Can Diffusion Tensor Imaging Apparent Diffusion Coefficient Diagnose Carpal Tunnel Syndrome? A Systematic Review and...

Area of Science:

• Neuroimaging
• Medical Physics
• Orthopedics

Background:

• Carpal tunnel syndrome (CTS) is a common peripheral neuropathy.
• Median nerve microstructural changes are key in CTS pathophysiology.
• Diffusion tensor imaging (DTI) offers sensitive detection of nerve microstructural alterations.

Approach:

• A systematic review and meta-analysis of 22 studies involving 592 CTS patients and 414 controls.
• Median nerve apparent diffusion coefficient (ADC) values were pooled and analyzed.
• ADC measurements were compared between CTS patients and healthy controls at specific anatomical wrist levels.

Key Points:

• Median nerve ADC was significantly decreased in CTS patients compared to controls at the pisiform and hamate levels.
• Specific ADC values were reported for CTS and control groups at the distal radioulnar joint, pisiform, and hamate.
• High heterogeneity (I² > 50%) was observed in most pooled analyses, suggesting variability in study methodologies.

Conclusions:

• Median nerve ADC is a reliable imaging biomarker for diagnosing CTS, particularly when measured at the pisiform and hamate.
• Establishing anatomical level-specific ADC cut-offs can improve CTS diagnostic accuracy.
• Future research incorporating wrist coils may further enhance ADC measurement precision for CTS diagnosis.