Study On The Diagnostic Value Of Neuroultrasound Combined With MRI In Cubital Tunnel Syndrome

BackgroundCubital tunnel syndrome(CuTS)is the second most common compression peripheral neuropathy in the upper limb,as well as one of the common syndromes of hand surgeons.The early diagnosis and treatment of CuTS is of great significance to the prognosis of patients.If the treatment of intrinsic muscular atrophy of the hand is delayed,even if the surgical recovery is not ideal,a thorough understanding of the ulnar nerve anatomy and common compression sites is required to determine the cause of neuropathy and correct treatment.Understanding the clinical manifestations and accurate localization of ulnar nerve compression can guide surgeons to determine whether they have surgical indications and make reasonable surgical plans.At present,the most common examination methods include physical examination and neuroelectrophysiological technology.However,this examination method sometimes fails to clarify the degree of ulnar nerve injury,information about the cause and accurate positioning.Thus,the study of high-frequency ultrasound and MRI examination can make up for the deficiency of electrophysiology in morphology and etiology.However,there are relatively few reports at home and abroad at present.Based on the above,we hope to explore various examinations through this experiment to learn more about their advantages and disadvantages and correlation,so as to provide a more reasonable theoretical basis and guidance scheme for clinical treatment.PurposeComparison studies and correlation analysis were conducted on the high-frequency ultrasound and MRI manifestations of patients with different degrees of CuTS and neuroelectrophysiological techniques,so as to evaluate the consistency and superiority of the three.Methods40 patients in the group of patients diagnosed with cubit tunnel syndrome(CuTS)and 30 in the normal control group were collected and treated in zhengzhou first people’s hospital.Neuroelectrophysiological,high-frequency ultrasound and MRI examinations were performed on the subjects.Neuroelectrophysiological techniques were mainly used to observe conduction latency,motor(segmental)velocity(MCV),amplitude(CMAP,SNAP)and pneumogram.The maximum cross-sectional area of ulnar nerve at the cubital canal(CSA),the cross-sectional area of the proximal(distal)compression end/the cross-sectional area of the compression nerve(CSASR),and the long axis inner diameter were measured by high-frequency ultrasound;MRI T2WI index RSIR(elbow ulnar nerve/muscle signal intensity ratio)and diffusion tensor imaging(DTI)in white matter fiber tracts tracking can quantitatively measure the apparent diffusion coefficient(ADC)and anisotropy index(FA).ResultsAccording to the electrophysiological grading standard,the patients were divided into 15 cases in mild group,7 cases in moderate group and 18 cases in severe group.1.MCV,CMAP,SNAP and SCV in the case group and the control group had statistical significance(P<0.05),among which MCV,CMAP,SNAP and SCV in the case group were lower than those in the control group.2.CSA,CSASR,long-axis inner diameter,RSIR and FA values in the case group were statistically significant compared with those in the control group(P<0.05).CSA,CSASR,long-axis inner diameter and RSIR values were all higher than those in the control group,while FA values were lower than those in the control group,while ADC values were not statistically different.3.FA value of the mild CuTS group showed statistical difference with that of the control group(P<0.05),while the other measured values showed no statistical difference.4.The difference of CSA,CSASR,long-axis inner diameter,RSIR and FA in the CuTS group and the control group was statistically significant(P<0.05).The values of CSA,CSASR,long-axis inner diameter and RSIR were significantly increased,while the FA value was decreased,and the ADC value was not significantly different.5.CSA and CSASR measured by high-frequency ultrasound have good linear correlation with electrophysiological correlation indexes,and CSA and CSASR have negative correlation with SCV,SNAP,MCV and CMAP(correlation coefficient r value is-0.821 and-0.788 respectively).0.723,0.783;0.782,0.815;(DTI)FA has a good linear correlation with electrophysiological indicators SCV,SNAP,MCV and CMAP,and a positive correlation(correlation coefficient r value 0.844,0.833,0.703,0.651).However,MRI(T2WI)RSIR has a certain linear correlation with electrophysiological SCV and MCV(correlation coefficient r value is-0.710,-0.689),and neither ADC nor electrophysiological indicators show a linear correlation.Conclusion1.Electrophysiological detection can be used to diagnose CuTS,which can be detected earlier,but false negative exists in patients with atypical clinical symptoms,unable to provide anatomical information,and the diagnostic value is limited.2.High frequency ultrasound can intuitively the morphology of ulnar nerve and the surrounding anatomic relationship,patient follow-up compliance is good,can make up for the defect of electrophysiological examination,but the lack of sensitivity for early CuTS,the results of the study found that CSA,CSASR associated with electrophysiological index has good linear correlation,can respectively from the structure and function in patients with different degrees of CuTS.3.MRI and DTI technologies are relatively new research methods,which can intuitively understand the ulnar nerve movement in 3d,and find the early CuTS well.It is found that RSIR is correlated with some electrophysiological parameters,while FA is correlated with electrophysiological parameters in a positive way,and ADC shows no linear correlation with all electrophysiological indicators.It can be seen that MRI T2WI has good clinical value in etiology for localization and FA value of DTI.Application of electrophysiological combined imaging examination in the diagnosis of CuTS can improve the accuracy of clinical diagnosis and treatment strategy.