实时剪切波弹性成像在不同程度腕管综合征中的应用
摘要
目的探讨实时剪切波弹性成像(SWE)在不同程度腕管综合征中的应用价值。方法选择腕管综合征患者84例,共100根正中神经,其中单侧病变68例,双侧病变16例。依据神经电生理检查提示正中神经损伤严重程度将100根正中神经分为轻度(n=42)、中度(n=34)和重度(n=24)3组。选择健康体检者(对照组)21例,共42根正中神经(n=42)。对各组均行正中神经的常规二维超声及SWE检查,分别检查正中神经的腕部豌豆骨水平横截面积(CSA_W)、弹性模量均值(W_(Emean))、腕横纹以上5cm处弹性模量均值(F_(Emean))及同一感兴趣区(ROI)内正中神经与指浅屈肌的弹性模量均值比(F_(Ratio)),比较轻度、中度、重度3组与对照组之间的差异,并绘制受试者工作特性(ROC)曲线。结果轻度组正中神经的W_(Emean)值及重度组的CSA_W值和中度、重度2组W_(Emean)、F_(Emean)、F_(Ratio)值均明显高于对照组(均P<0.05)。中度、重度2组正中神经的W_(Emean)、F_(Emean)值及中度组F_(Ratio)值和重度CSA_W值均明显高于轻度组(均P<0.05)。重度组正中神经的CSA_W值明显高于中度组(P<0.05)。CSA_WAUC与W_(Emean)、F_(Ratio)、F_(Emean)比较差异有统计学意义(P<0.05),CSA_W诊断效能与W_(Emean)、F_(Ratio)、F_(Emean)比较差异有统计学意义(P<0.05)。结论 SWE能够提供正中神经平均弹性模量值,定量正中神经的硬度,在不同程度腕管综合征的诊断中具有重要的价值。
引文
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[3] Kantarci F,Ustabasioglu F E,Delil S,et al.Median nerve stiffness measurement by shear wave elastography:a potential sonographic method in the diagnosis of carpal tunnel syndrome[J].European Radiology,2014,24(2):434-440.
[4] Cingoz M,Kandemirli S G,Alis D C,et al.Evaluation of median nerve by shear wave elastography and diffusion tensor imaging in carpal tunnel syndrome[J].Eur J Radiol,2018,101(4):59-64.
[5] Ng A W,Griffith J F,Lee R K,et al.Ultrasound carpal tunnel syndrome:additional criteria for diagnosis[J].Clin Radiol,2018,73(2):214.e11-214.e18.
[6] Ghasemi Rad M,Nosair E,Vegh A,et al.A handy review of carpal tunnel syndrome:From anatomy to diagnosis and treatment[J].World J Radiol,2014,6(6):284-300.
[7] Creze M,Nordez A,Soubeyrand M,et al.Shear wave sonoelastography of skeletal muscle:basic principles,biomechanical concepts,clinical applications,and future perspectives[J].Skeletal Radiol,2018,47(4):457-471.
[8] Ryu J,Jeong W K.Current status of musculoskeletal application of shear wave elastography[J].Ultrasonography,2017,36(3):185-197.
[9]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.
[10] Wang Y,Qiang B,Zhang X,et al.A non-invasive technique for estimating carpal tunnel pressure by measuring shear wave speed in tendon:a feasibility study[J].J Biomech,2012,45(16):2927-2930.