The Role of Diffusion Tensor Images in the Evaluation of the Median Nerve in Patients with Carpal Tunnel Syndrome

Abstract Background Carpal tunnel syndrome (CTS) is a common medical condition, which causes pain, numbness, and tingling in the hand and arm of the affected individual. CTS occurs when the median nerve is squeezed or compressed as it travels through the wrist. Risk factors for CTS include obesity, monotonous wrist activity, pregnancy, genetic heredity, and rheumatoid inflammation Aim of the Work The aim of this study is to evaluate the role of Diffusion tensor images in the detection the changes and abnormalities of median nerve entrapment in cases of carpal tunnel syndrome. Patients and Methods This Cross-sectional study was carried out on 25 Patients diagnosed as carpal tunnel syndrome from physical medicine, neurology and orthopedic clinics at Ain Shams University. Results Regarding the Clinical picture in the studied patients, we found that there was pain, parathesia and wastening of the thenar muscles (in 100%,96% and 12% respectively). Diabetics, rheumatic arthritis patients were found in 24% and 8% respectively), A case with bifid median nerve. Regarding the severity of the symptoms by Nerve conduction studies (NCS) in the studied patients, we found that symptoms were mild for 20 %, moderate for 64 % and severe for 16 % of the cases. Regarding the Cross sectional area (CSA) (mm∧2) in the studied patients, we found that the mean inlet and outlet were 21.92 ± 7.215, 14.41 ± 5.051 respectively. Regarding the T2 Weighted images (MRI sequence) in the studied patients, we found that increased T2 signal, bowing of capsule, thickening at inlet and flattening at outlet were noted in (100% for all), increased CS diameter was seen in (92%) and edema in (28%) of the cases. Conclusion In conclusion, we found that the mean FA and ADC were 0.431± 0.064 and 0.431± 0.064 respectively, FA was cutoff, sensitivity, specificity (0.47,20%, 70% respectively) and ADC was cutoff, sensitivity, specificity (1.054, 40%,25%/ respectively) and there was negative correlation and no statistically significant between FA and ADC (P-value 0.189) and therefore when we recommend new cutoff values for FA and ADC to be (0.412 and 1.049 respectively).