Abstract
Objectives
To preliminarily investigate the diagnostic performance of contrast-enhanced magnetic resonance neurography (CE-MRN) for carpal tunnel syndrome (CTS) and evaluate the association between CE-MRN parameters and clinical assessments.Materials and methods
The study involved thirty-one idiopathic CTS patients and thirty healthy controls. Clinical assessments encompassed symptom evaluation and the Boston Carpal Tunnel Questionnaire (BCTQ). On CE-MRN, a "negative enhancement" sign, defined as focal signal reduction in the median nerve, was used to identify entrapment. Median nerve width and nerve-to-muscle T2 signal intensity ratio (nT2) were measured on CE-MRN and non-contrast MRN (ncMRN), and entrapment length was measured on CE-MRN. Routine MRI metrics encompassed cross-sectional area, flattening ratio, bowing ratio, and relative signal intensity. Diagnostic performance and correlations with clinical variables were analyzed.Results
The CE-MRN demonstrated a sensitivity of 0.87 and specificity of 0.90 for detecting CTS using "negative enhancement" sign. The combination of nerve width and nT2 on CE-MRN, demonstrated higher diagnostic efficacy for CTS compared to routine MRI and ncMRN (AUC 0.87-0.94 for CE-MRN vs. AUC 0.73-0.91 for ncMRN vs. AUC 0.55-0.86 for routine MRI). Among the CE-MRN metrics, nT2 showed a negative correlation with BCTQ symptom scores, while entrapment length demonstrated a positive correlation with disease duration (p Conclusions
The "negative enhancement" sign on CE-MRN improves the diagnostic accuracy of idiopathic CTS. CE-MRN, which is characterized by three-dimensional visualization, may offer an innovative and non-invasive visual approach for the clinical diagnosis and evaluation of CTS.