Jiaan Zhu

Preliminary Evaluation of the Sural Nerve Using 22-MHz Ultrasound: A New Approach for Evaluation of Diabetic Cutaneous Neuropathy

Background The application of 22-MHz high-frequency ultrasound allows for visualization of the inner part of the sural nerve. The aim of this study was to evaluate the morphological changes of sural nerves in patients with type 2 diabetes mellitus using ultrasound. Materials and Methods The thickness/width (T/W) ratio, the cross-sectional area (CSA) of the sural nerves and the maximum thickness (MT) of the nerve fascicles were measured in 100 patients with type 2 diabetes mellitus and 50 healthy volunteers using 22-MHz ultrasound. Receiver operating characteristic (ROC) curves were plotted to determine the optimal cut-off values as well as the sensitivities and specificities. All parameters were significantly different between the subject and control groups. The ROC curves demonstrated that the MT was the most predictive of diabetic cutaneous neuropathy, with an optimal cut-off value of 0.365 mm that yielded a sensitivity of 90.3% and a specificity of 87.7%. Conclusions The results of this study suggest that 22-MHz ultrasound may be a valuable tool for evaluating diabetic cutaneous nerve neuropathy.

Ultrasound-guided, minimally invasive, percutaneous needle puncture treatment for tennis elbow

IntroductionThis report evaluates the efficacy of percutaneous needle puncture under sonographic guidance in treating lateral epicondylitis (tennis-elbow).MethodsUltrasound-guided percutaneous needle puncture was performed on 76 patients who presented with persistent elbow pain. Under a local anesthetic and sonographic guidance, a needle was advanced into the calcification foci and the calcifications were mechanically fragmented. This was followed by a local injection of 25 mg prednisone acetate and 1% lidocaine. If no calcification was found then multiple punctures were performed followed by local injection of 25 mg prednisone acetate and 1% lidocaine. A visual analog scale (VAS) was used to evaluate the degree of pain pre-and posttreatment at 1 week to 24 weeks. Elbow function improvement and degree of self-satisfaction were also evaluated.ResultsOf the 76 patients, 55% were rated with excellent treatment outcome, 32% good, 11% average, and 3% poor. From 3 weeks posttreatment, VAS scores were significantly reduced compared with the pretreatment score (P<0.05) and continued to gradually decline up to 24 weeks posttreatment. Sonography demonstrated that the calcified lesions disappeared completely in 13% of the patients, were reduced in 61% of the patients, and did not change in 26% of the patients. Color Doppler flow signal used to assess hemodynamic changes showed a significant improvement after treatment in most patients.ConclusionUltrasound-guided percutaneous needle puncture is an effective and minimally invasive treatment for tennis elbow. Sonography can be used to accurately identify the puncture location and monitor changes.

Preliminary study of the types of traumatic peripheral nerve injuries by ultrasound.

ObjectivesTo investigate the types of traumatic peripheral nerve injuries by ultrasound (US). To demonstrate the efficacy of US in case of peripheral nerve injuries and, in particular, its importance of demonstrating and monitoring the appearances of the nerve itself.MethodsTwo hundred and two patients, of which 117 subsequently underwent operative treatment, were prospectively examined by US in such a way that the transducer was moved to the nerve damaged region from the normal nerve located near a known anatomical landmark. The ultrasound features of the traumatic peripheral nerve injuries were classified according to abnormal fascicle, perineurium, epineurium, and peripheral tissues of peripheral nerve.ResultsThe ultrasound features of the traumatic peripheral nerve injuries were classified into 7 types. In the 117 cases that underwent operative treatment, the accuracy of classification by using US was 93.2%.ConclusionsUltrasound seems to be a valuable investigation for evaluating the type of traumatic peripheral nerve injury.

Ultrasound microbubble contrast agents: Application to therapy for peripheral vascular disease

Ultrasound contrast agents are not only effective in ultrasonic imaging but are also important tools for drug or gene delivery. Ultrasound beams can disrupt microbubbles and cell membranes, offering the opportunity to locally deliver drugs or genes. Liposome-shelled microbubbles have many advantages and are widely used in many applications, while Lipofectamine™ (Invitrogen, Life Technologies, Carlsbad, CA, USA), as a material of microbubble membranes, has been used to enhance the effects of gene delivery. Ultrasound contrast agents that have therapeutic effects can be used for treating peripheral vascular diseases, particularly in thrombotic and angiogenic diseases. A combination of targeted contrast agent and drug-carrying contrast agent may be safer and more effective in treating thrombosis. Vascular endothelial growth factor-loaded microbubbles are expected to treat a variety of neovascular diseases such as severe limb ischemia and other diseases. Although there are several limitations in the application of therapeutic ultrasound microbubble contrast agents, it will offer a new hope for the treatment of peripheral vascular disease.

Scanning of the sacroiliac joint and entheses by color Doppler ultrasonography in patients with ankylosing spondylitis.

Objective. To assess Doppler ultrasonography by comparing its detection of sacroiliitis with detection of enthesitis in patients with ankylosing spondylitis (AS). Methods. One hundred sixty-one patients with AS (according to modified New York criteria or Spondyloarthritis International Society classification criteria for axial spondyloarthritis) underwent ultrasonography (US) of the sacroiliac joint (SIJ) and major entheses of the lower limbs. Vascularization of the SIJ and morphologic changes and vascularization of entheses were observed. The resistive index of the SIJ was measured. Doppler ultrasonography examination was repeated in 20 patients by another ultrasonographer. Results. In the AS active group [Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) ≥ 4], 90.7% of SIJ showed vascularization; this was significantly more than in the inactive group (38.5%). The resistive index of the active group in the SIJ area was significantly lower than that of the inactive group. Doppler US scanning of the SIJ was more sensitive (92.0%) than that of the entheses (52.2%). Agreement of Doppler US scanning of the SIJ and BASDAI was good, while agreement of the entheses and BASDAI was poor. Conclusion. Lower resistive index value and vascularization in the SIJ had good agreement with AS activity. Doppler US is more sensitive in detecting sacroiliitis than in detecting enthesitis.

Carpal Tunnel Syndrome Assessment with Ultrasonography: Value of Inlet-to-Outlet Median Nerve Area Ratio in Patients versus Healthy Volunteers

Objective To evaluate the diagnostic value of the Inlet-to-outlet median nerve area ratio (IOR) in patients with clinically and electrophysiologically confirmed carpal tunnel syndrome (CTS). Methods Forty-six wrists in 46 consecutive patients with clinical and electrodiagnostic evidence of CTS and forty-four wrists in 44 healthy volunteers were examined with ultrasonography. The cross-sectional area (CSA) of the median nerve was measured at the carpal tunnel inlet (the level of scaphoid-pisiform) and outlet (the level of the hook of the hamate), and the IOR was calculated for each wrist. Ultrasonography and electrodiagnostic tests were performed under blinded conditions. Electrodiagnostic testing combined with clinical symptoms were considered to be the gold standard test. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic value between the inlet CSA and IOR. Results The study population included 16 men and 30 women (mean age, 45.3 years; range, 18–83 years). The control population included 18 men and 26 women (mean age, 50.4 years; range, 18–79 years). The mean inlet CSA was 8.7 mm2 in healthy controls and 14.6mm2 in CTS group (P<0.001). The mean IOR in healthy volunteers (1.0) was smaller than that in patients (1.6, P<0.001). Receiver operating characteristic analysis revealed a diagnostic advantage to using the IOR rather than the inlet CSA (P<0.01). An IOR cutoff value of ≥ 1.3 would yield 93% specificity and 91% sensitivity in the diagnosis of CTS. Conclusion The IOR of median nerve area promises to be an effective means in the diagnosis of CTS. A large-scale, randomized controlled trial is required to determine how and when this parameter will be used.

Preliminary study of sural nerve morphological changes in uremic hemodialysis patients using 22-MHz high-frequency ultrasound

Introduction: The aim of this study was to evaluate the ultrasound (US) morphological changes of sural nerves (SNs) of uremic patients on hemodialysis. Methods: Sixty‐six SNs in 33 uremic patients were examined by 22‐MHZ high‐frequency US and routine nerve conduction studies (NCS), and 76 SNs in 38 controls were also examined. Cross‐sectional area (CSA) and maximal fascicular thickness (MFT) of the SNs were measured. Results: The inner parts of the SN were clearly identified in all participants. There were significant increases in CSA and MFT in the patient group (1.86 ± 0.53 mm2 and 0.37 ± 0.08 mm, respectively) compared with the control group (1.38 ± 0.25 mm2 and 0.32 ± 0.03 mm, respectively) (P < 0.001). Fifty‐seven SNs (86.36%) had abnormal CSAs, and 51 SNs (77.27%) had abnormal MFTs in the patient group, which was higher than NCS abnormalities (66.67%). Conclusions: A 22‐MHZ US can show morphological changes in the SNs of uremic patients and may be a valuable tool. Muscle Nerve, 2012

Evaluating the long-term effect of ultrasound-guided needle puncture without aspiration on calcifying supraspinatus tendinitis.

IntroductionThe aim of this study was to evaluate whether aspiration affects patient outcome during ultrasound-guided needle puncture treatment for calcifying supraspinatus tendinitis.MethodsEighty-one patients with calcifying supraspinatus tendinitis received needle puncture therapy under ultrasonography guidance. Group A received ultrasound-guided percutaneous needle punctures and aspiration of calcareous deposits, while Group B received ultrasound-guided punctures only. Patients were evaluated using a visual analog scale (VAS) for pain, shoulder function, and satisfaction 1, 2, 3, 6, 12, 24, and 36 weeks after treatment. The different VAS parameters were combined and the differences between groups were analyzed.ResultsIn both groups, VAS scores significantly decreased over the 36 weeks following treatment (P<0.05). Overall, the majority (6/7) of the VAS scores were not statistically different between groups.ConclusionThe results of the study suggest that aspirating calcified deposits do not affect patient outcome. Puncturing the calcified deposits (without aspiration) appears to be an effective treatment method for calcifying supraspinatus tendinitis.

An ultrasound study of anatomic variants of the sural nerve

Introduction: There are anatomic variations of the sural nerve (SN). Knowledge of these morphological types and the length of the SN are important for planning surgical reconstruction of peripheral nerves. Our purpose was to classify the morphological types of the SN by using ultrasound. Methods: Two‐hundred SNs in 100 normal subjects were examined by ultrasound with 13‐MHz linear‐array transducers. Classification of the SN was evaluated by its formation. The distance between the union and the distal point of the lateral malleolus was measured. Results: SN variants could be classified into three types: type I (81%); type II (18%); and type III (1%). In type I, the average length of the SN was 15.8 ± 5.7 cm. Conclusions: The morphological types of the SN can be determined using ultrasound. Ultrasound classification of the SN is useful with regard to donor nerve surgical reconstruction of peripheral nerves. Muscle Nerve, 2011

Inverse Association of Serum Vitamin D in Relation to Carotid Intima-Media Thickness in Chinese Postmenopausal Women

Objective This study aimed to investigate the relationship between serum vitamin D level and carotid intima-media thickness (C-IMT) in Chinese postmenopausal women. Methods Nine hundred and twenty six Chinese postmenopausal women without carotid artery plaque or history of cardiovascular disease were selected for analysis. Measurements of serum 25 hydroxyvitamin D3 (25(OH)D3) concentration and C-IMT were made by electrochemiluminescence immunoassay and B-mode ultrasound, respectively. Trend analysis was conducted according to tertiles of C-IMT. Results The median serum 25(OH)D3 level was 11.03 ng/mL, with an interquartile range of 8.22–14.70. A decreasing trend of serum 25(OH)D3 level was accompanied by increased C-IMT tertiles (P for trend = 0.001). Correlation analysis found an inverse relationship between serum 25(OH)D3 level and C-IMT (r = –0.113, P = 0.001). After adjustment for confounding factors, multiple regression analysis showed that serum 25(OH)D3 level independently and negatively associated with C-IMT (Standard β = –0.112, P < 0.001). Moreover, the inverse correlation of serum 25(OH)D3 with C-IMT was also found in a subgroup of women with normal glucose tolerance, blood pressure and body mass index, and without undergoing lipid-lowering therapy (standard β = –0.140, P = 0.018). Conclusions Serum 25(OH)D3 level was inversely correlated with C-IMT in Chinese postmenopausal women.