声触诊组织成像诊断腕管综合征正中神经病变的价值

Value of virtual touch tissue image quantification in the diagnosis of median neuropathy of carpal tunnel syndrome

目的探讨声触诊组织成像量化(VTIQ)技术诊断腕管综合征(CTS)正中神经病变的临床应用价值。方法选取我院40例CTS患者(67只腕关节,CTS组)和20例健康志愿者(40只腕关节,对照组),均行二维超声和VTIQ检查,比较两组剪切波速度(SWV)和正中神经横截面积(CSA)的差异。应用MRI测量钩骨钩水平正中神经扁平率(MNFR),分析SWV及CSA与MNFR的相关性;绘制受试者工作特征(ROC)曲线分析SWV、CSA及其联合应用对CTS的诊断效能,计算曲线下面积(AUC)。结果CTS组SWV为(4.20±0.69)m/s,高于对照组(3.04±0.44)m/s,差异有统计学意义(t=-10.587,P<0.01);CTS组正中神经CSA为(0.125±0.036)cm2,高于对照组(0.084±0.016)cm2,差异有统计学意义(t=-8.310,P<0.01)。随机选取20例CTS患者(29只腕关节)测得MNFR为3.17±0.95;相关性分析显示,CTS患者正中神经SWV和CSA与MNFR均呈正相关(r=0.538、0.508,P=0.010、0.016)。ROC曲线分析结果显示,SWV和CSA联合应用诊断CTS的AUC为0.948(95%可信区间0.909~0.987),高于两指标单独应用的AUC(均P<0.01);联合应用的诊断敏感性、特异性和准确率分别为98.0%、70.0%、87.0%。结论VTIQ技术诊断CTS患者正中神经病变有较好的应用价值,可为临床治疗CTS提供参考依据。

Objective To explore the clinical application value of virtual touch tissue image quantification(VTIQ)in the diagnosis of median neuropathy of carpal tunnel syndrome(CTS).Methods A total of 40 CTS patients(67 wrists,CTS group)and 20 healthy volunteers(40 wrists,control group)were examined by two-dimensional ultrasound and VTIQ.The differences of shear wave velocity(SWV)and median nerve cross-sectional area(CSA)between the two groups were analyzed.MRI was used to measure the median nerve flattening rate(MNFR),and the correlation between SWV,CSA and MNFR were analyzed.The ROC curves were drawn to evaluate the diagnostic efficacy of SWV,CSA and the combined application in the diagnosis of CTS,and the area under the curve(AUC)was calculated.Results SWV of CTS group was(4.20±0.69)m/s,which was higher than that of control group(3.04±0.44)m/s,the difference was statistically significant(t=-10.587,P<0.01).The median nerve CSA of CTS group was(0.125±0.036)cm2,which was higher than that of the control group(0.084±0.016)cm2,the difference was statistically significant(t=-8.310,P<0.01).The MNFR of 20 patients(29 wrists)with CTS was 3.17±0.95.Correlation analysis showed that median nerve SWV and CSA were positively correlated with MNFR in CTS patients(r=0.538,0.508,P=0.010,0.016).ROC curve analysis showed that the AUC of SWV combined with CSA in the diagnosis of CTS was 0.948(95%CI 0.909~0.987),which was higher than that of SWV or CSA alone(both P<0.01).The sensitivity,specificity and accuracy of combined application were 98.0%,70.0%and 87.0%,respectively.Conclusion VTIQ technique has a high efficiency in the diagnosis of median neuropathy in patients with CTS,and it can provide reference for clinical treatment of CTS.