Relationship between sonographically measured median nerve cross-sectional area and presence of peripheral neuropathy in diabetic subjects

Background: Carpal tunnel syndrome is the most prevalent peripheral nerve entrapment condition of the upper limb. Among metabolic risk factors, diabetes is considered the most relevant. Although wrist ultrasound assessment of the median nerve has demonstrated a good correlation with the gold standard for the diagnosis of this syndrome, neurophysiological study, its usefulness in patients with diabetes is questionable because the compressive phenomenon is not the predominant one. Method: We conducted a retrospective study to compare the clinical and median nerve ultrasound features of patients with carpal tunnel syndrome previously diagnosed or not diagnosed with diabetes. Additionally, a linear multivariate regression analysis was performed to determine to what extent the cross-sectional area of the median nerve was dependent on the condition of diabetes by fixing other variables such as sex, age, or time of evolution. Results: We included 303 records of patients (mean age 44.3 ± 11.7 years old, 57.89% female, mean of time of evolution 13.6 ± 8.3 months) from 2012 to 2020. The cross-sectional area of the median nerve was 10.46 ± 1.44 mm2 in non-diabetic patients and 8.92 ± 0.9 mm2 in diabetic patients (p < 0.001). Additionally, diabetic patients had a shorter time of evolution (7.91 ± 8.28 months vs. 14.36 ± 0.526 months, p < 0.001). In the multivariate analysis, the resultant model (fixed R-square = 0.659, p = 0.003) included a constant of the following four variables: the evolution time (Beta coeff. = 0.108, p < 0.001 95% CI 0.091 to 0.126, standardized coeff. = 0.611), the condition of diabetes (Beta coeff. = −0.623, p < 0.001 95% CI −0.907 to −0.339, standardized coeff. = −0.152), the severity (Beta coeff. = 0.359, p = 0.001 95% CI 0.147 to 0.571, standardized coeff. = 0.169), and the masculine sex (Beta coeff. = 0.309, p = 0.003, 95% CI 0.109 to 0.509, standardized coeff. = 0.103). Conclusions: Ultrasound assessment of the median nerve in patients with diabetes is not a useful tool to confirm whether carpal tunnel syndrome should be diagnosed or not diagnosed.

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Bifid Median Nerve in Carpal Tunnel Syndrome: Assessment with US Cross-sectional Area Measurement

Radiology ◽

10.1148/radiol.11101644 ◽

2011 ◽

Vol 259 (3) ◽

pp. 808-815 ◽

Cited By ~ 40

Author(s):

Andrea S. Klauser ◽

Ethan J. Halpern ◽

Ralph Faschingbauer ◽

Florian Guerra ◽

Carlo Martinoli ◽

...

Keyword(s):

Carpal Tunnel Syndrome ◽

Median Nerve ◽

Carpal Tunnel ◽

Cross Sectional Area ◽

Area Measurement ◽

Sectional Area ◽

Cross Sectional ◽

Tunnel Syndrome

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Role of diffusion tensor imaging in the evaluation of ulnar nerve involvement in leprosy

British Journal of Radiology ◽

10.1259/bjr.20210290 ◽

2021 ◽

pp. 20210290

Author(s):

Ankita Aggarwal ◽

Chandan Jyoti Das ◽

Neena Khanna ◽

Raju Sharma ◽

Deep Narayan Srivastava ◽

...

Keyword(s):

Diffusion Tensor Imaging ◽

Peripheral Neuropathy ◽

Ulnar Nerve ◽

Diffusion Tensor ◽

Cross Sectional Area ◽

Ulnar Neuropathy ◽

Control Group ◽

Sectional Area ◽

Cross Sectional

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.

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Value of cross-sectional area of median nerve by MRI in carpal tunnel syndrome

Asian Journal of Surgery ◽

10.1016/j.asjsur.2019.08.001 ◽

2020 ◽

Vol 43 (6) ◽

pp. 654-659

Author(s):

Jin Sung Park ◽

Hee-Chan Won ◽

Jin-Young Oh ◽

Dong-Hee Kim ◽

Sun-Chul Hwang ◽

...

Keyword(s):

Carpal Tunnel Syndrome ◽

Median Nerve ◽

Carpal Tunnel ◽

Cross Sectional Area ◽

Sectional Area ◽

Cross Sectional ◽

Tunnel Syndrome

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Electrodiagnostic Studies and Ultrasound Cross-Sectional Area of the Median Nerve in Patients With Isolated Cervical Radiculopathy

Journal of Hand Surgery Global Online ◽

10.1016/j.jhsg.2020.03.007 ◽

2020 ◽

Vol 2 (3) ◽

pp. 126-128

Author(s):

Cory Demino ◽

Gloria Sanin ◽

Jennifer D’Auria ◽

John R. Fowler

Keyword(s):

Median Nerve ◽

Cervical Radiculopathy ◽

Cross Sectional Area ◽

Sectional Area ◽

Cross Sectional

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Sonographic Measurement of Cross-sectional Area of the Median Nerve in Academic Dentists Without Symptoms or Signs of Carpal Tunnel Syndrome

Journal of Diagnostic Medical Sonography ◽

10.1177/8756479318816951 ◽

2018 ◽

Vol 35 (2) ◽

pp. 105-111

Author(s):

Akram Asbeutah ◽

Mohsen Dashti ◽

Abdullah AlMajran ◽

Aref Ghayyath

Keyword(s):

Median Nerve ◽

Statistical Significance ◽

Working Hours ◽

Cross Sectional Area ◽

Dominant Hand ◽

Sectional Area ◽

Cross Sectional ◽

Increased Risk ◽

Bone Level ◽

The Right

The objective was to evaluate the distribution of the cross-sectional area (CSA) and flattening ratio (FR) of the median nerve (MN) in asymptomatic academic dentists using ultrasonography (US). Fifty academic dentists underwent US of the MN in transverse section at the pisiform bone level and the CSA (mm2) and FR were measured bilaterally. A CSA of <10 mm2 was considered normal. Paired t-test showed no statistical significance between either hand for CSA and FR ( P> .05). Two independent t-tests showed significant statistical differences ( P= .023) between males and females in the right dominant hand for CSA. Linear correlation analysis showed no significant correlation between CSA and FR for number of years of experience or number of working hours per day in either hand ( P>.05). The CSA was abnormal in the right dominant hand in 20 (40%) of the subjects. These male academic dentists were at increased risk of having an enlarged MN without symptoms.

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