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MRI criteria for diagnosis and predicting severity of carpal tunnel syndrome

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Abstract

Objective

To study MRI criteria for diagnosing and predicting severity of carpal tunnel syndrome (CTS).

Methods

Sixty-nine wrists in 41 symptomatic CTS patients and 32 wrists in 28 asymptomatic subjects were evaluated by MRI. Circumferential surface area (CSA), flattening ratio, relative median nerve signal intensity, and retinacular bowing were measured. CTS severity was classified as mild, moderate, or severe. Parameters for patients with and without CTS and for the three severity groups were compared. ROC curves were plotted to assess accuracy for CTS diagnosis and severity prediction.

Results

Significant differences were found between CTS and control wrists for median nerve CSA, flattening ratio at inlet, relative median nerve signal intensity, and retinacular bowing. ROC curve analysis revealed a sensitivity, specificity, and accuracy of median nerve CSA > 15 mm2 proximal to the tunnel (CSAp) of 85.5, 100, and 90.1%. Using either CSAp or CSAd > 15 mm2 as a diagnostic criterion, MRI could achieve a sensitivity of 100% and specificity of 94% for diagnosis of CTS while overall accuracy was 98%.

Significant differences were found among the three severity groups. Sensitivity, specificity, and accuracy of prediction of severe CTS using for CSAp > 19 mm2 were 75.0, 65.9, and 69.6%, respectively.

Conclusions

MRI is highly accurate at diagnosing CTS and moderately accurate at determining CTS severity. We recommend using CSA > 15 mm2 either proximal to or distal to the tunnel as a diagnostic criterion for CTS and CSA > 19 mm2 proximal to the tunnel as a marker for severe CTS.

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Acknowledgements

The work described in this paper was partially supported by a grant from the Research Grants Council of the Hong Kong Special Administrative Region, China (Project No.SEG_CUHK02). Special thanks to Jason Leung, CUHK statistician, for his help with this manuscript.

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Authors and Affiliations

  1. Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, 30–32 Ngan Shing Street, Shatin, N.T, Hong Kong

    Alex W. H. Ng, James F. Griffith, Cina S. L. Tong & Eric K. C. Law

  2. Department of Orthopedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, 30–32 Ngan Shing Street, Shatin, N.T, Hong Kong

    W. L. Tse, Clara W. Y. Wong & P. C. Ho

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  1. Alex W. H. Ng
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  2. James F. Griffith
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Correspondence to Alex W. H. Ng.

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All procedures performed in this study were in accordance with the ethical standards of our institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Written informed consent was obtained from all individual participants included in the study.

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Ng, A.W.H., Griffith, J.F., Tong, C.S.L. et al. MRI criteria for diagnosis and predicting severity of carpal tunnel syndrome. Skeletal Radiol 49, 397–405 (2020). https://doi.org/10.1007/s00256-019-03291-0

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