Quantifying the elastic characteristics of the median nerve in healthy subjects: reliability of real-time shear-wave elastography

doi:10.12307/2023.578

Abstract

Abstract: BACKGROUND: Real-time shear-wave elastography can display tissue elasticity noninvasively, At present, it is mostly used in the study of soft tissue diseases such as thyroid gland and mammary gland, but rarely used in the study of peripheral nerves and their lesions.
OBJECTIVE: To calculate the test-retest and inter-operator reliability of assessing median nerve elasticity by real-time shear-wave elastography and to explore the relationship between the elastic modulus of macroaxis and minor axis of the median nerve at the same measurement site.
METHODS: A total of 20 healthy subjects, including 10 men and 10 women, were randomly recruited in this study. In the reliability test, two operators A and B assessed elastic modulus of the long axis of the median nerve on the handed and unhanded sides using the real-time shear-wave elastography, respectively. Five days later, operator A quantified the median nerve elasticity repeatedly using the same measurement method. In addition, real-time shear-wave elastography was used to measure the elastic modulus of the macroaxis and minor axis of the median nerve at the rasceta.
RESULTS AND CONCLUSION: In the reliability test, the inter-operator and test-retest reliabilities of the median nerve elastic modulus on the handed side were excellent with the intraclass correlation coefficient of 0.98 and 0.96, respectively. The intra-operator and test-retest reliabilities on the unhanded side were also excellent with the intraclass correlation coefficient of 0.78 and 0.86, respectively. There was no correlation between the elastic modulus of the macroaxis and minor axis of the median nerve (r=0.039, P=0.87). These findings indicate that real-time shear-wave elastography can quantitatively evaluate the elastic characteristics of the median nerve in healthy subjects on the handed or unhanded side with a high reliability. In addition, it can be inferred that the elastic modulus of the minor axis of the median nerve is not reliable in the correlation test, relative to that of the macroaxis of the median nerve that can act as a routine reference index in clinical practice.

Key words: shear-wave elastography, median nerve, elastic modulus, reliability, correlation

CLC Number:

Chen Chao, Geng Fengqin, Shen Suhong. Quantifying the elastic characteristics of the median nerve in healthy subjects: reliability of real-time shear-wave elastography[J]. Chinese Journal of Tissue Engineering Research, 2023, 27(23): 3742-3746.

Figures/Tables 4

References

[1] ATROSHI I, GUMMESSON C, JOHNSSON R, et al. Prevalence of carpaltunnel syndrome in a general population. JAMA. 1999;282(2):153-158.
[2] Practice parameter for electrodiagnostic studies in carpal tunnel syndrome: summary statement. Muscle Nerve. 2002;25:918.
[3] LEE TH, LI Y. Consideration of repetitive nerve stimulation of the median nerve in patients being evaluated for myasthenia gravis. Muscle Nerve. 2019;60(6):658-661.
[4] SUCHER BM, SCHREIBER AL. Carpal tunnel syndrome diagnosis. Phys Med Rehabil Clin N Am. 2014;25(2):229-247.
[5] CHEN YT, WILLIAMS L, ZAK MJ, et al. Review of Ultrasonography in the Diagnosis of Carpal Tunnel Syndrome and a Proposed Scanning Protocol. J Ultrasound Med. 2016;35:2311.
[6] BANG M, KIM JM, KIM HS. The usefulness of ultrasonography to diagnose the early stage of carpal tunnel syndrome in proximal to the carpal tunnel inlet: A prospective study. Medicine (Baltimore). 2019;98(26):e16039.
[7] 王晓春.腕管综合征误诊为颈椎病分析[J].中国现代医生,2010,48(26):82-87.
[8] 李阳,朱向阳,黄淮宇.腕管综合征的诊断进展[J].中国康复理论与实践, 2013,19(3):246-249.
[9] 吴香花,吴珊.神经超声在周围神经疾病中的诊断应用[J]. 中华脑科疾病与康复杂志(电子版),2018,8(1):45-48.
[10] GASPAROTTI R, PADUA L, BRIANI C, et al. New technologies for the assessment of neuropathies. Nat Rev Neurol. 2017;13(4):203-216.
[11] LAMPI MC, REINHART-KING CA. Targeting extracellular matrix stiffness to attenuate disease: From molecular mechanisms to clinical trials. Sci Trans Med. 2018;10(422):eaao0475.
[12] BOBER BG, SHAH SB. Paclitaxel Alters Sensory Nerve Biomechanical Properties. J Biomech. 2015;48(13):S0021929015003978.
[13] 孟加新,向橙,马润瑶,等.剪切波弹性成像的临床应用前景[J].牡丹江医学院学报,2021,42(1):161-163.
[14] INAL M, TAN S, DEMIRKAN S, et al. Evaluation of optic nerve with strain and shear wave elastography in patients with behçet’s disease and healthy subjects. Ultrasound Med Biol. 2017;43(7):1348-1354.
[15] NOGUEIRA-BARBOSA MH, LUGÃO HB, GREGIO-JÚNIOR E, et al. Ultrasound elastography assessment of the median nerve in leprosy patients. Muscle Nerve. 2017;56(3):393-398.
[16] DISSELHORST-KLUG C, SCHMITZ-RODE T, RAU G. Surface electromyography and muscle force: Limits in sEMG-force relationship and new approaches for applications. Clin Biomech. 2009;24(3):225-235.
[17] SALMAN ROGHANI R, HASHEMI SE, HOLISAZ MT, et al. The diagnostic accuracy of median nerve ultrasonography in elderly patients with carpal tunnel syndrome: sensitivity and specificity assessment. Clin Interv Aging. 2018;13:1953-1962.
[18] 李辉萍,宋涛,左若群,等.体外冲击波与超声波治疗轻中度腕管综合征的对比研究[J].中华物理医学与康复杂志,2020,42(5):443-445.
[19] AZADEH A, VASAGHI A, JALLI R, et al. Comparison of inching electrodiagnosis method and ultrasonographic findings in the determination of median nerve entrapment site in carpal tunnel syndrome. AmJ Phys Med Rehab. 2017;96: 869-873.
[20] PARK JS, WON HC, OH JY, et al. Value of cross-sectional area of median nerve by MRI in carpal tunnel syndrome. Asian J Surg. 2020;43(6):654-659.
[21] PETROVER D, RICHETTE P. Treatment of carpal tunnel syndrome : from ultrasonography to ultrasound guided carpal tunnel release. Joint Bone Spine. 2018;85(5):545-552.
[22] SIGRIST RMS, LIAU J, KAFFAS AE, et al. Ultrasound elastography:review of techniques and clinical applications. Theranostics. 2017;7(5):1303-1329.
[23] VALENTE G, RINALDI L, MOGGIO G, et al. Point shear wave elastography and vibration controlled transient elastography for estimating liver fibrosis in a cohort of liver transplant patients. Eur Rev Med Pharmacol Sci. 2020;24(13):7357-7365.
[24] COSGROVE DO, BERG WA, DORÉ CJ, et al. Shear wave elastography for breast masses is highly reproducible. Eur Radiol. 2012;22(5):1023-1032.
[25] KOZINC Ž, ŠARABON N. Shear-wave elastography for assessment of trapezius muscle stiffness: Reliability and association with low-level muscle activity. PLoS One. 2020;15(6):e0234359.
[26] ZHU B, YAN F, HE Y, et al. Evaluation of the healthy median nerve elasticity: Feasibility and reliability of shear wave elastography. Medicine (Baltimore). 2018;97(43):e12956.
[27] KANTARCI F, USTABASIOGLU FE, DELIL S, et al. Median nerve stiffness measurement by shear wave elastography: a potential sonographic method in the diagnosis of carpal tunnel syndrome. Eur Radiol. 2014;24(2):434-440.
[28] 黄点点,陈路增,邢海英,等.正中神经剪切波弹性成像的可重复性评价[J].中国医学影像学杂志,2018,26(5):383-387.
[29] BLAND JM, ALTMAN DG. A note on the use of the intraclass correlation coefficient in the evaluation of agreement between two methods of measurement. Comp Biol Med. 1990;20(5):337-340.
[30] JAESCHKE R, THOIRS K, BAIN G, et al. Systematic review: hand activity and ultrasound of the median nerve. Occup Med (Lond). 2017;67(5):389-393.
[31] PANAGOPOULOS GN, WU T, FOWLER JR. Correlation of ultrasound cross-sectional area of the median nerve, nerve conduction studies and 2-point discrimination. Muscle Nerve. 2019;59(2):236-239.