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From the Departments of Radiology (Drs. Jarvik and Haynor), Neurosurgery (Drs. Jarvik, Kliot, and Haynor), Neurology (Drs. Yuen, Erlich, and Franklin), and Rehabilitation and Physical Medicine (Drs. Kraft and Wang), School of Medicine, and Department of Environmental Health, (Drs. Franklin and Wu, C. Bradley, D. Fulton-Kehoe, and T. Smith-Weller), Health Services (Dr. Jarvik), and Biostatistics (Dr. Heagerty), School of Public Health and Community Medicine, University of Washington, Seattle.
Address correspondence and reprint requests to Dr. Jeffrey G. Jarvik, Department of Radiology, Box 357115, University of Washington, 1959 NE Pacific, Seattle, WA 98195; e-mail: jarvikj{at}u.washington.edu
Objectives: To evaluate the reliability and diagnostic accuracy of high-resolution MRI of the median nerve in a prospectively assembled cohort of subjects with clinically suspected carpal tunnel syndrome (CTS).
Methods: The authors prospectively identified 120 subjects with clinically suspected CTS from five Seattle-area clinics. All subjects completed a hand-pain diagram and underwent a standardized nerve conduction study (NCS). The reference standard for determining CTS status was a classic or probable hand pain diagram and NCS with a difference >0.3 ms between the 8-cm median and ulnar peak latencies. Readers graded multiple imaging parameters of the MRI on four-point scales. The authors also performed quantitative measurements of both the median nerve and carpal tunnel cross-sectional areas. NCS and MRI were interpreted without knowledge of the other study or the hand pain diagram.
Results: Intrareader reliability was substantial to near perfect (kappa = 0.76 to 0.88). Interreader agreement was lower but still substantial (kappa = 0.60 to 0.67). Sensitivity of MRI was greatest for the overall impression of the images (96%) followed by increased median nerve signal (91%); however, specificities were low (33 to 38%). The length of abnormal signal on T2-weighted images was significantly correlated with nerve conduction latency, and median nerve area was larger at the distal radioulnar joint (15.8 vs 11.8 mm2) in patients with CTS. A logistic regression model combining these two MR variables had a receiver operating characteristic area under the curve of 0.85.
Conclusions: The reliability of MRI is high but the diagnostic accuracy is only moderate compared with a research-definition reference standard.
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