Ultrasound‐Based Multi‐Planar Bilateral Comparisons as a Diagnostic and Treatment‐Definition Method for Unilateral Peripheral Nerve Entrapment

• Published in: Journal of ultrasound in medicine 2024-10, Vol.43 (10), p.1883-1901
• Main Authors: Yu, Miao, Ding, Wenquan, Shao, Guoqing, Li, Miaozhong, Zhou, Xiaoling, Liu, Linhai, Li, Xueyuan
• Format: Article
• Language: English
• Subjects: Adult; Aged; carpal tunnel syndrome; cubital tunnel syndrome; Electrodiagnosis - methods; electrophysiology; entrapment neuropathy; Female; Humans; Male; Middle Aged; Nerve Compression Syndromes - diagnostic imaging; peripheral nerve; radial nerve compression; Reproducibility of Results; Sensitivity and Specificity; ultrasonography; Ultrasonography - methods
• ISSN: 0278-4297; 1550-9613; 1550-9613
• DOI: 10.1002/jum.16521

Objective The primary goal was to determine the performance of the cross‐section area swelling rate (CSASR) for diagnostic and therapeutic purposes based on the reference standard of electrodiagnosis examination (EDX) in this diagnostic test study. Methods First, patients with symptoms like unilateral carpal tunnel syndrome (CTS), cubital tunnel syndrome (CuTS), and radial nerve compression (RNC) underwent EDX and ultrasound examination. Second, patients with positive ultrasound were calculated for the CSASR of diseased nerve. Based on previously established CSASR criteria, each patient was categorized as having or not having peripheral nerve entrapment, and for those meeting diagnostic criteria, non‐surgical or surgical treatment was recommended. Then, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy rate (ACC) of ultrasound diagnosis and therapeutic decision‐making were calculated based on the reference standard of EDX that had been historically used in the practice. Results The total sensitivity, specificity, PPV, NPV, and ACC of ultrasound diagnosis are respectively 93.4, 85.2, 94.7, 82.1, and 91.3%. Which of therapeutic decision‐making by ultrasound are, respectively, 83.3, 52.2, 78.4, 60.0, and 73.2%. Conclusion The sensitivity and Youden's index of CSASR diagnostic threshold for CuTS is higher than other ultrasound methods. The CSASR diagnostic threshold for CuTS has a potential diagnostic role, but the current date is still not enough to support the potential diagnostic role for CTS or RNS. There is insufficient evidence to suggest that CSASR for CuTS can be used in isolation for diagnosis. Additional research is needed to confirm the diagnostic role of CSASR. The current results suggest that this ultrasound examination method is not suitable for therapeutic decision‐making.