Value of Grayscale and Power Doppler High-Resolution Ultrasound in Assessment of Patients with Clinically Suspected Carpal Tunnel Syndrome

Objectives To determine the value of grayscale and power Doppler ultrasound (PDUS) in the evaluation of carpal tunnel syndrome (CTS) in clinically suspected patients. Methods Eighty-seven wrists of 61 patients with clinically suspected CTS and 57 wrists of 30 healthy control participants were included in our study. Median nerve (MN) cross-sectional area (CSA) measurements were performed at the tunnel inlet level (wCSA) and proximal pronator quadratus muscle level (fCSA). Two parameters were calculated: CSA absolute difference (Delta CSA), which was the difference between the two measurements; and CSA ratio (RCSA), calculated by dividing wCSA over fCSA. The MN at the wrist level was evaluated for hypervascularity with PDUS. Results The mean wCSA, R-CSA, and Delta CSA values were significantly higher in patients (17 mm(2), 2.45, and 9.9 mm(2), respectively) than in control participants (8 mm(2), 1.29, and 1.65 mm(2); (P < .0001). At their corresponding cutoff values, the wCSA yielded higher sensitivity (95%) and lower specificity (88%) compared to the RCSA and Delta CSA (89% and 93% sensitivity and 93% and 89% specificity). Power Doppler US was the most specific US parameter (100%) but the least sensitive (76%). A multivariate logistic regression model including the wCSA, RCSA, and PDUS yielded 97% diagnostic accuracy at their optimal cutoffs, which increased to 99% after eliminating age and body mass index confounding effects. Conclusions The combination of MN swelling measurements and PDUS increases the diagnostic accuracy of US in patients with clinically suspected CTS.