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Exploratory use of ultrasound to determine whether demyelination following carpal tunnel syndrome co-exists with axonal degeneration

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Neural Regeneration Research 2018年第2期13卷 317-323页

作者： Xue Deng lai-heung phoebe chau Suk-Yee Chiu Kwok-Pui Leung Sheung-Wai Li Wing-Yuk Ip Department of Orthopedics & Traumatology The University of Hong Kong Clinical Electro-diagnostic Unit Tung Wah Hospital Department of Medicine The University of Hong Kong

Carpal tunnel syndrome （CTS） accompanied by secondary axonal degeneration cannot be clearly dis- criminated using the current cross-validated ultrasound severity classification system. This study aimed at exploring cut-off values of ultrasound parameters, including wrist cross-sectional area （W-CSA）, wrist perimeter （W-P）, ratio of cross-sectional area （R-CSA） and perimeter （R-P）, changes of CSA and P from wrist to one third distal forearm （△CSA＆AP） for differentiation. Seventy-three patients （13 male and 60 female） were assigned into group A （demyelination only, n = 40） and group B （demyelination with secondary axonal degeneration, n = 33） based on the outcomes of nerve conduction studies （NCS）. Receiver Operative Characteristics （ROC） curves were plotted to obtain sensitivity, specificity, and accuracy of cut- off values for all the ultrasound parameters. The overall identified cut-off values （W-CSA 12.0 mm2, W-P 16.27 mm, R-CSA 1.85, R-P 1.48, △CSA 6.98 mm2, △P 5.77 mm） had good sensitivity （77.1-88.6%）, fair specificity （40-62.2%） and fair-to-good accuracy （0.676-0.758）. There were also significant differences in demographics （age and severity gradation, P 〈 0.001）, NCS findings （wrist motor latency and conduction velocity, P 〈 0.0001; wrist motor amplitude, P 〈 0.05; distal sensory latency, P 〈 0.05; sensory amplitude, P 〈 0.001） and ultrasound measurements （W-CSA, W-P, R-CSA, R-P, △CSA＆△P, P 〈 0.05） between groups. These findings suggest that ultrasound can be potentially used to differentiate demyelinating CTS with sec- ondary axonal degeneration and provide better treatment guidance.

关键词： carpal tunnel syndrome nerve conduction studies ultrasound receiver operating characteristic curve peripheral nerve compression injury ultrasonography neural conduction axonal degeneration neural regeneration

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Neural plasticity secondary to carpal tunnel syndrome: a pseudo-continuous arterial spin labeling study

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Neural Regeneration Research 2021年第1期16卷 158-165页

作者： Xue Deng phoebe lai-heung chau Suk-Yee Chiu Kwok-Pui Leung Yong Hu Wing-Yuk Ip Department of Orthopedics&Traumatology The University of Hong KongHong Kong Special Administrative RegionChina Clinical Neuro-diagnostic Unit Tung Wah HospitalHong Kong Special Administrative RegionChina Department of Medicine The University of Hong KongHong Kong Special Administrative RegionChina

Conventional neuroimaging techniques cannot truly reflect the change of regional cerebral blood flow in patients with carpal tunnel ***-continuous arterial spinning labeling(pCASL)as an efficient non-invasive neuroimaging technique can be applied to directly quantify the neuronal activities of individual brain regions that show the persistent symptoms owing to its better spatial resolution and increased signal-to-noise ***,this prospective observational study was conducted in 27 eligible female carpal tunnel syndrome,aged 57.7±6.51 *** tests,nerve conduction studies and pCASL neuroimaging assessment were *** results showed that the relevant activated brain regions in the cortical,subcrotical,and cerebral regions were correlated with numbness,pain,functionality,median nerve status and motor amplitude of median nerve(K=21–2849,r=–0.77–0.76,P<0.05).There was a tendency of pain processing which shifted from the nociceptive circuitry to the emotional and cognitive one during the process of chronic pain caused by carpal tunnel *** suggests the necessity of addressing the ignored cognitive or emotional state when managing patients with carpal tunnel *** for this study was obtained from the Institutional Review Board of The University of Hong Kong/Hospital Authority Hong Kong West,China(HKU/HA HKW IRB,approval ***17-129)on April 11,*** study was registered in Clinical Trial Registry of The University of Hong Kong,China(registration number:HKUCTR-2220)on April 24,2017.

关键词： Boston carpal tunnel questionnaire carpal tunnel syndrome cognitive nerve conduction studies pain principal component analysis pseudo-continuous arterial spin labeling

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