ELASTOGRAPHY OF THE TIBIAL NERVE IN INJURIES CAUSED BY GUNSHOT TRAUMA
Tatarina A.V.1, Dubrovskikh S.N.1, Gumerova E.A.1, Stepanova Yu.A.2
1 - National Medical Research Center of High Medical Technologies - A.A. Vishnevsky Central Military Clinical Hospital.
Krasnogorsk, Russia.
2 - A.V. Vishnevsky National Medical Research Center of Surgery. Moscow, Russia.
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o examine the capability of elastography (compression elastography and shear wave elastography) in the diagnosis of peripheral nerve damage due to gunshot injury.
Material and methods. The results of shear wave elastography and compression elastography of the tibial nerve for 35 patients treated from March 2022 to March 2024 with signs of traumatic damage to the peripheral nerves of the lower extremities were analyzed and compared with a control group consisting of 30 volunteers without signs of neuropathy and traumatic history. The study was carried out using a linear sensor with a frequency range from 4 to 9 MHz on an ACUSSON S2000 device in B-mode with cross-sectional area (CSA) measurement in cm2. Color images with color gradation were obtained in compression elastography mode, three-fold measurements were performed in shear wave elastography mode, average stiffness values (E) were calculated in kPa, shear wave propagation velocity (VS) values was calculated in m/s.
Results. The stiffness of the tibial nerve and the velocity of shear wave propagation in the study group were significantly higher than those in the control group. A correlation was revealed with the CSA of the nerve. The optimal threshold value of the tibial nerve SWE in traumatic nerve injury was determined as 31.58 kPa. The sensitivity and specificity of the model were 82.9% and 66.7%, respectively. The threshold value of the wave propagation velocity was determined as 3.01 m/s. The sensitivity and specificity of the model were 94.3% and 53.3%, respectively.
It is shown that the stiffness and velocity of the shear wave propagation do not depend on the side of the traumatic injury, on the segment of the damaged nerve, on the time elapsed from the moment of injury to the study and on the surgical treatment of the nerve trunk in the anamnesis.
Discussion. The results obtained in the current work were compared with the results of other studies of the tibial nerve. The differences in the data can be predominantly attributed to use of ultrasound scanners from different manufacturers, as well as to the fact that studies by other authors were conducted with patients possessing signs of diabetic neuropathy with the control group of healthy individuals. At the same time, the indicators described for the control group (without signs of neuropathy) of the study by A.S. Dikici et al. (2019) are similar to our data for the control group. The tendency to increase of the nerve stiffness upon its structural changes is highlighted in all studies.
Conclusion. The results of the current study show that nerve stiffness tends to increase with traumatic damage to peripheral nerves, which corresponds to the loss of elastic myelin and its replacement by connective tissue. Sonoelastography as a non-invasive method can be employed as an additional tool in the diagnosis of traumatic damage to the peripheral nerves. Therefore, for further application of the method a standardized protocol needs to be developed.
Keywords: tibial nerve, ultrasound, elastography, shear wave, nerve injury.
Corresponding author: Tatarina A.V., e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript
For citation: Tatarina A.V., Dubrovskikh S.N., Gumerova E.A., Stepanova Yu.A. Elastography of the tibial nerve in injuries caused by gunshot trauma. REJR 2024; 14(4):153-166. DOI: 10.21569/2222-7415-2024-14-4-153-166.
Received: 27.06.24 Accepted: 22.10.24