Diagnostic Accuracy of Integrating Ultrasound and Shear Wave Elastography in Assessing Carpal Tunnel Syndrome Severity: a Prospective Observational Study

Abstract

Ahmed Mohamed El-Maghraby,1 Yassir Edrees Almalki,2 Mohammad Abd Alkhalik Basha,1 Mohamad Gamal Nada,1 Fatma El Ahwany,1 Sharifa Khalid Alduraibi,3 Shaker Hassan S Alshehri,4 Asim S Aldhilan,3 Ziyad A Almushayti,3 Alaa K Alduraibi,3 Mervat Aboualkheir,5 Osama Attia,6 Mona M Amer,7 Ahmed M Abdelkhalik Basha,8 Ibrahim M Eladl1 1Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig, 44519, Egypt; 2Division of Radiology, Department of Internal Medicine, Medical College, Najran University, Najran, 61441, Kingdom of Saudi Arabia; 3Department of Radiology, College of Medicine, Qassim University, Buraidah, 52571, Kingdom of Saudi Arabia; 4Department of Orthopedic Surgery, College of Medicine, King Khalid University, Abha, 61421, Kingdom of Saudi Arabia; 5Department of Internal Medicine, College of Medicine, Taibah University, Madinah, 42361 Kingdom of Saudi Arabia; 6Department of Internal Medicine, Faculty of Human Medicine, Zagazig University, Zagazig, 44519, Egypt; 7Department of Neurology, Faculty of Human Medicine, Zagazig University, Zagazig, 44519, Egypt; 8Faculty of General Medicine, Saint Petersburg State University, Egypt Branch, Cairo, 11646, EgyptCorrespondence: Yassir Edrees Almalki, Email [email protected]: Carpal tunnel syndrome (CTS) is a common condition characterized by compression of the median nerve (MN) within the carpal tunnel. Accurate diagnosis and assessment of CTS severity are crucial for appropriate management decisions. This study aimed to investigate the combined diagnostic utility of B-mode ultrasound (US) and shear wave elastography (SWE) for assessing the severity of CTS in comparison to electrodiagnostic tests (EDT).Materials and Methods: This prospective observational study was conducted over 9-month periods at a tertiary care hospital. A total of 48 patients (36 females, 12 males; mean age 44 ± 10.9 years; age range 28– 57 years) with clinically suspected CTS were enrolled. All patients underwent EDT, US, and SWE. Based on the EDT results, CTS cases were categorized into four groups: mild, moderate, severe, and negative. The cross-sectional area (CSA) and elasticity (E) of the MN were measured at the tunnel inlet (CSAu and Eu) and pronator quadratus region (CSAo and Eo). The differences (CSAu-CSAo and Eu-Eo) were calculated. The primary outcomes were the diagnostic performance of CSAu, CSAu-CSAo, Eu, and Eu-Eo in differentiating moderate/severe from mild/negative CTS compared to EDT findings. Secondary outcomes included a correlation of US/SWE parameters with EDT grades and between each other. ANOVA, correlation, regression, and receiver operating characteristic (ROC) curve analyses were performed.Results: CSAu and CSAu–CSAo increased progressively with worsening CTS severity. E measurements were significantly higher in moderate-to-severe CTS compared to mild or negative cases. The combined metric of CSAu-CSAo at a 5 mm threshold exhibited enhanced performance, with a higher sensitivity (83.3%), specificity (100%), and area under the curve (AUC) (0.98), surpassing the results of CSAu when used independently. Similarly, the SWE measurements indicated that Eu-Eo at a 56.1kPa cutoff achieved an AUC of 0.95, with a sensitivity of 93.3% and specificity of 94.4%, outperforming the metrics for Eu when used alone, which had an AUC of 0.93, with identical sensitivity and specificity values (93.3% and 94.4%, respectively).Conclusion: The integration of ultrasound, shear wave elastography, and electrodiagnostic tests provides a comprehensive approach to evaluate anatomical and neurological changes and guide management decisions for CTS.Keywords: carpal tunnel syndrome, median never, ultrasound, shear wave elastography

Keywords

• carpal tunnel syndrome
• median never
• ultrasound
• shear wave elastography