver-operating characteristic(ROC)curve was fitted to determine the optimum cut off point and to compare the sensitivity and specificity between them.Results(1)The cross-sectional area(CSA)of the median nerve(MN)at the tunnel inlet was significantly larger in patients than in controls(14.11±2.73)mm~2 vs(9.26±1.56)mm~2(P<0.01),while the mean velocity of horizontal shear wave was significantly larger(3.19±0.15)m/s vs(2.74±0.36)m/s(P<0.01).(2)The ROC curve was fitted for the different methods of HFUS and VTIQ.For the former,the area under the curve was 0.94(95%CI,0.89～0.98).The diagnostic threshold of CSA at the tunnel inlet was≥11.5 mm~2,which had a sensitivity of 82.2%and a specificity of91.3%.While the latter,the area under the curve was 0.84(95% CI,0.76～0.93).The diagnostic threshold of SWE_(mean) was≥3.13 m/s,which had a sensitivity of 75.6% and a specificity of 77.4%.Sensitivity was similar between VTIQ and HFUS(P=0.59),whereas specificity was significantly lower in VTIQ than in HFUS(P=0.03).(3)Sensitivity and specificity of the series test of HFUS and VTIQ have no significant changes with HFUS(P>0.05).Specificity of the parallel test of HFUS and VTIQ was significantly lowered(P<0.05)without significant change in sensitivity(P>0.05)with HFUS.Conclusions Although the sensitivity of VTIQ is similar to HFUS for the diagnosis of CTS,its diagnostic accuracy is lower than HFUS.the diagnostic value of VTIQ or VTIQ combined HFUS in the diagnosis of CTS was not Raised.
Objective To determine the diagnostic value of HFUS and VTIQ in the diagnosis of CTS and to assess the diagnostic value of HFUS with VTIQ in the diagnosis of CTS.Methods The neuropathic group consisted of35 patients(total 45 nerves)and the control group consisted of twenty-three healthy volunteers(total 46 nerves)were subiect to HFUS and VTIQ measurements using clinical diagnosis and neuroelectrophysiology as the reference standard,then the diagnostic value of different methods were compared.A receiver-operating characteristic(ROC)curve was fitted to determine the optimum cut off point and to compare the sensitivity and specificity between them.Results(1)The cross-sectional area(CSA)of the median nerve(MN)at the tunnel inlet was significantly larger in patients than in controls(14.11±2.73)mm~2 vs(9.26±1.56)mm~2(P<0.01),while the mean velocity of horizontal shear wave was significantly larger(3.19±0.15)m/s vs(2.74±0.36)m/s(P<0.01).(2)The ROC curve was fitted for the different methods of HFUS and VTIQ.For the former,the area under the curve was 0.94(95%CI,0.89～0.98).The diagnostic threshold of CSA at the tunnel inlet was≥11.5 mm~2,which had a sensitivity of 82.2%and a specificity of91.3%.While the latter,the area under the curve was 0.84(95% CI,0.76～0.93).The diagnostic threshold of SWE_(mean) was≥3.13 m/s,which had a sensitivity of 75.6% and a specificity of 77.4%.Sensitivity was similar between VTIQ and HFUS(P=0.59),whereas specificity was significantly lower in VTIQ than in HFUS(P=0.03).(3)Sensitivity and specificity of the series test of HFUS and VTIQ have no significant changes with HFUS(P>0.05).Specificity of the parallel test of HFUS and VTIQ was significantly lowered(P<0.05)without significant change in sensitivity(P>0.05)with HFUS.Conclusions Although the sensitivity of VTIQ is similar to HFUS for the diagnosis of CTS,its diagnostic accuracy is lower than HFUS.the diagnostic value of VTIQ or VTIQ combined HFUS in the diagnosis of CTS was not Raised.
引文
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[10]傅强,崔立刚,李志强,等.腕管内正中神经变异的声像图表现及其临床意义[J].中华超声影像学杂志,2012,21(10):884-887.
[11]陈欣,田德润,王植,等.神经肌电图与MRI诊断早期腕管综合征的功用[J].中华手外科杂志,2016,32(1):12-15.
[12]CIVELEK E,CANSEVER T,SERDAR K,et a1.Comparison of histopathology of transverse carpal ligament in patients with idiopathic carpal tunnel syndrome and hemodialysis patients with carpal tunnel syndrome[J].Surg Sci,2011,2(1):8-12.
[13]吕秀花,段云友,张莉,等.剪切波弹性成像检测正中神经病变的初步研究[J].中华超声影像学杂志,2015,24(2):147-150.
[2]PARK J E,CHOI Y J,LEE S S,et al.Assessment of measurement repeatability and reliability with virtual touch tissue quantification imaging in cervical lymphadenopathy[J].Ultrasound Med,2016,35(5):927-932.
[3]杨舒萍,吕国荣,郑小云,等.不同弹性成像定量技术对乳腺肿瘤的诊断价值[J].中国超声医学杂志,2016,32(9):780-782.
[4]ORMAN G,OZBEN S,HUSEYINOGLU N,et a1.Ultrasound elastographic evaluation in the diagnosis of carpal tunnel syndrome:initial findings[J].Ultrasound Med Biol,2013,39(7):1184-1189.
[5]MIYAMOTO H,HALPERN E J,KASTLUNGER M,et a1.Carpal tunnel syndrome:diagnosis by means of median nerve elasticity-improved diagnostic accuracy of US with sonoelastography[J].Radiology,2014,270(2):481-486.
[6]KANTARCI F,USTABASIOGLU F E,DELIL S,el al.Median nerve stiffness measurement by shear wave elastography:a potential sonographic method in the diagnosis of carpal tunnel syndrome[J].Eur Radiol,2014,24(2):434-440.
[7]LI C,LüY P,ZHOU A Y.Value of high-frequency ultrasound in diagnosis of carpal tunnel syndrome[J].Journal of Nanchang University:Medical Sciences,2013,53(11):26-29.
[8]陈涛,郭稳,秦晓婷,等.腕管处正中神经超声成像研究[J].中国超声医学杂志,2014,30(2):162-166.
[9]CARA McD,MICHAEL A,DAVID K,et a1.The role of ultrasound in the diagnosis and management of carpal tunnel syndrome:a new paradigm[J].Rheumatology,2015,54(4):9-19.
[10]傅强,崔立刚,李志强,等.腕管内正中神经变异的声像图表现及其临床意义[J].中华超声影像学杂志,2012,21(10):884-887.
[11]陈欣,田德润,王植,等.神经肌电图与MRI诊断早期腕管综合征的功用[J].中华手外科杂志,2016,32(1):12-15.
[12]CIVELEK E,CANSEVER T,SERDAR K,et a1.Comparison of histopathology of transverse carpal ligament in patients with idiopathic carpal tunnel syndrome and hemodialysis patients with carpal tunnel syndrome[J].Surg Sci,2011,2(1):8-12.
[13]吕秀花,段云友,张莉,等.剪切波弹性成像检测正中神经病变的初步研究[J].中华超声影像学杂志,2015,24(2):147-150.
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