Abstract
The purpose of the study was to investigate the relationship between diffusion tensor imaging (DTI) and the clinical classification of cubital tunnel syndrome (CuTS). Ten patients with CuTS (7 men and 3 women; mean age: 52.7 years) and 5 patients without ulnar neuropathy (2 men and 3 women; mean age: 38.0 years) were enrolled in this retrospective study. Fifteen patients were clinically classified into three groups: “Normal”, “1 and 2A”, and “2B and 3” by an orthopedic surgeon using the modified McGowan stages. DTI was acquired using a 3.0-T MRI. Fractional anisotropy (FA) of the ulnar nerve was measured in slices covering 20 mm proximal to 20 mm distal to ulnar sulcus. Median FA values in each group were compared by Kruskal–Wallis and Steel–Dwass test (P < 0.05). Five patients with CuTS were classified as “1 and 2A” and five patients as “2B and 3”. The FA values, proximal 12 mm to the ulnar sulcus were 0.486 ± 0.117, 0.425 ± 0.166 and 0.298 ± 0.0386 in the “Normal”, “1 and 2A” and “2B and 3” groups, respectively. The FA values of patients classified as “Normal” were significantly higher than those classified as “2B and 3” (P = 0.0326 in Steel–Dwass test). FA proximal to the ulnar sulcus might be associated to the modified McGowan stages for the clinical classification of CuTS.
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs12194-024-00813-x/MediaObjects/12194_2024_813_Fig1_HTML.png)
Similar content being viewed by others
Data availability
My manuscript has no associated data.
References
Mondelli M, Giannini F, Ballerini M, Ginanneschi F, Martorelli E. Incidence of ulnar neuropathy at the elbow in the province of Siena. J Neurol Sci. 2005;234:5–10.
Rhodes NG, Howe BM, Frick MA, et al. MR imaging of the postsurgical cubital tunnel: an imaging review of the cubital tunnel, cubital tunnel syndrome, and associated surgical techniques. Skeletal Radiol. 2019;48:1541–54.
Mallette P, Zhao M, Zurakowski D, Ring D. Muscle atrophy at diagnosis of carpal and cubital tunnel syndrome. J Hand Surg [Am]. 2007;32:855–8.
Goldberg B, Light T, Blair S. Ulnar neuropathy at the elbow: results of medial epicondylectomy. J Hand Surg. 1989;14(2):182–8.
Rashid G, Tora MS, Di L, Texakalidis P, Bentley JN, Boulis NM. Case series: a minimally invasive tunneling approach for cubital tunnel syndrome. Cureus. 2019. https://doi.org/10.7759/cureus.4540.
Basser PJ, Mattiello J, Le Bihan D. MR diffusion tensor spectroscopy and imaging. Biophys J. 1994;66:259–67.
Pierpaoli C, Jezzard P, Basser PJ, Barnett A, Chiro GD. Diffusion tensor MR imaging of the human brain. Radiology. 1996;201:637–48.
Pierpaoli C, Basser PJ. Toward a quantitative assessment of diffusion anisotropy. Magn Reson Med. 1996;36:893–906.
Basser PJ, Pierpaoli C. Microstructural and physiological features of tissues elucidated by quantitative-diffusion-tensor MRI. J Magn Reson B. 1996;111:209–19.
Jeon T, Fung MM, Koch KM, Tan ET, Sneag DB. Peripheral nerve diffusion tensor imaging: overview, pitfalls, and future directions. J Magn Reson Imaging. 2018;47(5):1171–89.
Wako Y, Nakamura J, Eguchi Y, et al. Diffusion tensor imaging and tractography of the sciatic and femoral nerves in healthy volunteers at 3T. J Orthop Surg Res. 2017;12:1–8.
Jengojan S, Kovar F, Breitenseher J, Weber M, Prayer D, Kasprian G. Acute radial nerve entrapment at the spiral groove: detection by DTI-based neurography. Eur Radiol. 2015;25:1678–83.
Klauser AS, Abd Ellah M, Kremser C, et al. Carpal tunnel syndrome assessment with diffusion tensor imaging: value of fractional anisotropy and apparent diffusion coefficient. Eur Radiol. 2018;28:1111–7.
Ginat DT, Collins J, Christov F, Nelson EG, Gluth MB. Delineation of the intratemporal facial nerve in a cadaveric specimen on diffusion tensor imaging using a 9.4 T magnetic resonance imaging scanner: a technical note. Radiol Phys Technol. 2019;12:357–61.
Baumer P, Pham M, Reutters M, et al. Peripheral neuropathy: detection with diffusion-tensor imaging. Radiology. 2014;273:185–93.
Breitenseher JB, Kranz G, Hold A, et al. MR neurography of ulnar nerve entrapment at the cubital tunnel: a diffusion tensor imaging study. Eur Radiol. 2015;25:1911–8.
Johnson D, Stevens KJ, Riley G, Shapiro L, Yoshioka H, Gold GE. Approach to MR imaging of the elbow and wrist: technical aspects and innovation. Magn Reson Imaging Clin N Am. 2015;23:355–66.
Elster AD, Burdette JH. Questions and answers in MRI by University of Maryland-College Park. 2nd ed. St Louis: Mosby; 2001. p. 14.
Lin LI. A concordance correlation coefficient to evaluate reproducibility. Biometrics. 1989;45(1):255–68.
Terayama Y, Uchiyama S, Ueda K, et al. Optimal measurement level and ulnar nerve cross-sectional area cutoff threshold for identifying ulnar neuropathy at the elbow by MRI and ultrasonography. J Hand Surg Am. 2018;43(6):529–36.
Takagi T, Nakamura M, Yamada M, et al. Visualization of peripheral nerve degeneration and regeneration: monitoring with diffusion tensor tractography. Neuroimage. 2009;44:884–92.
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;67:329–35.
Pierpaoli C, Barnett A, Pajevic S, et al. Water diffusion changes in Wallerian degeneration and their dependence on white matter architecture. Neuroimage. 2001;13:1174–85.
Thomalla G, Glauche V, Weiller C, et al. Time course of wallerian degeneration after ischaemic stroke revealed by diffusion tensor imaging. J Neurol Neurosurg Psychiatry. 2005;76:266–8.
Kronlage M, Schwehr V, Schwarz D, et al. Peripheral nerve diffusion tensor imaging (DTI): normal values and demographic determinants in a cohort of 60 healthy individuals. Eur Radiol. 2018;28(5):1801–8.
Acknowledgements
We thank Mr. Kenjiro Nakama (Department of Orthopedic Surgery, Kurume University School of Medicine, Fukuoka, Japan) for classifying the patients using the modified McGowan stages.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflicts of interest
The authors declare that they have no conflict of interest.
Ethical approval
This study was approved by the Research Ethics Committee of The Kurume university (the approval number: 22004).
Informed consent
Informed consent was obtained from all participants in the form of opt-out on the web-site.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Kimura, M., Nagata, S., Suzuki, M. et al. The relationship between diffusion tensor imaging and the clinical classification of cubital tunnel syndrome. Radiol Phys Technol (2024). https://doi.org/10.1007/s12194-024-00813-x
Received:
Revised:
Accepted:
Published:
DOI: https://doi.org/10.1007/s12194-024-00813-x