Diffusion Tensor Imaging of the Median Nerve Before and After Carpal Tunnel Corticosteroid Injection in Patients With Carpal Tunnel Syndrome: Feasibility Study

NCT03299361 | Completed

• 1 other identifier: TSGHIRB 1-105-05-056
• Study Type: observational
• Target: 12
• Locations: 0 countries
• Sites: N/A

Brief Summary

Carpal tunnel syndrome (CTS) is the most common nerve compression disorder in the upper extremity. Therapy for carpal tunnel syndrome includes physical and occupational therapy, the use of splints and other local measures, and corticosteroid injection into the carpal tunnel. When these measures fail, open surgical release is considered the next step. Although the main disadvantage of corticosteroid injection is that symptoms are often short-lived relief and partial relief, it may not provide a permanent solution, corticosteroid injections are chosen because of lower level of invasiveness, faster recovery, and ease of the technique. Diffusion tensor magnetic resonance imaging (DTI) reveals tissue microstructure based on random movements of water molecules. The measured diffusion-weighted images are further analyzed for parameter images that describe different characteristics of diffusion: apparent diffusion coefficient (ADC) is an absolute measure of the strength of diffusion, and fractional anisotropy (FA) describes the asymmetry of the diffusion direction due to tissue structures. Because the axonal cell membrane and the myelin sheath in nerve fibers prevent diffusion in the direction which is perpendicular to their fascicles, resulting in the isotropy of the diffusion of water molecules being lost. DTI is the only method which can give an indirect view of the microstructure of nervous tissue in addition to the pathway of the fibers. DTI has been applied to study peripheral nerves, to demonstrate the feasibility of the method and to study nerve entrapment in carpal tunnel syndrome (CTS). The previous studies have demonstrated a decrease in FA in patients with CTS compared to healthy volunteers. The DTI parameters of the median nerve have revealed significant increase of FA and decrease in ADC with complete symptom relief 6 months after carpal tunnel release. However, Hiltunen et al. have demonstrated a significant decrease in ADC but no alter in FA in patients received open carpal tunnel release 1 year later and felt complete symptoms relief. By means of open carpal tunnel release, follow-up recordings were made at least 6 months after the operation to ensure time for post-operative tissue recovery. As a result, the investigators still do not understand the relevance between the parameters of DTI to symptoms relief in CTS patients receiving conservative treatment. Different from carpal tunnel release, steroid injections are popular technique for CTS treatment and are believed to reduce perineural inflammation or soft tissue swelling, and may stabilize the neural membrane, thus limiting the ephaptic transmission in ischemic nerve fibers which causes symptoms. Corticosteroid injections can provide a rapid symptom relief at 2 weeks follow up. However, there is no report addressing the relation of functional change of median nerve at several anatomic locations to the symptom relief of CTS. Here the investigators monitored, by means of DTI, median nerve integrity in CTS patients before and after corticosteroid injection. This information may help to explain the hypothesis regarding the effect of corticosteroid to the median nerve, to identify which anatomic location of median nerve relevant to the symptom relief of CTS after corticosteroid injection, and be useful for the clinical follow-up of patients with nerve entrapments following conservative treatment.

Conditions

Carpal Tunnel Syndrome

Keywords

Carpal tunnel syndrome; Corticosteroid; Diffusion tensor imaging; Injection; Magnetic resonance image; Ultrasound

Outcome Measures

Primary Outcomes (2)

• Inter-scan change of DTI at baseline and 2 weeks after injection

  The DTI values for each wrist at baseline were compared to the DTI of the same wrist at 2 weeks in individual patients. DTI parameters: FA (numeric; unit free), ADC (numeric; unit: mm2/s), and DTT (morphology, unit free); BCTQ (numeric; unit free)

  February, 2017

• Correlation of Inter-scan change of DTI with symptoms relief

  The investigators determined the inter-scan correlation between increment of DTI parameters and the decrement of BCTQ. DTI parameters: FA (numeric; unit free), ADC (numeric; unit: mm2/s), and DTT (morphology, unit free); BCTQ (numeric; unit free)

  February, 2017

Interventions

Magnetic resonance image (MRI) OTHER

Diffusion tensor magnetic resonance imaging (DTI) of MRI reveals tissue microstructure based on random movements of water molecules. Here we monitored, by means of DTI, median nerve integrity in CTS patients before and after corticosteroid injection. This information may help to explain the hypothesis regarding the effect of corticosteroid to the median nerve, to identify which anatomic location of median nerve relevant to the symptom relief of CTS after corticosteroid injection, and be useful for the clinical follow-up of patients with nerve entrapments following conservative treatment.

Eligibility Criteria

• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)
• Sampling Method: Probability Sample

Study Population

1. All patients had the clinical diagnosis supported by electrodiagnostic investigations. 2. All patients underwent US-guided corticosteroid injection of median nerve and received MR study before and after the injection.

You may qualify if:

• clinical diagnosis of unilateral or bilateral CTS based on a standardized and validated diagnostic scale

You may not qualify if:

• prior carpal tunnel release or contraindications to MRI

Sponsors & Collaborators

• Tri-Service General Hospital: lead

Related Publications (12)

• Stevens JC, Sun S, Beard CM, O'Fallon WM, Kurland LT. Carpal tunnel syndrome in Rochester, Minnesota, 1961 to 1980. Neurology. 1988 Jan;38(1):134-8. doi: 10.1212/wnl.38.1.134.

  PMID: 3336444 RESULT

• Katz JN, Simmons BP. Clinical practice. Carpal tunnel syndrome. N Engl J Med. 2002 Jun 6;346(23):1807-12. doi: 10.1056/NEJMcp013018. No abstract available.

  PMID: 12050342 RESULT

• Gonzalez MH, Bylak J. Steroid injection and splinting in the treatment of carpal tunnel syndrome. Orthopedics. 2001 May;24(5):479-81. doi: 10.3928/0147-7447-20010501-16.

  PMID: 11379997 RESULT

• Jarvik JG, Comstock BA, Kliot M, Turner JA, Chan L, Heagerty PJ, Hollingworth W, Kerrigan CL, Deyo RA. Surgery versus non-surgical therapy for carpal tunnel syndrome: a randomised parallel-group trial. Lancet. 2009 Sep 26;374(9695):1074-81. doi: 10.1016/S0140-6736(09)61517-8.

  PMID: 19782873 RESULT

• Basser PJ, Mattiello J, LeBihan D. MR diffusion tensor spectroscopy and imaging. Biophys J. 1994 Jan;66(1):259-67. doi: 10.1016/S0006-3495(94)80775-1.

  PMID: 8130344 RESULT

• Le Bihan D. Molecular diffusion, tissue microdynamics and microstructure. NMR Biomed. 1995 Nov-Dec;8(7-8):375-86. doi: 10.1002/nbm.1940080711.

  PMID: 8739274 RESULT

• Basser PJ, Jones DK. Diffusion-tensor MRI: theory, experimental design and data analysis - a technical review. NMR Biomed. 2002 Nov-Dec;15(7-8):456-67. doi: 10.1002/nbm.783.

  PMID: 12489095 RESULT

• Basser PJ, Pierpaoli C. Microstructural and physiological features of tissues elucidated by quantitative-diffusion-tensor MRI. J Magn Reson B. 1996 Jun;111(3):209-19. doi: 10.1006/jmrb.1996.0086.

  PMID: 8661285 RESULT

• Hiltunen J, Suortti T, Arvela S, Seppa M, Joensuu R, Hari R. Diffusion tensor imaging and tractography of distal peripheral nerves at 3 T. Clin Neurophysiol. 2005 Oct;116(10):2315-23. doi: 10.1016/j.clinph.2005.05.014.

  PMID: 16125460 RESULT

• Skorpil M, Karlsson M, Nordell A. Peripheral nerve diffusion tensor imaging. Magn Reson Imaging. 2004 Jun;22(5):743-5. doi: 10.1016/j.mri.2004.01.073.

  PMID: 15172070 RESULT

• Kabakci N, Gurses B, Firat Z, Bayram A, Ulug AM, Kovanlikaya A, Kovanlikaya I. Diffusion tensor imaging and tractography of median nerve: normative diffusion values. AJR Am J Roentgenol. 2007 Oct;189(4):923-7. doi: 10.2214/AJR.07.2423.

  PMID: 17885066 RESULT

• Khalil C, Hancart C, Le Thuc V, Chantelot C, Chechin D, Cotten A. Diffusion tensor imaging and tractography of the median nerve in carpal tunnel syndrome: preliminary results. Eur Radiol. 2008 Oct;18(10):2283-91. doi: 10.1007/s00330-008-0971-4. Epub 2008 Apr 17.

  PMID: 18418602 RESULT

MeSH Terms

Conditions

Carpal Tunnel Syndrome

Condition Hierarchy (Ancestors)

Median Neuropathy; Mononeuropathies; Peripheral Nervous System Diseases; Neuromuscular Diseases; Nervous System Diseases; Nerve Compression Syndromes; Cumulative Trauma Disorders; Sprains and Strains; Wounds and Injuries

Study Officials

• Yi-Chih Hsu, M.D

  Department of Radiology, Tri-Service General Hospital, National Defense Medical Center

  STUDY CHAIR

Study Design

• Study Type: observational
• Observational Model: CASE ONLY
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Radiologist

Study Record Dates

• First Submitted: September 20, 2017
• First Posted: October 3, 2017
• Study Start: May 26, 2016
• Primary Completion: December 31, 2016
• Study Completion: March 7, 2017
• Last Updated: October 3, 2017

Record last verified: 2017-09

Data Sharing

• IPD Sharing: Will not share