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Published in: Skeletal Radiology 4/2009

01-04-2009 | Scientific Article

Median nerve cross-sectional area and MRI diffusion characteristics: normative values at the carpal tunnel

Authors: Lawrence Yao, Neville Gai

Published in: Skeletal Radiology | Issue 4/2009

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Abstract

Objective

Enlargement of the median nerve is an objective potential imaging sign of carpal tunnel syndrome. Diffusion tensor MRI (DTI) may provide additional structural information that may prove useful in characterizing median neuropathy. This study further examines normal values for median nerve cross-sectional area (CSA), apparent diffusion coefficient (ADC), and fractional anisotropy (FA).

Materials and methods

Twenty-three wrists in 17 healthy volunteers underwent MRI of the wrist at 3 T. In 13 subjects, DTI was performed at a B value of 600 mm2/s. Median nerve CSA, ADC, and FA were analyzed at standardized anatomic levels.

Results

Mean (SD) median nerve CSA within the proximal carpal tunnel was 10.0 (3.4) mm2. The mean (SD) FA of the median nerve was 0.71 (0.06) and 0.70 (0.13) proximal to and within the carpal tunnel, respectively. There was a significant difference between nerve CSA and ADC, but not FA, at the distal forearm and proximal carpal tunnel. Nerve CSA, ADC, and FA did not differ between men and women or between dominant and non-dominant wrists. Nerve CSA at the proximal carpal tunnel was positively correlated with subject age and body mass index.

Conclusion

Our results suggest a 90% upper confidence limit for normal median nerve CSA of 14.4 mm2 at the proximal carpal tunnel, higher than normal limits reported by many ultrasound studies. We observed a difference between the CSA and ADC, but not the FA, of the median nerve at the distal forearm and proximal carpal tunnel levels.
Literature
1.
go back to reference Nakamichi K, Tachibana S. Ultrasonographic measurement of median nerve cross-sectional area in idiopathic carpal tunnel syndrome: diagnostic accuracy. Muscle Nerve 2002;26(6): 798–803.PubMedCrossRef Nakamichi K, Tachibana S. Ultrasonographic measurement of median nerve cross-sectional area in idiopathic carpal tunnel syndrome: diagnostic accuracy. Muscle Nerve 2002;26(6): 798–803.PubMedCrossRef
2.
go back to reference Cartwright MS, Shin HW, Passmore LV, Walker FO. Ultrasonographic reference values for assessing the normal median nerve in adults. J Neuroimaging 2008, May 8. Cartwright MS, Shin HW, Passmore LV, Walker FO. Ultrasonographic reference values for assessing the normal median nerve in adults. J Neuroimaging 2008, May 8.
3.
go back to reference Yesildag A, Kutluhan S, Sengul N, Koyuncuoglu HR, Oyar O, Guler K, Gulsoy UK. The role of ultrasonographic measurements of the median nerve in the diagnosis of carpal tunnel syndrome. Clin Radiol 2004;59(10): 910–915.PubMedCrossRef Yesildag A, Kutluhan S, Sengul N, Koyuncuoglu HR, Oyar O, Guler K, Gulsoy UK. The role of ultrasonographic measurements of the median nerve in the diagnosis of carpal tunnel syndrome. Clin Radiol 2004;59(10): 910–915.PubMedCrossRef
4.
go back to reference Wong SM, Griffith JF, Hui AC, Lo SK, Fu M, Wong KS. Carpal tunnel syndrome: diagnostic usefulness of sonography. Radiology 2004;232(1): 93–99.PubMedCrossRef Wong SM, Griffith JF, Hui AC, Lo SK, Fu M, Wong KS. Carpal tunnel syndrome: diagnostic usefulness of sonography. Radiology 2004;232(1): 93–99.PubMedCrossRef
5.
go back to reference Pasternack II, Malmivaara A, Tervahartiala P, Forsberg H, Vehmas T. Magnetic resonance imaging findings in respect to carpal tunnel syndrome. Scand J Work Environ Health 2003;29(3): 189–196.PubMed Pasternack II, Malmivaara A, Tervahartiala P, Forsberg H, Vehmas T. Magnetic resonance imaging findings in respect to carpal tunnel syndrome. Scand J Work Environ Health 2003;29(3): 189–196.PubMed
6.
go back to reference Jarvik JG, Yuen E, Kliot M. Diagnosis of carpal tunnel syndrome: electrodiagnostic and MR imaging evaluation. Neuroimaging Clin N Am 2004;14(1): 93–102.PubMedCrossRef Jarvik JG, Yuen E, Kliot M. Diagnosis of carpal tunnel syndrome: electrodiagnostic and MR imaging evaluation. Neuroimaging Clin N Am 2004;14(1): 93–102.PubMedCrossRef
7.
go back to reference Le Bihan D, Breton E, Lallemand D, Grenier P, Cabanis E, Laval-Jeantet M. MR imaging of intravoxel incoherent motions: application to diffusion and perfusion in neurologic disorders. Radiology 1986;161(2): 401–407.PubMed Le Bihan D, Breton E, Lallemand D, Grenier P, Cabanis E, Laval-Jeantet M. MR imaging of intravoxel incoherent motions: application to diffusion and perfusion in neurologic disorders. Radiology 1986;161(2): 401–407.PubMed
8.
go back to reference Basser PJ, Pierpaoli C. Microstructural and physiological features of tissues elucidated by quantitative-diffusion-tensor MRI. J Magn Reson B 1996;111(3): 209–219.PubMedCrossRef Basser PJ, Pierpaoli C. Microstructural and physiological features of tissues elucidated by quantitative-diffusion-tensor MRI. J Magn Reson B 1996;111(3): 209–219.PubMedCrossRef
9.
go back to reference Le Bihan D, Mangin JF, Poupon C, Clark CA, Pappata S, Molko N, Chabriat H. Diffusion tensor imaging: concepts and applications. J Magn Reson Imaging 2001;13(4): 534–546.PubMedCrossRef Le Bihan D, Mangin JF, Poupon C, Clark CA, Pappata S, Molko N, Chabriat H. Diffusion tensor imaging: concepts and applications. J Magn Reson Imaging 2001;13(4): 534–546.PubMedCrossRef
10.
go back to reference Khalil C, Hancart C, Le Thuc V, Chantelot C, Chechin D, Cotten A. Diffusion tensor imaging and tractography of the median nerve in carpal tunnel syndrome: preliminary results. Eur Radiol 18: 2283–2291. Khalil C, Hancart C, Le Thuc V, Chantelot C, Chechin D, Cotten A. Diffusion tensor imaging and tractography of the median nerve in carpal tunnel syndrome: preliminary results. Eur Radiol 18: 2283–2291.
11.
go back to reference Kabakci N, Gürses B, Firat Z, Bayram A, Uluğ AM, Kovanlikaya A, Kovanlikaya I. Diffusion tensor imaging and tractography of median nerve: normative diffusion values. Am J Roentgenol 2007;189(4): 923–927.CrossRef Kabakci N, Gürses B, Firat Z, Bayram A, Uluğ AM, Kovanlikaya A, Kovanlikaya I. Diffusion tensor imaging and tractography of median nerve: normative diffusion values. Am J Roentgenol 2007;189(4): 923–927.CrossRef
12.
go back to reference Sarría L, Cabada T, Cozcolluela R, Martínez-Berganza T, García S. Carpal tunnel syndrome: usefulness of sonography. Eur Radiol 2000;10(12): 1920–1925.PubMedCrossRef Sarría L, Cabada T, Cozcolluela R, Martínez-Berganza T, García S. Carpal tunnel syndrome: usefulness of sonography. Eur Radiol 2000;10(12): 1920–1925.PubMedCrossRef
13.
go back to reference Wong SM, Griffith JF, Hui AC, Tang A, Wong KS. Discriminatory sonographic criteria for the diagnosis of carpal tunnel syndrome. Arthritis Rheum 2002;46(7): 1914–1921.PubMedCrossRef Wong SM, Griffith JF, Hui AC, Tang A, Wong KS. Discriminatory sonographic criteria for the diagnosis of carpal tunnel syndrome. Arthritis Rheum 2002;46(7): 1914–1921.PubMedCrossRef
14.
go back to reference Mesgarzadeh M, Schneck CD, Bonakdarpour A, Mitra A, Conaway D. Carpal tunnel: MR imaging. Part II. Carpal tunnel syndrome. Radiology 1989;171(3): 749–754.PubMed Mesgarzadeh M, Schneck CD, Bonakdarpour A, Mitra A, Conaway D. Carpal tunnel: MR imaging. Part II. Carpal tunnel syndrome. Radiology 1989;171(3): 749–754.PubMed
15.
go back to reference Monagle K, Dai G, Chu A, Burnham RS, Snyder RE. Quantitative MR imaging of carpal tunnel syndrome. AJR Am J Roentgenol 1999;172(6): 1581–1586.PubMed Monagle K, Dai G, Chu A, Burnham RS, Snyder RE. Quantitative MR imaging of carpal tunnel syndrome. AJR Am J Roentgenol 1999;172(6): 1581–1586.PubMed
16.
go back to reference Seror P. Sonography and electrodiagnosis in carpal tunnel syndrome diagnosis, an analysis of the literature. Eur J Radiol 2008;67(1): 146–152.PubMedCrossRef Seror P. Sonography and electrodiagnosis in carpal tunnel syndrome diagnosis, an analysis of the literature. Eur J Radiol 2008;67(1): 146–152.PubMedCrossRef
17.
go back to reference Allmann KH, Horch R, Uhl M, Gufler H, Altehoefer C, Stark GB, Langer M. MR imaging of the carpal tunnel. Eur J Radiol 1997;25(2): 141–145.PubMedCrossRef Allmann KH, Horch R, Uhl M, Gufler H, Altehoefer C, Stark GB, Langer M. MR imaging of the carpal tunnel. Eur J Radiol 1997;25(2): 141–145.PubMedCrossRef
18.
go back to reference Becker J, Nora DB, Gomes I, Stringari FF, Seitensus R, Panosso JS, Ehlers JC. An evaluation of gender, obesity, age and diabetes mellitus as risk factors for carpal tunnel syndrome. Clin Neurophysiol 2002;113(9): 1429–1434.PubMedCrossRef Becker J, Nora DB, Gomes I, Stringari FF, Seitensus R, Panosso JS, Ehlers JC. An evaluation of gender, obesity, age and diabetes mellitus as risk factors for carpal tunnel syndrome. Clin Neurophysiol 2002;113(9): 1429–1434.PubMedCrossRef
19.
go back to reference Stanisz GJ, Midha R, Munro CA, Henkelman RM. MR properties of rat sciatic nerve following trauma. Magn Reson Med 2001;45(3): 415–420.PubMedCrossRef Stanisz GJ, Midha R, Munro CA, Henkelman RM. MR properties of rat sciatic nerve following trauma. Magn Reson Med 2001;45(3): 415–420.PubMedCrossRef
20.
go back to reference Beaulieu C, Does MD, Snyder RE, Allen PS. Changes in water diffusion due to Wallerian degeneration in peripheral nerve. Magn Reson Med 1996;36(4): 627–631.PubMedCrossRef Beaulieu C, Does MD, Snyder RE, Allen PS. Changes in water diffusion due to Wallerian degeneration in peripheral nerve. Magn Reson Med 1996;36(4): 627–631.PubMedCrossRef
Metadata
Title
Median nerve cross-sectional area and MRI diffusion characteristics: normative values at the carpal tunnel
Authors
Lawrence Yao
Neville Gai
Publication date
01-04-2009
Publisher
Springer-Verlag
Published in
Skeletal Radiology / Issue 4/2009
Print ISSN: 0364-2348
Electronic ISSN: 1432-2161
DOI
https://doi.org/10.1007/s00256-008-0626-1

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