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- Title
Visualization of intraneural edema using gadolinium-enhanced magnetic resonance imaging of carpal tunnel syndrome.
- Authors
Shigeru Kobayashi; Katsuhiko Hayakawa; Takashi Nakane; Adam Meir; Erisa Mwaka; Takafumi Yayama; Kenzo Uchida; Seiichiro Shimada; Tomoo Inukai; Hideaki Nakajima; Hisatoshi Baba
- Abstract
Abstract Background In general, carpal tunnel syndrome (CTS) is diagnosed based mainly on clinical findings and electrophysiology. However, the pathological state of the compressed median nerve could not be shown on imaging. Gadoliniumenhanced magnetic resonance (MR) imaging may give us an idea about the status of the blood-nerve barrier of peripheral nerves. Therefore, detecting intraneural edema may be a way of diagnosing entrapment neuropathy. The present study investigated the diagnostic role of gadolinium-enhanced MR imaging of CTS. Methods The subjects were 23 patients (34 hands) with idiopathic CTS. To serve as control subjects, 12 wrists of asymptomatic volunteers were studied. Using the spin-echo method, T1- and T2-weighted axial MR images were obtained. Intravenously injected gadolinium was used to obtain enhanced images. We studied the relation between nerve enhancement and the symptomatology. Results After intravenous injection of gadolinium, there was no enhancement of the unaffected nerves in the carpal tunnels of the control group. Gadolinium enhancement was found in only 87% of patients with CTS who visited the hospital at an early stage and therefore had no nerve deficiency on electrophysiological studies (39%). Based on this finding, during the early stages when the nerve is in a state of neuropraxia, gadolinium-enhanced MR imaging of the median nerve might prove to be the most sensitive modality for detecting early nerve dysfunction. MR imaging also revealed a higher frequency of enhancement in the advanced stage of CTS with muscle atrophy. Conclusions We conclude that gadolinium-enhanced MR imaging can detect not only morphological changes but also pathological changes of the median nerve in patients with CTS. Currently, gadolinium-enhanced-MR imaging is probably most commonly used to image patients who have ambiguous electrodiagnostic studies and clinical examination in an early stage of CTS.
- Subjects
DIAGNOSIS of edema; CARPAL tunnel syndrome; GADOLINIUM; CONTRAST-enhanced magnetic resonance imaging; ELECTROPHYSIOLOGY; MUSCULAR atrophy; MEDIAN nerve; DIAGNOSIS
- Publication
Journal of Orthopaedic Science, 2009, Vol 14, Issue 1, p24
- ISSN
0949-2658
- Publication type
Article
- DOI
10.1007/s00776-008-1291-x