Optimal Measurement Level and Ulnar Nerve Cross-Sectional Area Cutoff Threshold for Identifying Ulnar Neuropathy at the Elbow by MRI and Ultrasonography

2018 ◽  
Vol 43 (6) ◽  
pp. 529-536 ◽  
Author(s):  
Yasushi Terayama ◽  
Shigeharu Uchiyama ◽  
Kazuhiko Ueda ◽  
Nahoko Iwakura ◽  
Shota Ikegami ◽  
...  
2021 ◽  
pp. 20210290
Author(s):  
Ankita Aggarwal ◽  
Chandan Jyoti Das ◽  
Neena Khanna ◽  
Raju Sharma ◽  
Deep Narayan Srivastava ◽  
...  

Objective: Early detection of peripheral neuropathy is extremely important as leprosy is one of the treatable causes of peripheral neuropathy. The study was undertaken to assess the role of diffusion tensor imaging (DTI) in ulnar neuropathy in leprosy patients. Methods: This was a case–control study including 38 patients (72 nerves) and 5 controls (10 nerves) done between January 2017 and June 2019. Skin biopsy proven cases of leprosy, having symptoms of ulnar neuropathy (proven on nerve conduction study) were included. MRI was performed on a 3 T MR system. Mean cross-sectional area, fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values of ulnar nerve at cubital tunnel were calculated. Additional ancillary findings and appearance of base sequences were evaluated. Results: Ulnar nerve showed thickening with altered T2W signal in all the affected nerves, having an average cross-sectional area of 0.26 cm2. Low FA with mean of 0.397 ± 0.19 and high ADC with mean of 1.28 ± 0.427 x 10 −3 mm2/s of ulnar nerve in retrocondylar groove was obtained. In the control group, mean cross-sectional area was 0.71cm2 with mean FA and ADC of 0.53 ± 0.088 and 1.03 ± 0.24 x 10 −3 mm2/s respectively. Statistically no significant difference was seen in diseased and control group. Cut-off to detect neuropathy for FA and ADC is 0.4835 and 1.1020 × 10 −3 mm2/s respectively. Conclusion: DTI though is challenging in peripheral nerves, however, is proving to be a powerful complementary tool for assessment of peripheral neuropathy. Our study validates its utility in infective neuropathies. Advances in knowledge: 1. DTI is a potential complementary tool for detection of peripheral neuropathies and can be incorporated in standard MR neurography protocol. 2. In leprosy-related ulnar neuropathy, altered signal intensity with thickening or abscess of the nerve is appreciated along with locoregional nodes and secondary denervation changes along with reduction of FA and rise in ADC value. 3. Best cut-offs obtained in our study for FA and ADC are 0.4835 and 1.1020 × 10 −3 mm2/s respectively.


2016 ◽  
Vol 41 (8) ◽  
pp. 838-842 ◽  
Author(s):  
S. Duetzmann ◽  
K. G. Krishnan ◽  
F. Staub ◽  
J.-S. Kang ◽  
V. Seifert ◽  
...  

A total of 48 patients undergoing surgical decompression of the ulnar nerve at the cubital tunnel between February 2010 and May 2013 were retrospectively studied to determine changes in the cross-sectional area of the nerve by the technique of neurosonography. The mean follow-up was 46 months. Post-operative follow-up examination of the cross-sectional area of the ulnar nerve showed a slight reduction in the mean value from 13.8 mm2 (pre-operative) to 12.9 mm2 (post-operative). Of the 48 patients, 36 showed a reduction in the cross-sectional area. No correlation was detected between the clinical and sonographic outcomes. Ultrasound seems to be of limited value in the post-operative assessment of patients with entrapment neuropathy of the ulnar nerve. Level of Evidence: IV


2010 ◽  
Vol 43 (2) ◽  
pp. 298-299 ◽  
Author(s):  
Luca Padua ◽  
Ivan Marjanovic ◽  
Antonella Di Pasquale ◽  
Giovanna Liotta ◽  
Pietro A. Tonali

2009 ◽  
Vol 41 (5) ◽  
pp. 661-666 ◽  
Author(s):  
Ayse Oytun Bayrak ◽  
Ilkay Koray Bayrak ◽  
Hande Turker ◽  
Muzaffer Elmali ◽  
Mehmet Selim Nural

2015 ◽  
Vol 19 (1) ◽  
Author(s):  
Tania Roodt ◽  
Barbara Van Dyk ◽  
Sylvia Jacobs

Background: Magnetic resonance imaging is most commonly employed, alongside electrodiagnostic studies, in the diagnosis of ulnar nerve entrapment. It is expensive, time consuming, not readily available to the general public, and limits imaging to a segment of the nerve at any given time. In contrast, high-frequency ultrasound is an inexpensive imaging modality with a flexible field of view through which the nerve can be traced. An ultrasound cross-sectional area (CSA) >0.075 cm² has previously been suggested as indicative of nerve entrapment. Objectives: To confirm the suggested CSA measurement of 0.075 cm² and discuss the difference in CSA measurement between abnormal nerves, nerves in the contra-lateral elbow of the same participant, and those of asymptomatic participants. Methods: Ultrasonography was performed on both elbows of 25 patients with confirmed unilateral ulnar nerve entrapment and on 25 healthy controls for comparison. Three CSA measurements were taken of the ulnar nerve along its course, and the mean measurement was recorded.Results: CSA measurements were significantly different between patients with ulnar nerve entrapment and healthy controls (p < 0.05). In our study, a CSA >0.070 cm² defined ulnar nerve entrapment at the elbow. Conclusion: Ultrasound CSA measurement of the ulnar nerve is accurate in the diagnosis of ulnar nerve entrapment. The range of values and varied criteria previously reported call for standardisation of the procedure and CSA measurement. We suggest that a measurement of 0.070 cm² be considered as a new baseline for the optimal diagnosis of ulnar nerve entrapment.[PDF to follow]


2018 ◽  
Vol 129 (4) ◽  
pp. e2
Author(s):  
Jun Tsugawa ◽  
Yu-ichi Noto ◽  
Thanuja Dharmadasa ◽  
Nidhi Garg ◽  
Matthew C. Kiernan

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