title: A comparison of the performance of anatomical MRI and DTI in diagnosing carpal tunnel syndrome.
abstract: OBJECTIVE
  To compare the performance of anatomical magnetic resonance imaging (MRI) with that of diffusion tensor imaging (DTI) in the diagnosis of carpal tunnel syndrome (CTS).
  
  
  METHODS
  We performed 3T anatomical MRI and DTI on 42 patients and 42 age-matched controls. The median nerve cross-sectional area (CSA), relative median nerve signal intensity, and palmar bowing of the flexor retinaculum, assessed with anatomical MRI, and fractional anisotropy (FA) and apparent diffusion coefficient of the median nerve, assessed with DTI, were measured at four locations: the hamate level, the pisiform level (P0), the level located 1cm proximal to the P0 level (P1), and the distal radioulnar joint level (DR). Adding the ratios and differences of the median nerve parameters between the measurements at the DR and other locations to the diagnostic parameters, we evaluated the area under the receiver operating characteristic curves (AUCs) of all the diagnostic parameters of both scans.
  
  
  RESULTS
  The AUCs of FA(P1) (0.814) and FA(P0) (0.824) in DTI were larger than the largest AUC for anatomical MRI, CSA(P1) (0.759). However, the receiver operating characteristics of the three parameters were not significantly different (P>0.1). The sensitivity and specificity of CSA(P1) (76.2% and 73.8%) and FA(P1) (73.8% and 76.2%) increased after inclusive and exclusive combination to 90.5% each.
  
  
  CONCLUSIONS
  The individual performances of both scans were not significantly different in diagnosing CTS. Measuring both CSA and FA at P1 may be useful and efficient to utilize the merits of both scans and to increase the CTS diagnostic performance.
authors.affiliation: Department of Radiology, Hallym University Sacred Heart Hospital, Gwanpyeong-ro 170 beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do, 431-796, Republic of Korea; Department of Radiology, Kangwon National University Hospital, Baengnyeong-ro 156, Chuncheon-Si, Gangwon-Do, 200-722, Republic of Korea.
authors.forename: Sung Hye
authors.initials: SH
authors.lastname: Koh
authors.affiliation: Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Gwanpyeong-ro 170 beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do, 431-796, Republic of Korea. Electronic address: hallymradms@gmail.com.
authors.forename: Bong Cheol
authors.initials: BC
authors.lastname: Kwon
authors.affiliation: Department of Radiology, Hallym University Sacred Heart Hospital, Gwanpyeong-ro 170 beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do, 431-796, Republic of Korea.
authors.forename: Chanyeong
authors.initials: C
authors.lastname: Park
authors.affiliation: Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro, 173 beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Republic of Korea.
authors.forename: Su Yeon
authors.initials: SY
authors.lastname: Hwang
authors.affiliation: Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro, 173 beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Republic of Korea.
authors.forename: Joon Woo
authors.initials: JW
authors.lastname: Lee
authors.affiliation: Department of Radiology, Kangwon National University Hospital, Baengnyeong-ro 156, Chuncheon-Si, Gangwon-Do, 200-722, Republic of Korea.
authors.forename: Sam Soo
authors.initials: SS
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D019540:Area Under Curve; D002349:Carpal Tunnel Syndrome / Q000175:diagnosis* / Q000473:pathology; D056324:Diffusion Tensor Imaging; D005260:Female; D006801:Humans; D008022:Ligaments / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008475:Median Nerve / Q000473:pathology*; D008875:Middle Aged; D012372:ROC Curve; D012680:Sensitivity and Specificity; D014955:Wrist Joint / Q000473:pathology*
keywords: Carpal tunnel syndrome; Diffusion tensor imaging; Magnetic resonance imaging; Median nerve; Wrist