title: Carpal tunnel syndrome assessment with US: value of additional cross-sectional area measurements of the median nerve in patients versus healthy volunteers.
abstract: OBJECTIVE
  To improve accuracy in the diagnosis of carpal tunnel syndrome (CTS) by comparing cross-sectional area (CSA) measurements of the median nerve obtained at the level of the carpal tunnel (CSAc) with those obtained more proximally (CSAp), at the level of the pronator quadratus muscle.
  
  
  METHODS
  The study protocol was approved by the institutional review board, and all subjects gave written informed consent. One hundred wrists of 68 consecutive patients with CTS (16 men, 52 women; mean age, 57.9 years; range, 25-85 years) and 93 wrists of 58 healthy volunteers (16 male, 42 female; mean age, 55.1 years; range, 17-85 years) were examined with ultrasonography (US). Electrodiagnostic test results confirmed the diagnosis of CTS in all 68 patients. The US examiner was blinded to these test results. The CSA of the median nerve was measured at the carpal tunnel and proximal levels, and the difference between CSAc and CSAp (Delta CSA) was calculated for each wrist.
  
  
  RESULTS
  The mean CSAc in healthy volunteers (9.0 mm(2)) was smaller than that in patients (16.8 mm(2), P < .01). The mean Delta CSA was smaller in asymptomatic wrists (0.25 mm(2)) than in CTS-affected wrists (7.4 mm(2), P < .01). Receiver operating characteristic analysis revealed a diagnostic advantage to using the Delta CSA rather than the CSAc (P = .036). Use of a Delta CSA threshold of 2 mm(2) yielded the greatest sensitivity (99%) and specificity (100%) for the diagnosis of CTS.
  
  
  CONCLUSIONS
  Receiver operating characteristic analysis revealed improved accuracy in the diagnosis of CTS determined with the Delta CSA compared with the accuracy of the diagnosis determined with the CSAc.
authors.affiliation: Department of Diagnostic Radiology, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
authors.forename: Andrea S
authors.initials: AS
authors.lastname: Klauser
authors.forename: Ethan J
authors.initials: EJ
authors.lastname: Halpern
authors.forename: Tobias
authors.initials: T
authors.lastname: De Zordo
authors.forename: Gudrun M
authors.initials: GM
authors.lastname: Feuchtner
authors.forename: Rohit
authors.initials: R
authors.lastname: Arora
authors.forename: Johann
authors.initials: J
authors.lastname: Gruber
authors.forename: Carlo
authors.initials: C
authors.lastname: Martinoli
authors.forename: Wolfgang N
authors.initials: WN
authors.lastname: Löscher
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002349:Carpal Tunnel Syndrome / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008475:Median Nerve / Q000000981:diagnostic imaging / Q000503:physiopathology; D008875:Middle Aged; D009431:Neural Conduction / Q000502:physiology; D012016:Reference Values; D012680:Sensitivity and Specificity; D014463:Ultrasonography; D055815:Young Adult