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Updated: Jan 1, 2026
Screening of Axonal Degeneration in Carpal Tunnel Syndrome Using Ultrasonography and Nerve Conduction Studies
Published on: January 11, 2019
Value of Grayscale and Power Doppler High-Resolution Ultrasound in Assessment of Patients with Clinically Suspected
Amr Mohamed Gamil1, Mennatallah Hatem Shalaby2, Khaled Ali Shehata2
1Department of Radiodiagnosis, Egyptian National Institute of Neuromotor System, Cairo, Egypt.
Objectives:
To determine the value of grayscale and power Doppler ultrasound (PDUS) in the evaluation of carpal tunnel syndrome (CTS) in clinically suspected patients.
Methods:
Eighty-seven wrists of 61 patients with clinically suspected CTS and 57 wrists of 30 healthy control participants were included in our study. Median nerve (MN) cross-sectional area (CSA) measurements were performed at the tunnel inlet level (wCSA) and proximal pronator quadratus muscle level (fCSA). Two parameters were calculated: CSA absolute difference (ΔCSA), which was the difference between the two measurements; and CSA ratio (RCSA), calculated by dividing wCSA over fCSA. The MN at the wrist level was evaluated for hypervascularity with PDUS.
Results:
The mean wCSA, R-CSA, and ΔCSA values were significantly higher in patients (17 mm2 , 2.45, and 9.9 mm2 , respectively) than in control participants (8 mm2 , 1.29, and 1.65 mm2 ; (P < .0001). At their corresponding cutoff values, the wCSA yielded higher sensitivity (95%) and lower specificity (88%) compared to the RCSA and ΔCSA (89% and 93% sensitivity and 93% and 89% specificity). Power Doppler US was the most specific US parameter (100%) but the least sensitive (76%). A multivariate logistic regression model including the wCSA, RCSA, and PDUS yielded 97% diagnostic accuracy at their optimal cutoffs, which increased to 99% after eliminating age and body mass index confounding effects.
Conclusions:
The combination of MN swelling measurements and PDUS increases the diagnostic accuracy of US in patients with clinically suspected CTS.
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