수근관증후군에서 MRI와 초음파의 진단적 적용
Carpal Tunnel Syndrome ; Diagnostic Application of MRI and Sonography
박영수, 박관규, 이성문,
소속 상세정보
박영수 ( )
계명대학교 의과대학 신경외과학교실
박관규 ( )
계명대학교 의과대학 신경외과학교실
이성문 ( )
계명대학교 의과대학 진단방사선과학교실
KMID : 0359819990280121738
Abstract
수근관증후근으로 진단이 된 16명의 30예에서 손목부위 MRI를 촬영하여 T1강조영상과 STIR영상을 얻은 결과 정중신경의 고음영(87.5%), 수근관의 근위부에서 정중신경의 부종 원위부에서 정중신경의 압박소견(81.25%), 횡수근인대의 내반(81.25%) 등의 소견이 나타났다. 5명에선 MRI로서 수근관증후군의 원인질환을 알 수 있었는데 1명에선 조양이 발견되었고, 1명에선 단순 방사선 소견에선 나타나지 않은 요골골절이 확인되었으며 3명에서 굴근인대의 건초염이 확인되었다.
초음파를 이용하여 수근관의 근위부와 원위부에서 평편비를 구하고 정중신겨의 단면적을 구하였다. 수근관증후근의 환자에선 정상인에 비해 훨씬 납작해져 있으며단면적은 훨씬 커져있는 소견이었다. 손목의 중립위에 비해 굴전 및 신전시 정중신경의 변화를 관찰한 결과 정중신경의 단면적 변화는 거의 없었지만 1예에선 움직임에 따른 정중신경의 변화가 없어 주위의 유착을 알 수 있었다.
이로서 MRI 및 초음파는 수근관증후군의 진단에 임상소견, 신경전도 검사에 더불어 보조적인 진단 방법으로 가치가 있을 것으로 추정된다.
Objective: The diagnosis of carpal tunnel syndrome(CTS) can usually be made on the basis of clinical criteria and nerve conduction velocity. Until now, radiological examinations cannot give great influences on diagnosis and treatment of CTS. Recently, technology of MRI and sonography was advanced significantly as widely applicable they were used widely in the neurosurgical field. We investigated the usefulness of high resolution MRI and sonography for the diagnosis of CTS.
Methods : MRI of 30 wrists in 16 patients who had been clinically diagnosed as CTS was performed using axial T1weighted and short tau inversion recovery sequences. The study of sonography consisted of 17 wrists in 10 patients and control group of 14 wrists in 7 people who were asymptomatic. We investigated the increased median nerve signal, swelling and flattening of the median nerve, bowing of the flexor retinaculum, and the change of median nerve configuration during wrist flexion and extension.
Results : Increased signal of the median nerve was seen in 14 patients(88%), proximal swelling and distal flattening of the median nerve in 13(81%), and bowing of the flexor retinaculum in 13(81%) by MRI. Increased signal of the thenar muscles was found in 13 wrists, which was more frequent than gross thenar muscle atrophy(9 wrists). MRI revealed causative pathologies in 5 patients, which were tumor (1), radius fracture (1), and tenosynovitis (3). The sonography revealed more increased flattening ratio(3.4±0.7) and increased-cross area(16.5±7.7cm2) of the median nerve than control group(2.4±0.5 in flattening ratio and 7.2±1.4cm2 in cross area). There was no configuration change during wrist flexion and extension. But, no movement of the median nerve, suggesting adhesion, was revealed during wrist flexion and extension in one wrist.
Conclusion´: Although most cases of carpal tunnel syndrome are clinically straightforward,, those with confusing clinical pictures may benefit from imaging studies. Imaging criteria for the diagnosis of carpal tunnel syndrome can apply to both sonography and MRI.
키워드
Carpal tunnel syndrome;Diagnosis;MRI;Sonography
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