Feasibility of 3D Ultrasound to Evaluate Upper Extremity Nerves

Abstract

Purpose: This study investigates the performance of a 3 D Ultrasound (US) system in imaging elbow and wrist nerves.

Materials and Methods: Twenty healthy volunteers with asymptomatic median, ulnar and radial nerves were prospectively investigated. Bilateral 3DUS scans of the elbows and wrists were acquired by using a commercially available US scanner (18 MHz, AplioXG, Toshiba) and stored as a 3 D volume by a dedicated software (CURE, Robarts Research Institute). Retrospectively, qualitative (image quality, atypical nerve location, findings potentially associated with compression neuropathy) and quantitative (cross-sectional area measurements) evaluations were performed.

Results: In all 200 nerves 3DUS was feasible (100 %). Image quality was insufficient in 13.5 % (25 ulnar nerve elbow, 2 radial nerve) and sonomorphology was not assessable in those nerves. Measurement of cross sectional areas was feasible in all nerves (100 %). Median cross-sectional area (range) were: median nerve elbow 7 mm² (6 – 9), radial nerve 3 mm² (1 – 4), ulnar nerve elbow 8 mm² (5 – 11), median nerve wrist 8 mm² (5 – 10), and ulnar nerve wrist 4 mm² (2 – 6). No significant changes in nerve cross-sectional area along each nerve was found. Ulnar nerve subluxation was found in 2 nerves (6.7 %). No anconeus epitrochlearis muscle or osteophytes were found.

Conclusion: 3DUS is a feasible method for assessing nerves of the upper extremity and has been shown to provide a good overview of the median, ulnar and radial nerve at the elbow and wrist, but is limited for evaluation of the ulnar nerve in the cubital tunnel. This technique enables reliable measurements at different locations along the nerve.

Zusammenfassung

Ziel: In dieser Studie wird die Möglichkeit der 3-D-US-Untersuchung zur Beurteilung von Nerven am Ellbogen und Handgelenk genauer untersucht.

Material und Methoden: 20 gesunde Probanden mit asymptomatischen Nervus medianus, N. ulnaris und N. radialis wurden in dieser Studie prospektiv untersucht. 3-D-US-Bilder von jedem Nerv auf Höhe des Ellbogens und Handgelenks wurden mittels eines kommerziell erwerblichen US-Geräts angefertigt (18 MHz, AplioXG, Toshiba) und als 3-D-Volumina mittels einer speziellen Software gespeichert (CURE, Robarts Research Institute). Retrospektiv wurden die Bilder qualitativ (Bildqualität, atypische Nervenlage, Befunde, die potenziell mit einem Nervenkompressionssyndrom einhergehen könnten) und quantitative (Querschnittsfläche) ausgewertet.

Ergebnisse: Von allen 200 Nerven konnten 3-D-US-Bilder angefertigt werden (100 %). Insgesamt waren 13,5 % (25 × N. ulnaris am Ellbogen, 2 × N. radialis) von ungenügender Bildqualität und die Sonomorphologie in diesen Nerven auch nicht beurteilbar. In allen Nerven konnte die Querschnittsfläche gemessen werden (100 %). Die mediane Querschnittsflächen (Spanne) waren: N. medianus Ellbogen 7 mm² (6 – 9), N. radialis 3 mm² (1 – 4), N. ulnaris Ellbogen 8 mm² (5 – 11), N. medianus Handgelenk 8 mm² (5 – 10), und N. ulnaris Handgelenk 4 mm² (2 – 6). Entlang der einzelnen Nerven wurde keine signifikante Änderung der Nervenquerschnittsfläche entdeckt. Eine Subluxation des N. ulnaris am Ellbogen wurde in 2 Nerven (6,7 %) gefunden. Kein Musculus anconeus epitrochlearis und keine Osteophyten wurden gefunden.

Schlussfolgerung: Die 3-D-US ist eine leicht durchführbare bildgebende Methode die einen guten Überblick über die verschiedenen Nerven an Ellbogen und Handgelenk gibt, aber in der Diagnostik des N. ulnaris am Ellbogen nur limitiert anwendbar ist. Diese neue Technik erlaubt genaue Messungen der Nervenquerschnittsfläche entlang von Nerven.

Key words

ultrasound - nervous-peripheral - ultrasound 3 D/4 D

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