The Value Of Ultrasonography In Diagnosis Of Lipomatosis Of Nerve In The Upper Extremity

Objective: To discuss the ultrasonographic characteristics and its values on diagnosis of lipomatosis of nerve(LN)of peripheral nerve,and to discuss the clinical significance of ultrasonographic examination for preoperative evaluation.Methods: 8 cases of LN in the upper extremity treated in our hospital from 2013 to 2019 were analyzed retrospectively.All patients were examined by ultrasonography before operation.The ultrasonographic characteristics of affected nerve and surrounding tissue were analyzed and the accuracy of ultrasonographic diagnosis in LN of the upper limb was calculated.By comparing the ultrasonographic imaging with the surgical findings,we analyzed the relationship between range of lesions indicated by ultrasonography and the range of surgery.Results: There were 10 affected nerves in 8 patients,including 6 median nerve(60%)and 4 ulnar nerve(40%).5 cases were primary and 3 recurrent.Of the 8 patients,4 cases presented with mass extending from distal forearm to palm with macrodactyly,3 cases with only macrodactyly and 1 case with soft-tissue neoplasm in hypothenar.LN was diagnosed by ultrasonography in 5 cases.The accurate rate of ultrasonography on diagnosis of LN was 62.5%.The characteristic ultrasonographic appearance of LN showed that hypoechoic nerve bundles were interspersed by hyperechoic adipose tissue,known as “lotus-like” in transverse section and “cable-like” in longitudinal section.Ultrasonography showed thickened adipose tissue around the affected nerve in 5 cases and thickened flexor tendon in the affected nerve innervation in 3 cases.Among 5 cases of LN diagnosed by ultrasonography,3 cases showed that the range of lesions indicated by ultrasonography was consistent with that of surgery;2 cases showed that the range of lesions indicated by ultrasonography was larger than that of surgery.Surgical treatment was performed in 8 patients.Nerve decompression was performed in 5 patients,including 1 with bone malformation correction;pathological neural resection performed in 3 cases,including 1 with bone malformation correction.Conclusions: Ultrasonography can be applied for preoperative evaluation of LN as a routine,non-invasive examination.The characteristic ultrasonographic features of the affected nerves are of great value for definite diagnosis on LN.Ultrasonography can locate the scope of lesion accurately,which pr ovides reference for preoperative evaluation and determination for surgical scope.Sonographer should be highly aware of the possibility of LN for unexplained soft-tissue neoplasm in the wrist and plam,macrodactyly and syndactyly.For those suspected of the lesion of small nerve,sonograph er should select high-frequency probe to determine the neural structure.The possibility of LN should be considered into account tumor with hypoechoic and strong echo soft-tissue neoplasm in the course of nerve to avoid missed diagnosis.Other branches of brachial plexus in the upper limb should be scanned to determine whether there are multiple neural lesions.At the same time,whether there are excessive growth of soft tissue around the lesion nerve should be observed,which provides more detailed and accurate imaging information for clinicians.。...