Image analysis can reliably quantify median nerve echogenicity and texture changes in patients with carpal tunnel syndrome. (May 2023)

• Record Type: Journal Article
• Authors: Moschovos, Christos; Tsivgoulis, Georgios; Ghika, Apostolia; Bakola, Eleni; Papadopoulou, Marianna; Zis, Panagiotis; Zouvelou, Vasiliki; Salakou, Stavroula; Papagiannopoulou, Georgia; Kotsali-Peteinelli, Vassiliki; Chroni, Elisabeth; Kyrozis, Andreas
• Is Part Of: Clinical neurophysiology. Volume 149(2023)
• Page Start: 61
• Page End: 69
• Publication Date: 2023-05
• Subjects: Carpal Tunnel Syndrome -- Ultrasound -- EMG -- Image analysis -- Gray level co-occurrence matrix -- GLCM; CTS carpal tunnel syndrome -- GLCM gray level co-occurrence matrix -- CSA cross sectional area -- AUC area under curve -- ROC receiving operating curve -- EDx electrodiagnostic -- EMG electromyography -- BMI body mass index -- GSM median of the gray scale values -- IDM inverse different moment -- ASM angular second moment -- DTI diffusion tensor imaging; Neurophysiology -- Periodicals; Electroencephalography -- Periodicals; Electromyography -- Periodicals; Neurology -- Periodicals; 612.8
• DOI: 10.1016/j.clinph.2023.02.171
• Languages: English
• ISSNs: 1388-2457

Abstract

Highlights: Gray level co-occurrence matrix and brightness measures can reliably quantify median nerve changes in CTS. ROC curve analysis showed that image analysis measures had similar AUC values with cross sectional area in patients with CTS. Future ultrasound machines should incorporate the appropriate software for the calculation of image analysis measures. Abstract: Objective: To study the ability of image analysis measures to quantify echotexture changes of median nerve in order to provide a complementary diagnostic tool in CTS. Methods: Image analysis measures (gray level co-occurrence matrix (GLCM), brightness, hypoechoic area percentage using max entropy and mean threshold) were calculated in normalized images of 39 (19 younger and 20 older than 65y) healthy controls and 95 CTS patients (37 younger and 58 older than 65y). Results: Image analysis measures were equivalent or superior (older patients) to subjective visual analysis. In younger patients, GLCM measures showed equivalent diagnostic accuracy with cross sectional area (CSA) (Area Under Curve (AUC for inverse different moment = 0.97). In older patients all image analysis measures showed similar diagnostic accuracy to CSA (AUC for brightness = 0.88). Moreover, they had abnormal values in many older patients with normal CSA values. Conclusions: Image analysis reliably quantifies median nerve echotexture alterations in CTS and offers similar diagnostic accuracy to CSA measurement. Significance: Image analysis may offer added value to existing measures in the evaluation of CTS, especially in older patients. Its clinical implementation would require incorporation of mathematically simple software code for online nerve image analysis in ultrasound machines.