声触诊组织成像定量技术诊断腕管综合征正中神经卡压的价值

Value of virtual touch tissue imaging quantification to the diagnosis of median nerve stiffness of carpal tunnel syndrome

目的探讨声触诊组织成像定量技术(virtual touch tissue imaging quantification,VTIQ)在腕管综合征(carpal tunnel syndrome,CTS)正中神经卡压诊断中的价值。方法CTS患者49例(72腕)为CTS组,健康志愿者23例(46腕)为对照组,均行二维超声检查测量腕管入口处正中神经横截面积(cross-sectional area,CSA),并应用VTIQ技术测量正中神经的剪切波速度(shear wave velocity,SWV);绘制ROC曲线计算正中神经CSA及SWV诊断CTS的效能。结果 CTS组正中神经CSA[(0.131±0.041)cm2]较对照组[(0.073±0.019)cm2]大,SWV[(3.857±1.029)m/s]较对照组[(2.542±0.368)m/s]快(P<0.05);正中神经CSA诊断CTS最佳截断值为0.095cm2,AUC为0.894(95%CI:0.839~0.949,P=0.001),灵敏度、特异度和准确度分别为76.4%、89.1%和81.4%;正中神经SWV诊断CTS最佳截断值为3.020m/s,AUC为0.930(95%CI:0.886~0.975,P=0.001),灵敏度、特异度和准确率分别为83.3%、91.3%和86.4%。结论应用VTIQ技术检测腕管入口处正中神经SWV值和应用二维超声测量腕管入口处正中神经CSA,在CTS诊断中均具有较好的应用价值。

Objective To explore the value of virtual touch tissue imaging quantification(VTIQ)to the diagnosis of median nerve stiffness of carpal tunnel syndrome(CTS).Methods Forty-nine patients(72 wrists)with CTS(CTS group)and 23 healthy volunteers(46 wrists)(control group)received two-dimensional ultrasound to measure the cross-sectional area(CSA),and VTIQ was adopted to measure the shear wave velocity(SWV)of the median nerve at the entrance of the carpal tunnel.ROC was drawn to calculate the efficiency of median nerve CSA and SWV on CTS.Results The CSA was significantly larger and SWV was significantly quicker in CTS group((0.131±0.041)cm2,(3.857±1.029)m/s)than those in control group((0.073±0.019)cm2,(2.542±0.368)m/s)(P<0.05).When the optimal cut-off value was 0.095cm2,the AUC of CSA for CTS was 0.894(95%CI:0.839-0.949,P=0.001),and the sensitivity,specificity and accuracy were 76.4%,89.1% and 81.4%,respectively.When the optimal cut-off value was3.020m/s,the AUCof SWV for diagnosing CTS was 0.930(95%CI:0.886-0.975,P=0.001),and the sensitivity,specificity and accuracy were 83.3%,91.3% and 86.4%,respectively.Conclusion VTIQ technique can be used to detect the SWV and two-dimensional ultrasound can be used to measure CSA of the median nerve at the entrance of the carpal tunnel,both of which have good application values in the diagnosis of CTS.