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目的探讨超微血管成像(SMI)技术诊断腕管综合征(CTS)可行性。方法选择10例(18腕)经电生理检查诊断为CTS患者(CTS组),其中男性2例(4腕),女性8例(14腕);年龄39~70岁,平均年龄58.22岁。21例健康志愿者(对照组),其中男性2例(4腕),女性19例(38腕);年龄41~76岁,平均年龄54.43岁。行超声检查,在豌豆骨与舟状骨水平测量正中神经横截面积(CSA),采用SMI技术对正中神经内血流半定量评分并测量峰值血流速度,将CTS组与对照组进行对比研究,利用受试者工作特征曲线(ROC)确定不同方法的诊断阈值,比较不同方法的诊断价值。结果 CTS组正中神经CSA、血流半定量评分和峰值血流速度均高于对照组[(0.13±0.03)cm~2 vs(0.10±0.02)cm~2,(3.17±0.71)vs(1.50±0.55),(5.71±4.86)cm/s vs(2.74±0.44)cm/s],两组比较,差异具有统计学意义(P<0.05)。CSA的诊断阈值为≥0.12 cm~2,灵敏度为67%,特异度为83%,曲线下面积为0.84(P=0.000)。血流半定量评分的诊断阈值为≥3,灵敏度为83%,特异度为98%,曲线下面积为0.95(P=0.000)。峰值血流速度的诊断阈值为3.2 cm/s,灵敏度为83%,特异度为83%,曲线下面积为0.88(P=0.000)。应用SMI对正中神经内血流进行半定量评分及测量峰值血流速度诊断CTS均优于测量CSA。结论SMI技术评价正中神经内部血流信号有助于诊断CTS。
Objective To investigate the feasibility of diagnosing carpal tunnel syndrome (CTS) with microvascular imaging (SMI). Methods CTA patients (CTS group) were diagnosed by electrophysiological examination in 10 patients (18 wrists). There were 2 males (4 wrists) and 8 females (14 wrists) aged 39-70 years with a mean age of 58.22 years. Twenty-one healthy volunteers (control group), including 2 males (4 wrists) and 19 females (38 wrists), were 41 to 76 years old with a mean age of 54.43 years. Serial ultrasound examinations were performed to measure median nerve cross-sectional area (CSA) at pea bone and scaphoid level. Semi-quantitative scoring of median intraneuronal blood flow and peak blood flow velocity were performed using SMI technique. CTS and control groups were compared , Using the receiver operating characteristic curve (ROC) to determine the diagnostic threshold of different methods to compare the diagnostic value of different methods. Results The median nerve CSA, semiquantitative score of blood flow and peak blood flow velocity in the CTS group were significantly higher than those in the control group [(0.13 ± 0.03) cm 2 vs (0.10 ± 0.02 cm 2 vs 3.17 ± 0.71 vs 1.50 ± 0.55), (5.71 ± 4.86) cm / s vs (2.74 ± 0.44) cm / s, respectively. There was significant difference between the two groups (P <0.05). The diagnostic threshold for CSA was ≥0.12 cm 2, with a sensitivity of 67%, a specificity of 83%, and an area under the curve of 0.84 (P = 0.000). The semi-quantitative score for blood flow had a diagnostic threshold of ≥3, a sensitivity of 83%, a specificity of 98%, and an area under the curve of 0.95 (P = 0.000). The threshold for peak blood flow was 3.2 cm / s with a sensitivity of 83%, a specificity of 83%, and an area under the curve of 0.88 (P = 0.000). The use of SMI for semi-quantitative scoring of median intraneuronal blood flow and measurement of peak blood flow velocity were superior to CTS in the diagnosis of CTS. Conclusion SMI technique can be used to evaluate CTS by evaluating the signal of internal blood flow in the median nerve.