Feasibility of 3D Ultrasound to Evaluate Upper Extremity Nerves

M.-T. Girtler; A. Krasinski; C. Dejaco; H. H. Kitzler; L. G. Cui; S Sherebrin; L. Gardi; R. K. Chhem; A. Fenster; C. Romagnoli; T. De Zordo

doi:10.1055/s-0032-1325397

Ultraschall in der Medizin - European Journal of Ultrasound, Table of Contents

Ultraschall Med 2013; 34(4): 382-387
DOI: 10.1055/s-0032-1325397

Original Article

Feasibility of 3D Ultrasound to Evaluate Upper Extremity Nerves

3-D-Sonografie zur Beurteilung der Nerven der oberen Extremität

M.-T. Girtler

¹Robarts Research Institute, University of Western Ontario, Canada

,

A. Krasinski

¹Robarts Research Institute, University of Western Ontario, Canada

,

C. Dejaco

²Department of Rheumatology, Medical University Graz, Austria

,

H. H. Kitzler

¹Robarts Research Institute, University of Western Ontario, Canada

³Department of Neuroradiology, Technische Universität Dresden

,

L. G. Cui

¹Robarts Research Institute, University of Western Ontario, Canada

⁴Department of Diagnostic Ultrasound, Peking University Third Hospital, China

,

S Sherebrin

¹Robarts Research Institute, University of Western Ontario, Canada

,

L. Gardi

¹Robarts Research Institute, University of Western Ontario, Canada

,

R. K. Chhem

⁵Department of Radiology, Medical University Vienna, Austria

,

A. Fenster

¹Robarts Research Institute, University of Western Ontario, Canada

,

C. Romagnoli

¹Robarts Research Institute, University of Western Ontario, Canada

⁶Department of Radiology, University of Western Ontario, Canada

,

T. De Zordo

¹Robarts Research Institute, University of Western Ontario, Canada

⁷Department of Radiology, Medical University Innsbruck, Austria

› Author Affiliations

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

Full Text

References

References
1 Peer S. General Considerations and Technical Concept. In: Peer S, Bodner G, (eds) High-Resolution Sonography of the Peripheral Nervous System. Berlin, Heidelberg: Springer; 2008: 3
2 Husarik DB, Saupe N, Pfirrmann CW et al. Elbow nerves: MR findings in 60 asymptomatic subjects – normal anatomy, variants, and pitfalls. Radiology 2009; 252: 148-156
3 Wein TH, Albers JW. Electrodiagnostic approach to the patient with suspected peripheral polyneuropathy. Neurol Clin 2002; 20: 503-526
4 Fornage BD. Sonography of peripheral nerves of the extremities. Radiol Med 1993; 85: 162-167
5 Wiesler ER, Chloros GD, Cartwright MS et al. Ultrasound in the diagnosis of ulnar neuropathy at the cubital tunnel. J Hand Surg 2006; 31: 1088-1093
6 Allen GM, Drakonaki EE, Tan ML et al. High-resolution ultrasound in the diagnosis of upper limb disorders: a tertiary referral centre experience. Ann Plast Surg 2008; 61: 259-264
7 Yoon JS, Hong SJ, Kim BJ et al. Ulnar nerve and cubital tunnel ultrasound in ulnar neuropathy at the elbow. Arch Phys Med Rehabil 2008; 89: 887-889
8 Ozturk E, Sonmez G, Colak A et al. Sonographic appearances of the normal ulnar nerve in the cubital tunnel. J Clin Ultrasound 2008; 36: 325-329
9 McCartney CJ, Xu D, Constantinescu C et al. Ultrasound examination of peripheral nerves in the forearm. Reg Anesth Pain Med 2008; 33: 188
10 Jacob D, Creteur V, Courthaliac C et al. Sonoanatomy of the ulnar nerve in the cubital tunnel: a multicentre study by the GEL. Eur Radiol 2004; 14: 1770-1773
11 Beekman R, Visser LH. High-resolution sonography of the peripheral nervous system – a review of the literature. Eur J Neurol 2004; 11: 305-314
12 Martinoli C, Bianchi S, Zamorani MP et al. Ultrasound of the elbow. Eur J Ultrasound 2001; 14: 21-27
13 Kopf H, Loizides A, Mostbeck GH et al. Diagnostic sonography of peripheral nerves: indications, examination techniques and pathological findings. Ultraschall in Med 2011; 32: 242-263
14 Morrey BF, Adams RA. Semiconstrained arthroplasty for the treatment of rheumatoid arthritis of the elbow. J Bone Joint Surg Am 1992; 74: 479-490
15 Hobson-Webb LD, Massey JM, Juel VC et al. The ultrasonographic wrist-to-forearm median nerve area ratio in carpal tunnel syndrome. Clin Neurophysiol 2008; 119: 1353-1357
16 Ainsworth CD, Blake CC, Tamayo A et al. 3D ultrasound measurement of change in carotid plaque volume: a tool for rapid evaluation of new therapies. Stroke 2005; 36: 1904-1909
17 Egger M, Spence JD, Fenster A et al. Validation of 3D ultrasound vessel wall volume: an imaging phenotype of carotid atherosclerosis. Ultrasound Med Biol 2007; 33: 905-914
18 Landry A, Spence JD, Fenster A. Measurement of Carotid Plaque Volume by 3-Dimensional Ultrasound. Stroke 2004; 35: 864-869
19 Kato H, Hirayama T, Minami A et al. Cubital tunnel syndrome associated with medial elbow ganglia and osteoarthritis of the elbow. J Bone Joint Surg Am 2002; 84: 1413-1419
20 Rosenberg ZS, Bencardino J, Beltran J. MR imaging of normal variants and interpretation pitfalls of the elbow. Magn Reson Imaging Clin N Am 1997; 5: 481-499
21 Yoon JS, Walker FO, Cartwright MS. Ultrasonographic swelling ratio in the diagnosis of ulnar neuropathy at the elbow. Muscle Nerve 2008; 38: 1231-1235
22 Mondelli M, Filippou G, Frediani B et al. Ultrasonography in ulnar neuropathy at the elbow: relationships to clinical and electrophysiological findings. Neurophysiol Clin 2008; 38: 217-226
23 Jeon IH, Fairbairn KJ, Neumann L et al. MR imaging of edematous anconeus epitrochlearis: another cause of medial elbow pain?. Skeletal Radiol 2005; 34: 103-107
24 Lee JC, Healy JC. Normal sonographic anatomy of the wrist and hand. Radiographics 2005; 25: 1577-1590
25 Yamazaki H, Kato H, Hata Y et al. The two locations of ganglions causing radial nerve palsy. J Hand Surg Eur Vol 2007; 32: 341-345
26 Olehnik WK, Manske PR, Szerzinski J. Median nerve compression in the proximal forearm. J Hand Surg 1994; 19: 121-126
27 Klauser AS, Halpern EJ, De Zordo T et al. Carpal tunnel syndrome assessment with US: value of additional cross-sectional area measurements of the median nerve in patients versus healthy volunteers. Radiology 2009; 250: 171-177
28 Gruber H, Glodny B, Peer S. The validity of ultrasonographic assessment in cubital tunnel syndrome: the value of a cubital-to-humeral nerve area ratio (CHR) combined with morphologic features. Ultrasound Med Biol 2010; 36: 376-382