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Feasibility of Diagnosing Carpal Tunnel Syndrome with Diffusion Tensor Imaging: A Meta-Analysis
Adam G Evans, M.D.1, Ben A. Aiken, B.S.2, Maurice D. Morgan, B.S.2, Patrick E. Assi, M.D.1, Jeremy T. Joseph, M.D.1, Lauren M. Mioton, M.D.1, Isaac V. Manzanera Esteve, PhD1, J. Bradford Hill, M.D.1, Wesley P. Thayer, M.D., PhD1 and Salam Al Kassis, M.D.1, (1)Vanderbilt University Medical Center, Nashville, TN, (2)Meharry Medical College, Nashville, TN

Background: Carpal tunnel syndrome (CTS) is the most common compression neuropathy. Magnetic resonance (MR) diffusion tensor imaging (DTI) has become a popular research tool for investigating nerve injuries, such as CTS. DTI tracks water diffusion, the asymmetry of which is described as fractional anisotropy (FA). FA has been shown to be sensitive in detecting tissue changes in nerves, however, there is not yet a consensus on how to use FA values to diagnose CTS.

Materials and Methods: We performed a PRISMA-compliant systematic review of 5 databases to identify clinical studies of patients with CTS who underwent DTI. FA values were pooled for both patients and controls at commonly utilized regions of interest (ROIs) within the carpal tunnel.

Results: 21 studies met criteria with DTI imaging of 537 patients and 565 wrists with CTS and 409 control patients and 413 control wrists. Median nerve FA data were grouped at the level of the distal radioulnar joint (CTS mean FA: 0.57, I2=0%; control mean FA had inadequate number of studies), the pisiform (patient pooled mean FA: 0.42, I2=75%; control mean FA: 0.50, I2=58%), the hamate (patient mean FA: 0.43, I2=0%; control mean FA: 0.48, I2=0%), and as an average of several ROIs (patient mean FA: 0.50, I2=98%; patient mean FA: 0.59, I2=88%).

Conclusion: Individuals with CTS have a decreased median nerve FA than controls. The most comparable ROI across studies is at the level of the hamate. The hamate ROI may therefore provide the best diagnostic cut-off FA value for CTS, although additional studies should continue to report FA values for specific ROIs because insufficient studies reporting at the DRUJ were available. Consistency in DTI protocols, particularly in custom wrist coil use, may facilitate consistency in values between studies.

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