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Wolny T, Glibov K, Wieczorek M, Gnat R, Linek P. Changes in Ultrasound Parameters of the Median Nerve at Different Positions of the Radiocarpal Joint in Patients with Carpal Tunnel Syndrome. SENSORS (BASEL, SWITZERLAND) 2024; 24:4487. [PMID: 39065886 PMCID: PMC11281217 DOI: 10.3390/s24144487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Revised: 06/28/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024]
Abstract
Ultrasound imaging (US) is being increasingly used to aid in the diagnosis of entrapment neuropathies. This study aims to evaluate the shear modulus and cross-sectional area (CSA) of the median nerve in patients with carpal tunnel syndrome (CTS). A total of 35 patients with CTS participated in the study. CSA and shear modulus testing were performed in shear wave elastography (SWE) mode in five positions of the right and left radiocarpal joints (intermediate position 0°, 45° of extension, maximum extension, 45° of flexion, and maximum flexion). There were significant side-to-side differences in the median nerve shear modulus at each wrist position as compared to the asymptomatic side. There were significant side-to-side differences in the median nerve CSA at each wrist position as compared to the asymptomatic side. Shear modulus increases in patients with CTS at different angular positions of flexion and extension of the radiocarpal joint. In individuals with CTS, the CSA of the median nerve is greater on the symptomatic side compared to the asymptomatic side. The CSA decreases in positions of maximum extension and 45° of flexion and in maximum flexion relative to the resting position.
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Affiliation(s)
- Tomasz Wolny
- Musculoskeletal Elastography and Ultrasonography Laboratory, Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education, 40-065 Katowice, Poland; (R.G.); (P.L.)
| | - Katarzyna Glibov
- Department of Internal Diseases, Rehabilitation and Physical Medicine, Military Medical Academy, Memorial Teaching H of The Medical University of Lodz—Central Veterans Hospital, 90-419 Lodz, Poland;
| | - Michał Wieczorek
- Department of Neurological Rehabilitation, The Health Center in Mikołów Ltd., 43-190 Mikołów, Poland;
| | - Rafał Gnat
- Musculoskeletal Elastography and Ultrasonography Laboratory, Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education, 40-065 Katowice, Poland; (R.G.); (P.L.)
| | - Paweł Linek
- Musculoskeletal Elastography and Ultrasonography Laboratory, Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education, 40-065 Katowice, Poland; (R.G.); (P.L.)
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Luo YT, Huang YT, Chiu V, Chang YW, Horng YS. Diagnostic meta-analysis of the efficacy of ultrasonography for diagnosing carpal tunnel syndrome: A comparison between Asian and non-Asian populations. J Formos Med Assoc 2024:S0929-6646(24)00302-4. [PMID: 38965008 DOI: 10.1016/j.jfma.2024.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 04/13/2024] [Accepted: 06/30/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND Ultrasonography is used to diagnose carpal tunnel syndrome (CTS) according to various criteria. This diagnostic meta-analysis aimed to evaluate the efficacy of ultrasonography for diagnosing CTS, focusing on the cross-sectional area (CSA) of the median nerve (MN) at the inlet of the carpal tunnel and regional variations in diagnostic thresholds between Asian and non-Asian populations. METHODS A comprehensive literature search was conducted using PubMed, Embase, and the Cochrane Library. The risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2). Patient demographic data, diagnostic "gold standards", CSA cutoff values, and diagnostic results were extracted. Meta-analysis was performed to determine the sensitivity, specificity, and optimal CSA cutoff values. RESULTS For the 25 included studies, a combined sensitivity of 88% and specificity of 84% for CSA measurements at the carpal tunnel inlet were obtained. The Asian group had a sensitivity of 84% and specificity of 86%, while the non-Asian group had a sensitivity of 91% and specificity of 82%. The mean CSA in the Asian group was significantly lower than that in the non-Asian group (12.93 mm2 and 14.77 mm2, respectively; p = 0.042). For the Asian group, the summary receiver operating characteristic curve had an area under the curve (AUC) of 0.92 with an optimal cutoff of 10.5 mm2; for the non-Asian group, an AUC of 0.94 was obtained with a cutoff of 11.5 mm2. CONCLUSION Ultrasonography is a reliable diagnostic method for CTS, with distinct optimal cutoff values observed between Asian and non-Asian populations. Therefore, population-specific diagnostic criteria for CTS are recommended.
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Affiliation(s)
- Yan-Ting Luo
- Department of Physical Medicine and Rehabilitation, Taipei Tzuchi Hospital, Buddhist Tzuchi Medical Foundation, New Taipei City, Taiwan
| | - Yu-Ting Huang
- Department of Physical Medicine and Rehabilitation, Taipei Tzuchi Hospital, Buddhist Tzuchi Medical Foundation, New Taipei City, Taiwan
| | - Valeria Chiu
- Department of Physical Medicine and Rehabilitation, Taipei Tzuchi Hospital, Buddhist Tzuchi Medical Foundation, New Taipei City, Taiwan; Department of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Yi-Wei Chang
- Department of Physical Medicine and Rehabilitation, Taipei Tzuchi Hospital, Buddhist Tzuchi Medical Foundation, New Taipei City, Taiwan; Department of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Yi-Shiung Horng
- Department of Physical Medicine and Rehabilitation, Taipei Tzuchi Hospital, Buddhist Tzuchi Medical Foundation, New Taipei City, Taiwan; Department of Medicine, Tzu Chi University, Hualien, Taiwan.
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Martikkala L, Pemmari A, Himanen SL, Mäkelä K. Median Nerve Shear Wave Elastography Is Associated With the Neurophysiological Severity of Carpal Tunnel Syndrome. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:1253-1263. [PMID: 38516753 DOI: 10.1002/jum.16450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 03/08/2024] [Accepted: 03/08/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVES This study examines the associations between the median nerve (MN) shear wave elastography (SWE), the MN cross-sectional area (CSA), patient's symptoms, and the neurophysiological severity of carpal tunnel syndrome (CTS). The most appropriate site to perform SWE was also tested. METHODS This prospective study comprised 86 wrists of 47 consecutive patients who volunteered for MN ultrasound after an electrodiagnostic study. The neurophysiological severity of CTS was assessed according to the results of a nerve conduction study (NCS). The MN CSA was measured at the carpal tunnel inlet (wCSA) and the forearm (fCSA). SWE was performed on the MN in a longitudinal orientation at the wrist crease (wSWE), at the forearm (fSWE), and within the carpal tunnel (tSWE). RESULTS The wCSA and wSWE correlated positively with the neurophysiological severity of CTS (r = .619, P < .001; r = .582, P < .001, respectively). The optimal cut-off values to discriminate the groups with normal NCS and with findings indicating CTS were 10.5 mm2 for the wCSA and 4.12 m/s for the wSWE. With these cut-off values, wCSA had a sensitivity of 80% and specificity of 87% and wSWE a sensitivity of 88% and specificity of 76%. Neither tSWE nor fSWE correlated with the neurophysiological severity of CTS or differed between NCS negative and positive groups (P = .429, P = .736, respectively). CONCLUSION Shear wave velocity in the MN at the carpal tunnel inlet increases in CTS and correlates to the neurophysiological CTS severity equivalently to CSA measured at the same site.
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Affiliation(s)
- Lauri Martikkala
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Antti Pemmari
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Clinical Neurophysiology, Tampere University Hospital, Wellbeing Services County of Pirkanmaa, Tampere, Finland
| | - Sari-Leena Himanen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Clinical Neurophysiology, Tampere University Hospital, Wellbeing Services County of Pirkanmaa, Tampere, Finland
| | - Katri Mäkelä
- Department of Clinical Neurophysiology, Tampere University Hospital, Wellbeing Services County of Pirkanmaa, Tampere, Finland
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Hannaford A, Paling E, Silsby M, Vincenten S, van Alfen N, Simon NG. Electrodiagnostic studies and new diagnostic modalities for evaluation of peripheral nerve disorders. Muscle Nerve 2024; 69:653-669. [PMID: 38433118 DOI: 10.1002/mus.28068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 01/31/2024] [Accepted: 02/02/2024] [Indexed: 03/05/2024]
Abstract
Electrodiagnostic studies (EDx) are frequently performed in the diagnostic evaluation of peripheral nerve disorders. There is increasing interest in the use of newer, alternative diagnostic modalities, in particular imaging, either to complement or replace established EDx protocols. However, the evidence to support this approach has not been expansively reviewed. In this paper, diagnostic performance data from studies of EDx and other diagnostic modalities in common peripheral nerve disorders have been analyzed and described, with a focus on radiculopathy, plexopathy, compressive neuropathies, and the important neuropathy subtypes of Guillain-Barré syndrome, chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), vasculitic neuropathy and diabetic neuropathy. Overall EDx retains its place as a primary diagnostic modality in the evaluated peripheral nerve disorders. Magnetic resonance imaging and ultrasound have developed important complementary diagnostic roles in compressive and traumatic neuropathies and atypical CIDP, but their value is more limited in other neuropathy subtypes. Identification of hourglass constriction in nerves of patients with neuralgic amyotrophy may have therapeutic implications. Investigation of radiculopathy is confounded by poor correlation between clinical features and imaging findings and the lack of a diagnostic gold standard. There is a need to enhance the literature on the utility of these newer diagnostic modalities.
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Affiliation(s)
- Andrew Hannaford
- Department of Neurology, Concord Hospital, Sydney, New South Wales, Australia
- Brain and Nerve Research Centre, University of Sydney, Sydney, New South Wales, Australia
- Department of Neurology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Elijah Paling
- School of Medicine, University of Notre Dame, Sydney, New South Wales, Australia
| | - Matthew Silsby
- Department of Neurology, Concord Hospital, Sydney, New South Wales, Australia
- Brain and Nerve Research Centre, University of Sydney, Sydney, New South Wales, Australia
- Department of Neurology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Sanne Vincenten
- Department of Neurology and Clinical Neurophysiology, Radboud University Medical Center, Donders Center for Neuroscience, Nijmegen, the Netherlands
| | - Nens van Alfen
- Department of Neurology and Clinical Neurophysiology, Radboud University Medical Center, Donders Center for Neuroscience, Nijmegen, the Netherlands
| | - Neil G Simon
- Northern Beaches Clinical School, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
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Dahlin LB, Zimmerman M, Calcagni M, Hundepool CA, van Alfen N, Chung KC. Carpal tunnel syndrome. Nat Rev Dis Primers 2024; 10:37. [PMID: 38782929 DOI: 10.1038/s41572-024-00521-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/17/2024] [Indexed: 05/25/2024]
Abstract
Carpal tunnel syndrome (CTS) is the most common nerve entrapment disorder worldwide. The epidemiology and risk factors, including family burden, for developing CTS are multi-factorial. Despite much research, its intricate pathophysiological mechanism(s) are not fully understood. An underlying subclinical neuropathy may indicate an increased susceptibility to developing CTS. Although surgery is often performed for CTS, clear international guidelines to indicate when to perform non-surgical or surgical treatment, based on stage and severity of CTS, remain to be elucidated. Neurophysiological examination, using electrophysiology or ultrasonography, performed in certain circumstances, should correlate with the history and findings in clinical examination of the person with CTS. History and clinical examination are particularly relevant globally owing to lack of other equipment. Various instruments are used to assess CTS and treatment outcomes as well as the effect of the disorder on quality of life. The surgical treatment options of CTS - open or endoscopic - offer an effective solution to mitigate functional impairments and pain. However, there are risks of post-operative persistent or recurrent symptoms, requiring meticulous diagnostic re-evaluation before any additional surgery. Health-care professionals should have increased awareness about CTS and all its implications. Future considerations of CTS include use of linked national registries to understand risk factors, explore possible screening methods, and evaluate diagnosis and treatment with a broader perspective beyond surgery, including psychological well-being.
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Affiliation(s)
- Lars B Dahlin
- Department of Translational Medicine - Hand Surgery, Lund University, Malmö, Sweden.
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden.
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
| | - Malin Zimmerman
- Department of Translational Medicine - Hand Surgery, Lund University, Malmö, Sweden
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
- Department of Orthopedics, Helsingborg Hospital, Helsingborg, Sweden
| | - Maurizio Calcagni
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Caroline A Hundepool
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, The Netherlands
| | - Nens van Alfen
- Department of Neurology and Clinical Neurophysiology, Clinical Neuromuscular Imaging Group, Donders Center for Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Kevin C Chung
- Professor of Surgery, Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
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Rotaru-Zavaleanu AD, Lungulescu CV, Bunescu MG, Vasile RC, Gheorman V, Gresita A, Dinescu VC. Occupational Carpal Tunnel Syndrome: a scoping review of causes, mechanisms, diagnosis, and intervention strategies. Front Public Health 2024; 12:1407302. [PMID: 38841666 PMCID: PMC11150592 DOI: 10.3389/fpubh.2024.1407302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 05/08/2024] [Indexed: 06/07/2024] Open
Abstract
Carpal Tunnel Syndrome (CTS) has traditionally been viewed as a specialized medical condition. However, its escalating prevalence among professionals across a multitude of industries has sparked substantial interest in recent years. This review aims to delve into CTS as an occupational disease, focusing on its epidemiological patterns, risk factors, symptoms, and management options, particularly emphasizing its relevance in professional environments. The complex interaction of anatomical, biomechanical, and pathophysiological factors that contribute to the development of CTS in different work settings underlines the critical role of ergonomic measures, prompt clinical identification, and tailored treatment plans in reducing its effects. Nevertheless, the challenges presented by existing research, including diverse methodologies and definitions, highlight the need for more unified protocols to thoroughly understand and tackle this issue. There's a pressing demand for more in-depth research into the epidemiology of CTS, its injury mechanisms, and the potential role of targeted medicine. Moreover, recognizing CTS's wider ramifications beyond personal health is essential. The economic burden associated with CTS-related healthcare costs, productivity losses, and compensation claims can significantly impact both businesses and the broader society. Therefore, initiatives aimed at preventing CTS through workplace interventions, education, and early intervention programs not only benefit the affected individuals but also contribute to the overall well-being of the workforce and economic productivity. By fostering a collaborative approach among healthcare professionals, employers, policymakers, and other stakeholders, we can strive towards creating safer and healthier work environments while effectively managing the challenges posed by CTS in occupational settings.
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Affiliation(s)
| | | | - Marius Gabriel Bunescu
- Department of Occupational Medicine, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | | | - Victor Gheorman
- Department of Psychiatry, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Andrei Gresita
- College of Osteopathic Medicine, New York Institute of Technology, Old Westbury, NY, United States
| | - Venera Cristina Dinescu
- Department of Health Promotion and Occupational Medicine, University of Medicine and Pharmacy of Craiova, Craiova, Romania
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Tezcan EA, Levendoglu F, Durmaz MS, Batur EB, Gezer IA, Erol K. Utility of shear wave elastography for diagnosing carpal tunnel syndrome with psoriatic arthritis. Ir J Med Sci 2024; 193:977-985. [PMID: 37670102 DOI: 10.1007/s11845-023-03512-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 08/28/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND Carpal tunnel syndrome (CTS) is a type of peripheral entrapment neuropathy and common for the patients with psoriatic arthritis (PsA). Shear wave elastography (SWE) is a new ultrasonography technique that can be used for diagnosing CTS, but not studied in PsA patients. AIMS The aim of this study to measure the stiffness of median nerve and hand muscles by quantitative SWE to identify whether SWE can be used for diagnosing CTS in patients with PsA or not. METHODS To diagnose CTS, all patients had electrodiagnostic study. The stiffness values of the median nerve, abductor pollicis brevis, and abductor digiti minimi were determined using SWE. Muscle stiffness ratio was also calculated. RESULTS Consideration is given to 48 patients with PsA (93 wrists) and 29 healthy volunteers (57 wrists). Median nerve stiffness was found to be significantly higher, and abductor pollicis brevis' stiffness and muscle stiffness ratio were significantly lower in PsA patients' wrists compared to control group (p = 0.002, p < 0.001, p = 0.001, respectively) and in CTS wrists compared to others (p < 0.001, p < 0.001, p = 0.001, respectively). Receiver operating characteristic analysis identified 28.2 kPA as the median nerve stiffness cut-off point for differentiating CTS in PsA patients (p = 0.001). CONCLUSIONS We found that SWE has a good diagnostic value for CTS with PsA patients; hence, we can conclude that SWE could diagnose CTS in PsA patients.
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Affiliation(s)
- Ezgi Akyildiz Tezcan
- Department of Physical Medicine and Rehabilitation, Cumra State Hospital, Konya, 42500, Turkey.
| | - Funda Levendoglu
- Department of Physical Medicine and Rehabilitation, Selcuk University Medical Faculty, Konya, Turkey
| | | | - Elif Balevi Batur
- Department of Physical Medicine and Rehabilitation, Selcuk University Medical Faculty, Konya, Turkey
| | - Ilknur Albayrak Gezer
- Department of Physical Medicine and Rehabilitation, Selcuk University Medical Faculty, Konya, Turkey
| | - Kemal Erol
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Selcuk University Medical Faculty, Konya, Turkey
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Chowdhary K, Raum G, Visco C. Diagnostic utility of shear wave elastography in musculoskeletal injuries: A narrative review. PM R 2024; 16:384-397. [PMID: 38607311 DOI: 10.1002/pmrj.13179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 02/20/2024] [Accepted: 02/27/2024] [Indexed: 04/13/2024]
Abstract
Shear wave elastography (SWE) is an emerging and promising ultrasound modality, and is more recently employed in the diagnosis of musculoskeletal (MSK) pathologies. SWE evaluates tissue stiffness by measuring the speed of propagating acoustic waves through body tissue structures. Knowing the variations in stiffness of MSK soft tissue can provide helpful diagnostic insight for the evaluation of pathology in muscles, tendons, ligaments, nerves, and other soft tissues. The goal of this review is to synthesize recent literature on the utility of SWE for MSK pathology diagnosis. This review reveals that SWE adds important diagnostic data for the evaluation of several pathologies, such as median mononeuropathy at the wrist, Achilles tendinopathy, and plantar fasciitis. The review also reveals a lack of evidence pertaining to appropriate standardization of use and the connection to reliable and valid diagnostic benefit in the clinical setting.
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Affiliation(s)
- Kuntal Chowdhary
- Department of Rehabilitation and Regenerative Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - George Raum
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Christopher Visco
- Department of Rehabilitation and Regenerative Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
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Lin TY, Shen PC, Chang KV, Wu WT, Özçakar L. Assessment of the carpal tunnel and associated neural structures with superb microvascular imaging: a scoping review. Expert Rev Med Devices 2024; 21:141-147. [PMID: 37978908 DOI: 10.1080/17434440.2023.2285856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 11/16/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION Superb microvascular imaging (SMI) is an advanced ultrasound technique that portrays microcirculation. Its clinical applications have been studied in various diseases, including carpal tunnel syndrome (CTS) i.e. the most common entrapment neuropathy. This scoping review explores the role of SMI in diagnosing CTS or the assessment of relevant neural structures. METHODS We conducted a comprehensive search of electronic databases (PubMed, Embase and Web of Science) up to 26 September 2023. Two independent authors conducted the literature search, quality assessment, and data extraction. RESULTS This review includes seven studies comprising 385 wrists. SMI consistently revealed increased intraneural vascularity in the median nerves of patients with CTS compared to healthy individuals. While SMI demonstrated higher sensitivity than traditional Doppler methods for detecting CTS, its specificity was somewhat lower. Combining SMI with B-mode ultrasound appears to enhance the diagnostic accuracy for CTS. However, the relationship between SMI findings and CTS severity remains unclear. CONCLUSIONS This review highlighted the ability of SMI to provide detailed vascular structures in both healthy wrists and those with CTS. Additional research is crucial to determine the typical SMI findings of the carpal tunnel and within that context, tailor more precise diagnostic/therapeutic applications for the CTS population.
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Affiliation(s)
- Ting-Yu Lin
- Department of Physical Medicine and Rehabilitation, Lo-Hsu Medical Foundation, Inc, Lotung Poh-Ai Hospital, Yilan, Taiwan
| | - Peng-Chieh Shen
- Department of Physical Medicine and Rehabilitation, Lo-Hsu Medical Foundation, Inc, Lotung Poh-Ai Hospital, Yilan, Taiwan
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan
- Center for Regional Anesthesia and Pain Medicine, Wang-Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
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Yahia M, El Shambaky A, Lasheen D. Elastosonography and electrodiagnosis in relation to symptomatic and functional grading of carpal tunnel syndrome. Arch Rheumatol 2023; 38:620-632. [PMID: 38125057 PMCID: PMC10728749 DOI: 10.46497/archrheumatol.2023.10022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 03/05/2023] [Indexed: 12/23/2023] Open
Abstract
Objectives This study focused on the symptomatic and the functional evaluation in correlations to median nerve elasticity, its ultrasound parameters, and the electrodiagnostic grading of primary carpal tunnel syndrome (CTS) patients. Patients and methods In the case-control study, 100 wrists of 57 CTS patients (54 females, 3 males; mean age: 39±9.8 years; range, 20 to 60 years) clinically diagnosed according to the American Academy of Neurology Clinical Diagnostic Criteria were evaluated between December 2019 and December 2020. The control group included 110 nondiseased wrists of 55 sex- and age-matched healthy subjects (males 7, females 48; mean age: 35.7±10.3 years; range 20 to 58 years). Functional assessment using Hi-Ob-Db clinical scale, electrodiagnosis, ultrasonographic screening, and elasticity evaluation were done for all patients. Results CTS patients had an increased stiffness of the median nerve compared to controls. Functional stages were positively correlated with the ultrasonographic parameters and the electrodiagnostic stages of CTS. The elastogram of clinically diagnosed patients was revealed more stiffness of the MN, with negative electrodiagnosis results. Conclusion Clinically diagnosed CTS could be missed by the electrodiagnosis but then properly figured by ultrasonography and potentially graded by sonoelastography. Sonoelastography may be an effective method for early diagnosis and appropriate grading of CTS.
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Affiliation(s)
- Marwa Yahia
- Department of Rheumatology, Rehabilitation and Physical Medicine, Faculty of Medicine, Benha University, Benha, Egypt
| | - Ahmed El Shambaky
- Department of Rheumatology, Rehabilitation and Physical Medicine, Faculty of Medicine, Benha University, Benha, Egypt
| | - Doaa Lasheen
- Department of Rheumatology, Rehabilitation and Physical Medicine, Faculty of Medicine, Benha University, Benha, Egypt
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Ning G, Liang H, Zhang X, Liao H. Autonomous Robotic Ultrasound Vascular Imaging System With Decoupled Control Strategy for External-Vision-Free Environments. IEEE Trans Biomed Eng 2023; 70:3166-3177. [PMID: 37227912 DOI: 10.1109/tbme.2023.3279114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE Ultrasound (US) probes scan over the surface of the human body to acquire US images in clinical vascular US diagnosis. However, due to the deformation and specificity of different human surfaces, the relationship between the scan trajectory of the skin and the internal tissues is not fully correlated, which poses a challenge for autonomous robotic US imaging in a dynamic and external-vision-free environment. Here, we propose a decoupled control strategy for autonomous robotic vascular US imaging in an environment without external vision. METHODS The proposed system is divided into outer-loop posture control and inner-loop orientation control, which are separately determined by a deep learning (DL) agent and a reinforcement learning (RL) agent. First, we use a weakly supervised US vessel segmentation network to estimate the probe orientation. In the outer loop control, we use a force-guided reinforcement learning agent to maintain a specific angle between the US probe and the skin in the dynamic imaging processes. Finally, the orientation and the posture are integrated to complete the imaging process. RESULTS Evaluation experiments on several volunteers showed that our RUS could autonomously perform vascular imaging in arms with different stiffness, curvature, and size without additional system adjustments. Furthermore, our system achieved reproducible imaging and reconstruction of dynamic targets without relying on vision-based surface information. CONCLUSION AND SIGNIFICANCE Our system and control strategy provides a novel framework for the application of US robots in complex and external-vision-free environments.
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Zhang XY, Zhang D, Han LZ, Pan YS, Wei Q, Lv WZ, Dietrich CF, Wang ZY, Cui XW. Predicting Malignancy of Thyroid Micronodules: Radiomics Analysis Based on Two Types of Ultrasound Elastography Images. Acad Radiol 2023; 30:2156-2168. [PMID: 37003875 DOI: 10.1016/j.acra.2023.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/29/2023] [Accepted: 02/01/2023] [Indexed: 04/03/2023]
Abstract
RATIONALE AND OBJECTIVES To develop a multimodal ultrasound radiomics nomogram for accurate classification of thyroid micronodules. MATERIALS AND METHODS A retrospective study including 181 thyroid micronodules within 179 patients was conducted. Radiomics features were extracted from strain elastography (SE), shear wave elastography (SWE) and B-mode ultrasound (BMUS) images. Minimum redundancy maximum relevance and least absolute shrinkage and selection operator algorithms were used to select malignancy-related features. BMUS, SE, and SWE radiomics scores (Rad-scores) were then constructed. Multivariable logistic regression was conducted using radiomics signatures along with clinical data, and a nomogram was ultimately established. The calibration, discriminative, and clinical usefulness were considered to evaluate its performance. A clinical prediction model was also built using independent clinical risk factors for comparison. RESULTS An aspect ratio ≥ 1, mean elasticity index, BMUS Rad-score, SE Rad-score, and SWE Rad-score were identified as the independent predictors for predicting malignancy of thyroid micronodules by multivariable logistic regression. The radiomics nomogram based on these characteristics showed favorable calibration and discriminative capabilities (AUCs: 0.903 and 0.881 for training and validation cohorts, respectively), all outperforming clinical prediction model (AUCs: 0.791 and 0.626, respectively). The decision curve analysis also confirmed clinical usefulness of the nomogram. The significant improvement of net reclassification index and integrated discriminatory improvement indicated that multimodal ultrasound radiomics signatures might work as new imaging markers for classifying thyroid micronodules. CONCLUSION The nomogram combining multimodal ultrasound radiomics features and clinical factors has the potential to be used for accurate diagnosis of thyroid micronodules in the clinic.
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Affiliation(s)
- Xian-Ya Zhang
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Di Zhang
- Department of Medical Ultrasound, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Lin-Zhi Han
- Department of Radiology, Xupu Chengnan Hospital, Huaihua, China
| | - Ying-Sha Pan
- Department of Radiology, The First Affiliated Hospital of University of South China, Hengyang, China
| | - Qi Wei
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wen-Zhi Lv
- Department of Artificial Intelligence, Julei Technology Company, Wuhan, China
| | | | - Zhi-Yuan Wang
- Department of Medical Ultrasound, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Xin-Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Nam K, Mendoza FA, Wessner CE, Allawh TC, Forsberg F. Ultrasound quantitative assessment of ventral finger microvasculopathy in systemic sclerosis with Raynaud's phenomena: a comparative study. RMD Open 2023; 9:rmdopen-2022-002954. [PMID: 36787926 PMCID: PMC9930605 DOI: 10.1136/rmdopen-2022-002954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 02/01/2023] [Indexed: 02/16/2023] Open
Abstract
OBJECTIVE To assess the finger vascularity of systemic sclerosis patients with Raynaud's phenomenon (RP-SSc) using various ultrasound techniques. METHODS All fingers (except thumbs) of 18 RP-SSc patients and 18 controls were imaged at room temperature using four ultrasound vascular imaging techniques. The percent vascular area was quantified by counting blood flow pixels in a 25 mm2 square centred at the nail fold for the dorsal side and in 25 mm2 and 100 mm2 square from the fingertip for the ventral side. The mean vascular intensity was calculated from the corresponding areas for dorsal and ventral sides. RESULTS The percent vascular areas and mean vascular intensities in RP-SSc were significantly lower than those in controls for both dorsal and ventral sides (p<0.01). The mean vascular intensities showed slightly higher area under the curve (AUC) than the percent vascular areas (0.53-0.91 vs 0.53-0.90) regardless of imaging technique and assessment side. For each imaging technique, the ventral side vascularity showed a higher AUC (0.74-0.91) compared with the dorsal side (0.53-0.81). Moreover, ventral side abnormalities were associated with a history of digital ulcers. CONCLUSIONS Ultrasound demonstrated potential to quantify finger vascularity of RP-SSc. The ventral side of the fingers showed a higher accuracy in detecting RP-SSc than the dorsal side.
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Affiliation(s)
- Kibo Nam
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Fabian A Mendoza
- Department of Medicine, Division of Rheumatology and Jefferson Scleroderma Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Corinne E Wessner
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Tanya C Allawh
- Department of Medicine, Division of Rheumatology and Jefferson Scleroderma Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Flemming Forsberg
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Xu L, Ma T, Zhang M, Zhou L, Hu C. Effect of Wrist Dorsiflexion/Palmar Flexion on Median Nerve Deviation and Cross-Sectional Area in Patients with Carpal Tunnel Syndrome. DISEASE MARKERS 2023; 2023:3631193. [PMID: 36776922 PMCID: PMC9908345 DOI: 10.1155/2023/3631193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/09/2022] [Accepted: 10/14/2022] [Indexed: 02/05/2023]
Abstract
Objective To evaluate the effect of wrist dorsiflexion/palmar flexion on median nerve excursion and cross-sectional area in patients with carpal tunnel syndrome. Methods From November 2019 to December 2021, 85 patients (110 affected wrists) who presented to our department and were diagnosed with carpal tunnel syndrome were collected and classified by severity as mild to moderate. Twenty-five healthy controls were selected during the same period, with a total of 50 healthy wrists. All patients and healthy volunteers underwent high-frequency ultrasonography to measure the vertical deviation between the median nerve and the transverse carpal ligament during wrist dorsiflexion/palmar flexion and the changes in the cross-sectional area of the median nerve in the pisiform plane. All patients with carpal tunnel syndrome underwent neurophysiological testing to measure median nerve sensory conduction velocity, sensory latency time, and sensorimotor point fluctuation amplitude. Results The mean age of the patients was 50 ± 8 years, the proportion of males was 18%, and the disease course was 2.3 ± 1.2 years. In terms of severity grading, 38 patients (34.5%) had mild carpal tunnel syndrome, 30 patients (27.3%) had moderate carpal tunnel syndrome, and 42 patients (38.2%) had severe carpal tunnel syndrome. Compared with the control group, the distance between the proximal median nerve and the transverse carpal ligament, the distance between the distal median nerve and the transverse carpal ligament, and the cross-sectional area were decreased in the carpal tunnel syndrome group compared with those during wrist dorsiflexion, and the differences were statistically significant (P < 0.05). Compared with the control group, there were significant differences in the vertical distance and cross-sectional area between the median nerve and the transverse carpal ligament at the proximal and distal ends in the mild, moderate, and severe groups (P < 0.05). The proximal vertical distance of the median nerve was positively correlated with sensory latency (P < 0.05) and negatively correlated with sensory conduction velocity (P < 0.05). The vertical distance of the distal end of the median nerve was also significantly positively correlated with sensory latency (P < 0.05) and significantly negatively correlated with sensory conduction velocity (P < 0.05). Conclusion Wrist dorsiflexion/palmar flexion can affect median nerve deviation and cross-sectional area in patients with carpal tunnel syndrome. High-frequency ultrasound is helpful to detect such an effect and can also help determine the severity of carpal tunnel syndrome, which is worthy of clinical promotion.
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Affiliation(s)
- Lei Xu
- Department of Hand and Foot Surgery, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, 241000, China
| | - Tao Ma
- Department of Hand and Foot Surgery, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, 241000, China
| | - Min Zhang
- Department of Hand and Foot Surgery, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, 241000, China
| | - Linjie Zhou
- Department of Hand and Foot Surgery, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, 241000, China
| | - Caizhi Hu
- Department of Hand and Foot Surgery, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, 241000, China
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Sernik RA, Pereira RFB, Cerri GG, Damasceno RS, Bastos BB, Leão RV. Shear wave elastography is a valuable tool for diagnosing and grading carpal tunnel syndrome. Skeletal Radiol 2023; 52:67-72. [PMID: 35920932 DOI: 10.1007/s00256-022-04143-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 07/28/2022] [Accepted: 07/29/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To quantify the shear velocity and stiffness of the median nerve (MN) with shear wave elastography (SWE) at the carpal tunnel entrance and determine whether SWE is useful for diagnosing and staging carpal tunnel syndrome (CTS). MATERIALS AND METHODS The study included 58 patients (79 wrists) with clinical and electroneuromyographic diagnoses of CTS and 55 healthy controls (63 wrists). MN shear velocity and stiffness were measured by SWE on the axial plane in both groups. The differences between CTS patients and controls and between different grades of CTS based on electrodiagnostic tests were studied using Student's t test and ANOVA with ROC analysis. RESULTS The mean MN shear velocity and stiffness were significantly greater in CTS patients (2.5 ± 0.37 m/s and 19.4 ± 5.8 kPa) than in controls (1.91 ± 0.24 m/s and 11.1 ± 3.0 kPa) (p < 0.001) and greater in the severe CTS group (2.69 ± 0.39 m/s and 22.4 ± 7.1 kPa) than in the mild CTS group (2.37 ± 0.35 m/s and 17.3 ± 4,8 kPa). The cutoff value for the shear velocity was 2.13 m/s, with 86% and 82% sensitivity and specificity, respectively, and the cutoff value for stiffness was 13.6 kPa, with 87% and 82% sensitivity and specificity. CONCLUSION MN shear velocity and stiffness are significantly higher in CTS patients. SWE can be used to diagnose CTS and distinguish between patients with mild and severe disease.
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Affiliation(s)
- Renato Antonio Sernik
- Department of Radiology, Hospital Sírio-Libanês, R. Adma Jafet, 91, São Paulo, 01308-050, Brazil
| | | | - Giovanni Guido Cerri
- Department of Radiology, Hospital Sírio-Libanês, R. Adma Jafet, 91, São Paulo, 01308-050, Brazil
| | | | - Breno Braga Bastos
- Department of Radiology, Hospital Sírio-Libanês, R. Adma Jafet, 91, São Paulo, 01308-050, Brazil
| | - Renata Vidal Leão
- Department of Radiology, Hospital Sírio-Libanês, R. Adma Jafet, 91, São Paulo, 01308-050, Brazil.
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Shear-Wave-Elastography in Neurofibromatosis Type I. Diagnostics (Basel) 2022; 12:diagnostics12020360. [PMID: 35204451 PMCID: PMC8871512 DOI: 10.3390/diagnostics12020360] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/17/2022] [Accepted: 01/26/2022] [Indexed: 01/09/2023] Open
Abstract
Ultrasound shear wave elastography (SWE) is an increasingly used imaging modality that expands clinical ultrasound by measuring the elasticity of various tissues, such as the altered elasticity of tumors. Peripheral nerve tumors are rare, have been well-characterized by B-mode-ultrasound, but have not yet been investigated with SWE. Given the lack of studies, a first step would be to investigate homogeneous peripheral nerve tumors (PNTs), histologically neurofibromas or schwannomas, which can occur in multiple in neurofibromatosis type 1 and 2 (NF1 and 2), respectively. Hence, we measured shear wave velocity (SWV) in 30 PNTs of 11 patients with NF1 within the median nerve. The SWV in PNTs ranged between 2.8 ± 0.8 m/s and correlated with their width and approximate volume but not with their length or height. Furthermore, we determined the extent to which PNTs alter the SWV of the median nerve for three positions of the wrist joint: neutral (zero-degree), individual maximal flexion and maximal extension. Here, SWV was decreased in NF1 patients compared to age- and sex-matched controls (p = 0.029) during maximal wrist extension. We speculate that the presence of PNTs may have a biomechanical impact on peripheral nerves which has not been demonstrated yet.
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Gurun E, Akdulum I, Akyuz M, Tokgoz N, Ozhan Oktar S. Shear Wave Elastography Evaluation of Meniscus Degeneration with Magnetic Resonance Imaging Correlation. Acad Radiol 2021; 28:1383-1388. [PMID: 33402299 DOI: 10.1016/j.acra.2020.12.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/08/2020] [Accepted: 12/18/2020] [Indexed: 01/24/2023]
Abstract
RATIONALE AND OBJECTIVES The objective of the study was to assess the diagnostic efficiency of shear wave elastography in the grading of meniscal degeneration compared to magnetic resonance imaging (MRI) as a reference standard. MATERIALS AND METHODS Fifty patients were included in the study (who had bilateral knee MRI). Tissue elasticity was measured in the coronal plane from the meniscus body in kilopascal. Nonparametric testing (Mann-Whitney U) was utilized to assess the differences between mean elasticity of the meniscus tissue, gender. The inter-intraobserver agreement was determined by the intraclass correlation coefficient. The correlations between the mean elasticity of the meniscus versus age, height, and body mass index were calculated via the "Pearson Correlation Coefficient Test." The relationship between MRI meniscal degeneration grading and elastography elasticity module was determined via the "Spearman Correlation Test." A p value less than 0.05 was considered statistically significant. RESULTS İnter-intraobserver intraclass correlation coefficient of the lateral and medial meniscus mean stiffness values were good or excellent (>0.8). A statistically significant increase in stiffness of meniscus tissue was observed with an increase in age (p = 0.003 for medial menisci, 0.006 for lateral menisci). Tissue stiffness was higher in the medial meniscus than the lateral meniscus (p < 0.001). A positive correlation was observed between the MRI meniscal degeneration grade and tissue stiffness (p < 0.05). Additionally, mean stiffness values from lateral and medial menisci were higher in the group with degeneration (p < 0.0001). CONCLUSION Meniscus stiffness is increased with aging. There was a statistically significant positive correlation between meniscal stiffness and degeneration grading in MRI.
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Affiliation(s)
- Enes Gurun
- Department of Radiology, Gazi University Hospital, Ankara, Turkey.
| | - Ismail Akdulum
- Department of Radiology, Gazi University Hospital, Ankara, Turkey
| | - Melih Akyuz
- Department of Radiology, Gazi University Hospital, Ankara, Turkey
| | - Nil Tokgoz
- Department of Radiology, Gazi University Hospital, Ankara, Turkey
| | - Suna Ozhan Oktar
- Department of Radiology, Gazi University Hospital, Ankara, Turkey
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