A Novel Ultrasonographic Anthropometric-Independent Measurement of Median Nerve Swelling in Carpal Tunnel Syndrome: The "Nerve/Tendon Ratio" (NTR)
Background: There is little consensus on ultrasound (US) normative values of cross-sectional area of median nerve (MN-CSA) in carpal tunnel syndrome (CTS) because of its dependency on anthropometric parameters. We aim to propose a novel anthropometric-independent US parameter: MN-CSA/flexor radialis...
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Online Access: | https://hdl.handle.net/11365/1220894 https://doi.org/10.3390/diagnostics12112621 |
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ftunivsiena:oai:usiena-air.unisi.it:11365/1220894 2024-04-14T08:10:56+00:00 A Novel Ultrasonographic Anthropometric-Independent Measurement of Median Nerve Swelling in Carpal Tunnel Syndrome: The "Nerve/Tendon Ratio" (NTR) Paolo Falsetti Edoardo Conticini Caterina Baldi Emilio D'Ignazio Suhel Gabriele Al Khayyat Marco Bardelli Stefano Gentileschi Roberto D'Alessandro Miriana D'Alessandro Caterina Acciai Federica Ginanneschi Luca Cantarini Bruno Frediani Falsetti, Paolo Conticini, Edoardo Baldi, Caterina D'Ignazio, Emilio AL KHAYYAT, SUHEL GABRIELE Bardelli, Marco Gentileschi, Stefano D'Alessandro, Roberto D'Alessandro, Miriana Acciai, Caterina Ginanneschi, Federica Cantarini, Luca Frediani, Bruno 2022 ELETTRONICO https://hdl.handle.net/11365/1220894 https://doi.org/10.3390/diagnostics12112621 eng eng info:eu-repo/semantics/altIdentifier/pmid/36359465 info:eu-repo/semantics/altIdentifier/wos/WOS:000880962100001 volume:12 issue:11 numberofpages:11 journal:DIAGNOSTICS https://hdl.handle.net/11365/1220894 doi:10.3390/diagnostics12112621 info:eu-repo/semantics/altIdentifier/scopus/2-s2.0-85141732449 carpal tunnel syndrome electrodiagnostic median nerve neuropathy ultrasound info:eu-repo/semantics/article 2022 ftunivsiena https://doi.org/10.3390/diagnostics12112621 2024-03-21T15:51:40Z Background: There is little consensus on ultrasound (US) normative values of cross-sectional area of median nerve (MN-CSA) in carpal tunnel syndrome (CTS) because of its dependency on anthropometric parameters. We aim to propose a novel anthropometric-independent US parameter: MN-CSA/flexor radialis carpi CSA (FCR-CSA) ratio ("Nerve Tendon Ratio", NTR), in the diagnosis of clinically and electrodiagnostic (EDS)-defined CTS. Methods: 74 wrists of 49 patients with clinically defined CTS underwent EDS (scored by the 1-5 Padua Scale of electrophysiological severity, PS) and US of carpal tunnel with measurement of MN-CSA (at the carpal tunnel inlet), FCR-CSA (over scaphoid tubercle) and its ratio (NTR, expressed as a percentage). US normality values and intra-operator agreement were assessed in 33 healthy volunteers. Results: In controls, the mean MN-CSA was 5.81 mm2, NTR 64.2%. In 74 clinical CTS, the mean MN-CSA was 12.1 mm2, NTR 117%. In severe CTS (PS > 3), the mean MN-CSA was 15.9 mm2, NTR 148%. In CTS, both MN-CSA and NTR correlated with sensitive conduction velocity (SCV) (p < 0.001), distal motor latency (DML) (p < 0.001) and PS (p < 0.001), with a slight superiority of NTR vs. MN-CSA when controlled for height, wrist circumference and weight. In CTS filtered for anthropometric extremes, only NTR maintained a correlation with SCV (p = 0.023), DML (p = 0.016) and PS (p = 0.009). Diagnostic cut-offs were obtained with a binomial regression analysis. In those patients with a clinical diagnosis of CTS, the cut-off of MN-CSA (AUROC: 0.983) was 8 mm2 (9 mm2 with highest positive predictive value, PPV), while for NTR (AUROC: 0.987), the cut-off was 83% (100% with highest PPV). In patients with EDS findings of severe CTS (PS > 3), the MN-CSA (AUROC: 0.876) cut-off was 12.3 mm2 (15.3 mm2 with highest PPV), while for NTR (AUROC: 0.858) it was 116.2% (146.0% with highest PPV). Conclusions: NTR can be simply and quickly calculated, and it can be used in anthropometric extremes. Article in Journal/Newspaper DML Università degli Studi di Siena: USiena air Diagnostics 12 11 2621 |
institution |
Open Polar |
collection |
Università degli Studi di Siena: USiena air |
op_collection_id |
ftunivsiena |
language |
English |
topic |
carpal tunnel syndrome electrodiagnostic median nerve neuropathy ultrasound |
spellingShingle |
carpal tunnel syndrome electrodiagnostic median nerve neuropathy ultrasound Paolo Falsetti Edoardo Conticini Caterina Baldi Emilio D'Ignazio Suhel Gabriele Al Khayyat Marco Bardelli Stefano Gentileschi Roberto D'Alessandro Miriana D'Alessandro Caterina Acciai Federica Ginanneschi Luca Cantarini Bruno Frediani A Novel Ultrasonographic Anthropometric-Independent Measurement of Median Nerve Swelling in Carpal Tunnel Syndrome: The "Nerve/Tendon Ratio" (NTR) |
topic_facet |
carpal tunnel syndrome electrodiagnostic median nerve neuropathy ultrasound |
description |
Background: There is little consensus on ultrasound (US) normative values of cross-sectional area of median nerve (MN-CSA) in carpal tunnel syndrome (CTS) because of its dependency on anthropometric parameters. We aim to propose a novel anthropometric-independent US parameter: MN-CSA/flexor radialis carpi CSA (FCR-CSA) ratio ("Nerve Tendon Ratio", NTR), in the diagnosis of clinically and electrodiagnostic (EDS)-defined CTS. Methods: 74 wrists of 49 patients with clinically defined CTS underwent EDS (scored by the 1-5 Padua Scale of electrophysiological severity, PS) and US of carpal tunnel with measurement of MN-CSA (at the carpal tunnel inlet), FCR-CSA (over scaphoid tubercle) and its ratio (NTR, expressed as a percentage). US normality values and intra-operator agreement were assessed in 33 healthy volunteers. Results: In controls, the mean MN-CSA was 5.81 mm2, NTR 64.2%. In 74 clinical CTS, the mean MN-CSA was 12.1 mm2, NTR 117%. In severe CTS (PS > 3), the mean MN-CSA was 15.9 mm2, NTR 148%. In CTS, both MN-CSA and NTR correlated with sensitive conduction velocity (SCV) (p < 0.001), distal motor latency (DML) (p < 0.001) and PS (p < 0.001), with a slight superiority of NTR vs. MN-CSA when controlled for height, wrist circumference and weight. In CTS filtered for anthropometric extremes, only NTR maintained a correlation with SCV (p = 0.023), DML (p = 0.016) and PS (p = 0.009). Diagnostic cut-offs were obtained with a binomial regression analysis. In those patients with a clinical diagnosis of CTS, the cut-off of MN-CSA (AUROC: 0.983) was 8 mm2 (9 mm2 with highest positive predictive value, PPV), while for NTR (AUROC: 0.987), the cut-off was 83% (100% with highest PPV). In patients with EDS findings of severe CTS (PS > 3), the MN-CSA (AUROC: 0.876) cut-off was 12.3 mm2 (15.3 mm2 with highest PPV), while for NTR (AUROC: 0.858) it was 116.2% (146.0% with highest PPV). Conclusions: NTR can be simply and quickly calculated, and it can be used in anthropometric extremes. |
author2 |
Falsetti, Paolo Conticini, Edoardo Baldi, Caterina D'Ignazio, Emilio AL KHAYYAT, SUHEL GABRIELE Bardelli, Marco Gentileschi, Stefano D'Alessandro, Roberto D'Alessandro, Miriana Acciai, Caterina Ginanneschi, Federica Cantarini, Luca Frediani, Bruno |
format |
Article in Journal/Newspaper |
author |
Paolo Falsetti Edoardo Conticini Caterina Baldi Emilio D'Ignazio Suhel Gabriele Al Khayyat Marco Bardelli Stefano Gentileschi Roberto D'Alessandro Miriana D'Alessandro Caterina Acciai Federica Ginanneschi Luca Cantarini Bruno Frediani |
author_facet |
Paolo Falsetti Edoardo Conticini Caterina Baldi Emilio D'Ignazio Suhel Gabriele Al Khayyat Marco Bardelli Stefano Gentileschi Roberto D'Alessandro Miriana D'Alessandro Caterina Acciai Federica Ginanneschi Luca Cantarini Bruno Frediani |
author_sort |
Paolo Falsetti |
title |
A Novel Ultrasonographic Anthropometric-Independent Measurement of Median Nerve Swelling in Carpal Tunnel Syndrome: The "Nerve/Tendon Ratio" (NTR) |
title_short |
A Novel Ultrasonographic Anthropometric-Independent Measurement of Median Nerve Swelling in Carpal Tunnel Syndrome: The "Nerve/Tendon Ratio" (NTR) |
title_full |
A Novel Ultrasonographic Anthropometric-Independent Measurement of Median Nerve Swelling in Carpal Tunnel Syndrome: The "Nerve/Tendon Ratio" (NTR) |
title_fullStr |
A Novel Ultrasonographic Anthropometric-Independent Measurement of Median Nerve Swelling in Carpal Tunnel Syndrome: The "Nerve/Tendon Ratio" (NTR) |
title_full_unstemmed |
A Novel Ultrasonographic Anthropometric-Independent Measurement of Median Nerve Swelling in Carpal Tunnel Syndrome: The "Nerve/Tendon Ratio" (NTR) |
title_sort |
novel ultrasonographic anthropometric-independent measurement of median nerve swelling in carpal tunnel syndrome: the "nerve/tendon ratio" (ntr) |
publishDate |
2022 |
url |
https://hdl.handle.net/11365/1220894 https://doi.org/10.3390/diagnostics12112621 |
genre |
DML |
genre_facet |
DML |
op_relation |
info:eu-repo/semantics/altIdentifier/pmid/36359465 info:eu-repo/semantics/altIdentifier/wos/WOS:000880962100001 volume:12 issue:11 numberofpages:11 journal:DIAGNOSTICS https://hdl.handle.net/11365/1220894 doi:10.3390/diagnostics12112621 info:eu-repo/semantics/altIdentifier/scopus/2-s2.0-85141732449 |
op_doi |
https://doi.org/10.3390/diagnostics12112621 |
container_title |
Diagnostics |
container_volume |
12 |
container_issue |
11 |
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2621 |
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1796308591843475456 |