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Predictors of Carpal Tunnel Syndrome: Accuracy of Gray-Scale and Color Doppler Sonography

¹ Department of Radiology II, Innsbruck University Hospital, Anichstrasse 35, Innsbruck 6020, Austria.
² Department of Plastic Surgery, Innsbruck University Hospital, Innsbruck, Austria.
³ Department of Radiology I, Kurt Amplatz Center, Innsbruck University Hospital, Innsbruck, Austria.

OBJECTIVE. The purpose of this study was to retrospectively assess the accuracy of gray-scale and color Doppler sonography in the diagnosis of carpal tunnel syndrome.

MATERIALS AND METHODS. A total of 206 wrists in 151 patients with a clinical suspicion of carpal tunnel syndrome were examined with high-resolution sonography using a 7-15-MHz linear array transducer. The presence of median nerve swelling, edema, and flattening and increased bowing of the flexor retinaculum was evaluated with gray-scale sonography, and the presence of nerve hypervascularization was evaluated with color Doppler sonography. Sensitivity and specificity were calculated for each sonographic feature in comparison with nerve conduction studies as the standard of reference. Multivariate logistic regression analysis was used to determine variables predictive of carpal tunnel syndrome.

RESULTS. Carpal tunnel syndrome was confirmed in 172 wrists at nerve conduction studies. A median nerve cross-sectional area of at least 0.11 cm² was calculated as a definition of median nerve swelling. In comparison with nerve conduction studies, nerve swelling showed the highest accuracy (91%) among gray-scale sonography criteria, and the presence of intraneural hypervascularization showed the highest accuracy (95%) among all sonography criteria. Logistic regression analysis showed that nerve hypervascularization was the only variable that independently predicted median nerve entrapment (odds ratio, 16.4; 95% confidence interval, 8.7-31.1; p <0.001).

CONCLUSION. Color Doppler sonography is more accurate than gray-scale sonography for characterizing median nerve involvement in patients with suspected carpal tunnel syndrome.

Keywords: carpal tunnel syndrome • color Doppler sonography • gray-scale sonography • musculoskeletal imaging • nerve • nerve conduction studies • neuropathy • wrist

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