Superb Microvascular Imaging of Median Nerve in Carpal Tunnel Syndrome: A Novel Technique in Diagnostic Ultrasound
Condition: Carpal Tunnel Syndrome Bilateral
MeSH terms: Carpal Tunnel Syndrome; Syndrome
Study type: Interventional

Summary: 
      The aim of the study was to determine whether there is a correlation between the increased
      intraneural flow as measured using Doppler ultrasound (US) and superb microvascular imaging
      (SMI) methods and the severity of CTS as measured by nerve conduction studies. Moreover,
      investigators investigated the association of increased intraneural flow with the cross
      sectional area of the median nerve. The null hypothesis that there is no correlation between
      increased intraneural flow and the severity of carpal tunnel syndrome.
    

Detailed description: 
      Thanks to ultrasound (US) has a low cost, portable, available and non-invasive, the use of
      diagnostic US in musculoskeletal diseases is rapidly growing in worldwide. Because it is easy
      to identify the limb structures such as muscle, tendon, and nerves and also, their
      pathologies, US is frequently used by physiatrists, orthopedics, rheumatologists, sports
      medicine and pain management physicians nowadays. Providing images of the median nerve (MN)
      and accompanying structures and give dynamic images about the anatomy of the carpal tunnel
      are the most superiorities of US in carpal tunnel syndrome (CTS) diagnosis. The diagnose of
      CTS based on history and physical examination and confirmed with electrodiagnostic studies.
      Although the specificity of nerve conduction tests is high, there is significant variability
      in sensitivity (62-85%). Therefore, US has been suggested as an additional or alternative
      diagnose of CTS. Especially measurement of the cross-sectional area (CSA) of the MN is
      significantly greater in CTS patients and shows a significant correlation with
      electrodiagnostic findings such as sensory nerve conduction velocity (SCV) and distal motor
      latency (DML). Because it enhances the diagnostic accuracy the detection of the epineural or
      intraneuronal blood flow, the three techniques of Doppler US, are more recently preferred.
      The contributions of color, power and spectral Doppler techniques in CTS diagnosis, were
      studied in various studies before. While for the detection of intraneural flow, the power
      Doppler (PD) seems to be the best way, the specify, sensitivity and diagnostic accuracy of
      each Doppler techniques were good in most studies.

      Superb microvascular imaging (SMI) (Toshiba Medical Systems, Tokyo, Japan) is a new era in
      diagnostic ultrasound image processing technique. This new technology assigns accurate
      visualization of vascular structures with intensive clutter suppression to provide flow
      signals large to small vessels and represent this data at high frame rates. The both of the
      two modes (color SMI (cSMI) and the monochrome SMI (mSMI)) of the SMI, allows to visualizing
      lower velocity blood flows and smaller vessels without the use of contrast medium. To the
      best of our knowledge, there have been no clinical trials which studied of the healthy or
      injured median nerve blood flow with SMI.

      The aim of the study was to compare the diagnostic value of Doppler US and SMI methods in CTS
      based on detection of increased intraneural flow. Moreover, investigators investigated the
      association of increased intraneural flow with the CSA of the MN. The null hypothesis that
      there is no difference between Doppler US and SMI methods in the detection of increased
      intraneural flow in CTS patients.
    

Intervention name(s): Superb microvascular imaging (SMI) (Toshiba)
Intervention type(s): Device
Intervention description(s): to determine whether there is a correlation between the increased intraneural flow as measured using Doppler US and SMI methods and the severity of CTS as measured by nerve conduction studies, we designed this study
Intervention model: Single Group Assignment
Intervention model description: prospective cohort study
Masking: None (Open Label)
Primary purpose: Diagnostic
Keywords: Carpal Tunnel Syndrome; Superb microvascular imaging; Doppler ultrasound; Ultrasound; Median Nerve Entrapment; Diagnoses Disease