title: Assessment of median nerve with MR neurography by using diffusion-tensor imaging: normative and pathologic diffusion values.
abstract: OBJECTIVE
  To determine normative diffusion values of the median nerve at several anatomic locations in healthy men and women of variable age and to compare these normative values with those in patients with carpal tunnel syndrome.
  
  
  METHODS
  After ethics board approval and written informed consent were obtained, 45 healthy volunteers (30 women, 15 men) and 15 patients (10 women, five men) were studied. Volunteers were divided into three age groups. Magnetic resonance (MR) neurography with diffusion-tensor imaging (DTI) was performed in all study participants at 3.0 T by using a single-shot echo-planar imaging sequence (repetition time msec/echo time msec, 10 123/40; b=1200 sec/mm2). Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) of the median nerve were determined by two readers at three locations: the levels of the distal radioulnar joint, pisiform bone, and hamate bone.
  
  
  RESULTS
  Normative FA and ADC values were calculated for men and women, different age groups, and different anatomic locations. FA and ADC did not differ between men and women (P=.28 and P=.38, respectively). FA decreased and ADC increased when moving from proximal to distal locations (P<.001). FA decreased and ADC increased significantly with age (P<.001). There was a significant difference between healthy volunteers and patients with carpal tunnel syndrome (P<.001 for both FA and ADC). An FA threshold of 0.47 and an ADC threshold of 1.054×10(-3) mm2/sec might be used in the diagnosis of carpal tunnel syndrome.
  
  
  CONCLUSIONS
  Normative diffusion values for MR neurography of the median nerve with DTI depend on the anatomic location and age but not on sex. Age-specific FA and ADC threshold values might be used to diagnose carpal tunnel syndrome.
authors: Department of Radiology, University Hospital Zurich, and Institute for Biomedical Engineering, University of Zurich, Ramistrasse 100, CH 8091 Zurich, Switzerland.
authors: Roman
authors: R
authors: Guggenberger
authors: Daniel
authors: D
authors: Markovic
authors: Patrick
authors: P
authors: Eppenberger
authors: Avneesh
authors: A
authors: Chhabra
authors: Andreas
authors: A
authors: Schiller
authors: Daniel
authors: D
authors: Nanz
authors: Klaas
authors: K
authors: Prüssmann
authors: Gustav
authors: G
authors: Andreisek
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D016880:Anisotropy; D002349:Carpal Tunnel Syndrome / Q000473:pathology*; D016022:Case-Control Studies; D056324:Diffusion Tensor Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008475:Median Nerve / Q000033:anatomy & histology* / Q000473:pathology*; D008875:Middle Aged; D011446:Prospective Studies; D012372:ROC Curve; D012016:Reference Values