Comparison of electrodiagnosis, neurosonography and MR neurography in localization of ulnar neuropathy at the elbow - 06/06/21

Doi : 10.1016/j.neurad.2021.05.004

Michael J. Ho ^a,⁎ , Ulrike Held ^b, Klaus Steigmiller ^b, Andrei Manoliu ^c, Andreas Schiller ^d, Ricarda Hinzpeter ^e, Christian Lanz ^f, Carlo Martinoli ^g,^h, Hans H. Jung ⁱ, Jens A. Petersen ⁱ
^a Department of Diagnostic, Interventional and Pediatric Radiology (DIPR), Inselspital, Bern University Hospital, University of Bern, Switzerland
^b Epidemiology, Biostatistics and Prevention Institute, Department of Biostatistics, University of Zurich, Zurich, Switzerland
^c Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
^d Division of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
^e Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
^f Department of Neurology, Schulthess Klinik, Zurich, Switzerland
^g Department of Health Sciences (DISSAL), Università di Genova, Genova, Italy
^h IRCCS Ospedale Policlinico San Martino, Genova, Italy
ⁱ Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland

^⁎Corresponding author at: Lindenstrasse 41, 8008 Zurich, Switzerland.Lindenstrasse 41Zurich8008Switzerland

En prensa. Pruebas corregidas por el autor. Disponible en línea desde el Sunday 06 June 2021
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Highlights

•	MR Neurography with T2 CNR showed better results compared to the other diagnostic tests in precise localization of UNE.
•	Differences for all tests between affected arms and controls were most frequently the largest at D2 to P0 or P0 to P2.
•	Additional imaging with MRN DTI is a promising technique that could be used as a non-invasive biomarker for localization of UNE.

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Abstract

Introduction

In patients with ulnar neuropathy at the elbow (UNE) the precise determination of the site of lesion is important for subsequent differential diagnostic considerations and therapeutic management. Due to a paucity of comparable data, to better define the role of different diagnostic tests, we performed the first prospective study comparing the diagnostic accuracy of short segment nerve stimulation, nerve ultrasonography, MR neurography (MRN), and diffusion tensor imaging (DTI) in patients with UNE.

Methods

UNE was clinically diagnosed in 17 patients with 18 affected elbows. For all 18 affected elbows in patients and 20 elbows in 10 healthy volunteers, measurements of all different diagnostic tests were performed at six anatomical positions across the elbow with measuring points from distal (D4) to proximal (P6) in relation to the medial epicondyle (P0). Additional qualitative assessment regarding structural changes of surrounding nerve anatomy was conducted.

Results

The difference between affected arms of patients and healthy control arms were most frequently the largest at measure intervals D2 to P0 and P0 to P2 for electrophysiological testing, or measure points P0 and P2 for all other devices, respectively. At both levels P0 and at P2, T2 contrast-to-noise ratio (CNR) of MRN and mean diffusivity (MD) of DTI-based MRN showed best accuracies.

Discussion

This study revealed differences in diagnostic performance of tests concerning a specific location of UNE, with better results for T2 contrast to noise ratio (CNR) in MRN and mean diffusivity of DTI-based MRN. Additional testing with MRN and nerve ultrasonography is recommended to uncover anatomical changes.

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Keywords : MR neurography, Ulnar nerve, Nerve ultrasound, DTI, Ulnar neuropathy, Elbow