实时剪切波弹性成像诊断腕管综合征的价值分析

Application value of real-time shear wave elastography in diagnosis of carpal tunnel syndrome

目的探讨实时剪切波弹性成像(SWE)在腕管综合征(CTS)诊断中的应用价值。方法选取90例CTS患者(CTS组)和20例健康体检者(对照组),先应用二维超声观察其正中神经结构、形态、回声、与周围组织的关系,记录腕部豌豆骨水平及腕横纹以上5 cm处正中神经的直径(DW、DF)和横截面积(CSAW、CSAF),再应用SWE测量腕部豌豆骨水平及腕横纹以上5 cm处正中神经的弹性模量均值(WEmean、FEmean)及同一感兴趣区正中神经与指浅屈肌的弹性模量均值比(FRatio);绘制ROC曲线分析DW、CSAW 、WEmean诊断CTS的效能。结果CTS组DW、CSAW、WEmean与对照组比较,差异均有统计学意义(均P<0.05),DF、CSAF、FEmean及FRatio与对照组比较,差异均无统计学意义。DW、CSAW、WEmean诊断CTS的ROC 曲线下面积分别为0.718、0.654、0.942,WEmean 较CSAW 和DW 诊断效能更高,差异均有统计学意义(均P<0.05)。结论SWE可以准确反映正中神经硬度,为临床诊断CTS提供一种无创、简便的方法,具有较好的应用价值。

Objective To explore the application value of real-time shear wave elastorgraphy(SWE)in the diagnosis of carpal tunnel syndrome(CTS). Methods Ninety patients with CTS(CTS group)and twenty healthy volunteers(control group)were enrolled.The median nerve structure,morphology,echo and its relationship with surrounding tissues were observed by two-dimensional ultrasonography. The median nerve diameter(DW,DF) and cross-sectional area(CSAW,CSAF) were recorded at the level of carpal pea bone and 5 cm above wrist stria,respectively. The mean elastic modulus(WEmean,FEmean)of the median nerve and the mean elastic modulus ratio (FRatio) of median nerve to flexor digitorum superficialis in the same region were measured by SWE. The effectiveness of DW,CSAW and WEmean in diagnosing CTS were analyzed by ROC curve. Results There were significant differences in DW,CSAW,WEmean between CTS group and control group(all P<0.05). There were no significant differences in DF,CSAF,FEmean and FRatio between CTS group and control group. The areas under the ROC curve of CSAW,DW,and WEmean was 0.718,0.654,and 0.942,respectively. The diagnostic efficiency of WEmean was higher than that of CSAW and DW,and the difference were statistically significant(both P<0.05). Conclusion SWE can reflects the hardness of the median nerve,which provide a non-invasive and simple diagnostic method for CTS diagnosis.