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• Clinical Article •
Quantitative microstructural analysis of the ulnar nerve in cubital tunnel syndrome using high-resolution MRI and DTI
LI Yuping  ZHAO Fan  LI Guiping  CHANG Yingwei  LIU Chang  DENG Wenjia 

Cite this article as LI Y P, ZHAO F, LI G P, et al. Quantitative microstructural analysis of the ulnar nerve in cubital tunnel syndrome using high-resolution MRI and DTI[J]. Chin J Magn Reson Imaging, 2026, 17(6): 55-62. DOI:10.12015/issn.1674-8034.2026.06.007.


[Abstract] Objective To investigate the value of high-resolution MRI combined with diffusion tensor imaging (DTI) in the quantitative assessment of ulnar nerve microstructure in cubital tunnel syndrome (CTS) and to analyze the correlation between DTI parameters and clinical severity and electrophysiological parameters.Materials and Methods Forty-two patients with CTS (14 McGowan grade Ⅰ, 18 grade Ⅱ, and 10 grade Ⅲ) and 40 healthy controls were prospectively enrolled. Conventional 3.0 T MRI and DTI were used to measure the ulnar nerve cross-sectional area (CSA), signal intensity ratio, fractional anisotropy (FA), apparent diffusion coefficient (ADC), and radial diffusion coefficient (RD) at the entrance, midsection, and exit of the cubital tunnel. The correlation between imaging parameters and McGowan grade and electrophysiological parameters was analyzed, and the diagnostic performance was evaluated.Results The case group had higher CSA [(19.85 ± 5.32) vs. (8.24 ± 1.86) mm2] and RD [(1.45 ± 0.26) vs. (0.82 ± 0.10) × 10-3 mm2/s] in the mid-cubital tunnel than the control group, while the FA [(0.42 ± 0.09) vs. (0.61 ± 0.04)] was lower (all P < 0.001). FA was positively correlated with motor nerve conduction velocity (r = 0.682), while RD was negatively correlated (r = -0.712). With increasing McGowan grade, FA progressively decreased [grade Ⅰ (0.49 ± 0.06), grade Ⅱ (0.41 ± 0.05), grade Ⅲ (0.32 ± 0.04)], while RD gradually increased. The RD value had the highest diagnostic efficacy [area under the curve (AUC) = 0.918, sensitivity 88.10%, specificity 87.50%], and the AUC of the FA+RD combined model reached 0.943.Conclusions DTI technology can quantitatively assess the microstructural changes of the ulnar nerve in cubital tunnel syndrome. DTI parameters are closely correlated with clinical severity and electrophysiological indices. The combined application of FA and RD values has excellent diagnostic efficacy and provides an objective imaging basis for the early diagnosis and assessment of cubital tunnel syndrome.
[Keywords] cubital tunnel syndrome；ulnar nerve；diffusion tensor imaging；magnetic resonance imaging；peripheral neuropathy

LI Yuping   ZHAO Fan   LI Guiping*   CHANG Yingwei   LIU Chang   DENG Wenjia  

Department of Radiology, Affiliated Hospital of Chengde Medical University, Chengde 067000, China

Corresponding author: LI G P, E-mail: 15633142830@163.com

Conflicts of interest   None.

Received  2026-01-07
Accepted  2026-04-27
DOI: 10.12015/issn.1674-8034.2026.06.007
Cite this article as LI Y P, ZHAO F, LI G P, et al. Quantitative microstructural analysis of the ulnar nerve in cubital tunnel syndrome using high-resolution MRI and DTI[J]. Chin J Magn Reson Imaging, 2026, 17(6): 55-62. DOI:10.12015/issn.1674-8034.2026.06.007.

[1]
ANDERSON D, WOODS B, ABUBAKAR T, et al. A Comprehensive Review of Cubital Tunnel Syndrome[J/OL]. Orthop Rev (Pavia), 2022, 14(3): 38239 [2026-01-07]. https://doi.org/10.52965/001c.38239. DOI: 10.52965/001c.38239.
[2]
LI Z Q, JIANG L, YAO Z Q, et al. Study on interventional treatment of cubital tunnel syndrome under ultrasound guidance[J]. Chinese Journal of Ultrasound in Medicine, 2023, 39(1): 86-89. DOI: 10.3969/j.issn.1002-0101.2023.01.025.
[3]
HUSSEIN M, HANUMANTHU M M, SHIRODKAR K, et al. Cubital tunnel syndrome: anatomy, pathology, and imaging[J]. Skeletal Radiol, 2025, 54(1): 1-15. DOI: 10.1007/s00256-024-04705-4.
[4]
GRAF A, AHMED A S, ROUNDY R, et al. Modern Treatment of Cubital Tunnel Syndrome: Evidence and Controversy[J]. J Hand Surg Glob Online, 2023, 5(4): 547-560. DOI: 10.1016/j.jhsg.2022.07.008.
[5]
BABUSIAUX D, LAULAN J, BOUILLEAU L, et al. Contribution of static and dynamic ultrasound in cubital tunnel syndrome[J]. Orthop Traumatol Surg Res, 2014, 100(4Suppl): S209-S212. DOI: 10.1016/j.otsr.2014.03.008.
[6]
CARROLL T J, CHIROKIKH A, THON J, et al. Diagnosis of Ulnar Neuropathy at the Elbow Using Ultrasound-A Comparison to Electrophysiologic Studies[J]. J Hand Surg Am, 2023, 48(12): 1229-1235. DOI: 10.1016/j.jhsa.2023.08.014.
[7]
AGGARWAL A, JANA M, SRIVASTAVA D N, et al. Magnetic resonance neurography and ultrasonogram findings in upper limb peripheral neuropathies[J]. Neurol India, 2019, 67(Supplement): S125-S134. DOI: 10.4103/0028-3886.250701.
[8]
AGARWAL A, CHANDRA A, JAIPAL U, et al. Can imaging be the new yardstick for diagnosing peripheral neuropathy?-a comparison between high resolution ultrasound and MR neurography with an approach to diagnosis[J/OL]. Insights Imaging, 2019, 10(1): 104 [2026-01-07]. https://doi.org/10.1186/s13244-019-0787-6. DOI: 10.1186/s13244-019-0787-6.
[9]
ALBANO D, DI ROCCO G, GITTO S, et al. Imaging of elbow entrapment neuropathies[J/OL]. Insights Imaging, 2025, 16(1): 24 [2026-01-07]. https://doi.org/10.1186/s13244-025-01901-1. DOI: 10.1186/s13244-025-01901-1.
[10]
BOONSUTH R, BATTISTON M, GRUSSU F, et al. Feasibility of in vivo multi-parametric quantitative magnetic resonance imaging of the healthy sciatic nerve with a unified signal readout protocol[J/OL]. Sci Rep, 2023, 13(1): 6565 [2026-01-07]. https://doi.org/10.1038/s41598-023-33618-w. DOI: 10.1038/s41598-023-33618-w.
[11]
FOESLEITNER O, KNOP K C, LINDENAU M, et al. Quantitative MR Neurography in Multifocal Motor Neuropathy and Amyotrophic Lateral Sclerosis[J/OL]. Diagnostics (Basel), 2023, 13(7): 1237 [2026-01-07]. https://doi.org/10.3390/diagnostics13071237. DOI: 10.3390/diagnostics13071237.
[12]
SANTOS L A, SULLIVAN B, KVIST O, et al. Diffusion tensor imaging of the physis: the ABC's[J]. Pediatr Radiol, 2023, 53(12): 2355-2368. DOI: 10.1007/s00247-023-05753-z.
[13]
CHOI S W, BAE J Y, SHIN Y H, et al. Reliability and validity of the modified McGowan grade in patients with cubital tunnel syndrome[J]. Arch Orthop Trauma Surg, 2022, 142(7): 1697-1703. DOI: 10.1007/s00402-022-04367-8.
[14]
EHLER E, RIDZOŇ P, URBAN P, et al. Ulnar nerve at the elbow - normative nerve conduction study[J/OL]. J Brachial Plex Peripher Nerve Inj, 2013, 8(1): 2 [2026-01-07]. https://doi.org/10.1186/1749-7221-8-2. DOI: 10.1186/1749-7221-8-2.
[15]
American Association of Electrodiagnostic Medicine, American Academy of Neurology, American Academy of Physical Medicine and Rehabilitation. Practice parameter for electrodiagnostic studies in ulnar neuropathy at the elbow: summary statement[J/OL]. Muscle Nerve, 1999, 22(3): 408-411. DOI: 10.1002/(sici)1097-4598(199903)22:3<408::aid-mus16>3.0.co;2-7.
[16]
KIM K H, LEE M H, PARK S Y, et al. Ulnar neuropathy at the elbow: associations of pre-operative DTI parameters with clinical outcomes after cubital tunnel decompression[J]. Eur Radiol, 2023, 33(9): 6351-6358. DOI: 10.1007/s00330-023-09562-8.
[17]
KIMURA M, NAGATA S, SUZUKI M, et al. The relationship between diffusion tensor imaging and the clinical classification of cubital tunnel syndrome[J]. Radiol Phys Technol, 2024, 17(3): 645-650. DOI: 10.1007/s12194-024-00813-x.
[18]
HU Q Q, LIU C, ZOU Y F. Imaging and clinical application of MRI in the diagnosis of cubital tunnel syndrome[J]. Radiol Prac, 2017, 32(12): 1286-1290. DOI: 10.13609/j.cnki.1000-0313.2017.12.017.
[19]
LI L, CHEN P, YANG Y, et al. Clinical value of high-frequency Doppler ultrasound in the diagnosis of cubital tunnel syndrome and carpal tunnel syndrome[J]. Journal of China Clinic Medical Imaging, 2024, 35(6): 434-438. DOI: 10.12117/jccmi.2024.06.011.
[20]
HAN Z Y, CHEN A Q, LI X Z, et al. Application of 3D-T2WI-DESS and DTI imaging techniques in lumbosacral nerve anatomy and functional imaging[J]. J Clin Radiol, 2025, 44(4): 737-742. DOI: 10.13437/j.cnki.jcr.2025.04.036.
[21]
WENG N, SHAO C J, LI G D, et al. Quantitative analysis of early myelin sheath structural changes in rats with ischemic stroke by MRI signal intensity ratio combined with diffusion tensor imaging[J]. Chin J Magn Reson Imaging, 2022, 13(10): 150-156. DOI: 10.12015/issn.1674-8034.2022.10.023.
[22]
HUANG Y F, LU Y. Application value and research progress of DTI in the diagnosis of MSA[J]. Chinese Journal of Medical Imaging, 2023, 29(6): 709-712. DOI: 10.19627/j.cnki.cn31-1700/th.2023.06.013.
[23]
HAN D, SUN Y, LIU C J, et al. Quantitative Diagnostic Study of Neuromyelitis Optic by Conventional MRI and DTI[J]. The Journal of Practical Medicine, 2023, 39(8): 1035-1039. DOI: 10.3969/j.issn.1006-5725.2023.08.020.
[24]
MENG P, LI Y X, ZHOU X Y, et al. Application of functional magnetic resonance imaging in the early diagnosis of Parkinson's disease with mild cognitive impairment[J]. Journal of China Clinic Medical Imaging, 2025, 36(12): 842-845, 854. DOI: 10.12117/jccmi.2025.12.002.
[25]
WADE R G, TAKWOINGI Y, WORMALD J C R, et al. Meta-analysis of the normal diffusion tensor imaging values of the peripheral nerves in the upper limb[J/OL]. Sci Rep, 2023, 13(1): 4852 [2026-01-07]. https://doi.org/10.1038/s41598-023-31307-2. DOI: 10.1038/s41598-023-31307-2.
[26]
TANG L M R, XU Y. Research progress on biomarkers for early diagnosis and prognostic assessment of cerebral small vessel disease[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2023, 23(11): 978-985. DOI: 10.3969/j.issn.1672-6731.2023.11.024.
[27]
OOSTERBOS C, RADWAN A M, SUNAERT S, et al. Diffusion tensor imaging in peroneal neuropathy: a prospective, single-centre study[J/OL]. BMJ Neurol Open, 2025, 7(1): e000876 [2026-04-03]. https://pubmed.ncbi.nlm.nih.gov/39850797/. DOI: 10.1136/bmjno-2024-000876.
[28]
GASPAROTTI R, SALVALAGGIO A, CORBO D, et al. Magnetic resonance neurography and diffusion tensor imaging of the sciatic nerve in hereditary transthyretin amyloidosis polyneuropathy[J]. J Neurol, 2023, 270(10): 4827-4840. DOI: 10.1007/s00415-023-11813-z.
[29]
WANG S, LI Y, XING X, et al. DTI changes of brachial plexus nerve roots in amyotrophic lateral sclerosis and their correlation with electrophysiology[J/OL]. Eur Radiol Exp, 2025, 9(1): 107 [2026-01-07]. https://doi.org/10.1186/s41747-025-00645-3. DOI: 10.1186/s41747-025-00645-3.
[30]
UEHARA K, HASHIMOTO T, YUKATA K, et al. Clinical significance of upper arm motor nerve conduction velocity in cubital tunnel syndrome[J/OL]. J Hand Surg Eur Vol, 2024, 49(10): 1340-1347. DOI: 10.1177/17585732241293360.
[31]
REN Y M, TANG X Y, ENGSTROM B I, et al. Surgical decision making for mild-to-moderate cubital tunnel syndrome[J/OL]. J Hand Surg Glob Online, 2024, 6(3): 341-346. DOI: 10.1016/j.jhsg.2024.02.011.
[32]
BAUMER P, PHAM M, RUETTERS M, et al. Peripheral neuropathy: detection with diffusion-tensor imaging[J]. Radiology, 2014, 273(1): 185-193. DOI: 10.1148/radiol.14132837.
[33]
ROJOA D, RAHEMAN F, RASSAM J, et al. Meta-analysis of the normal diffusion tensor imaging values of the median nerve and how they change in carpal tunnel syndrome[J/OL]. Sci Rep, 2021, 11(1): 20935 [2026-01-07]. https://doi.org/10.1038/s41598-021-00353-z. DOI: 10.1038/s41598-021-00353-z.
[34]
WANG Y, WU W, KANG J, et al. Combination of morphological and multiparametric MR neurography enhances carpal tunnel syndrome diagnosis and evaluation[J/OL]. Sci Rep, 2025, 15(1): 184 [2026-01-07]. https://doi.org/10.1038/s41598-024-84489-8. DOI: 10.1038/s41598-024-84489-8.
[35]
FOTI G, LOMBARDO F, FIGHERA A, et al. Role of diffusion tensor imaging of sciatic nerve in symptomatic patients with inconclusive lumbar MRI[J/OL]. Eur J Radiol, 2020, 131: 109249 [2026-01-07]. https://doi.org/10.1038/s41598-024-84489-8. DOI: 10.1016/j.ejrad.2020.109249.
[36]
SAKAI T, AOKI Y, WATANABE A, et al. Functional Assessment of Lumbar Nerve Roots Using Coronal-plane Single-shot Turbo Spin-echo Diffusion Tensor Imaging[J]. Magn Reson Med Sci, 2020, 19(2): 159-165. DOI: 10.2463/mrms.tn.2019-0014.
[37]
VOSER T, MARTIN M, MURISET I, et al. Outcome Prediction by Diffusion Tensor Imaging (DTI) in Patients with Traumatic Injuries of the Median Nerve[J]. Neurol Int, 2024, 16(5): 1026-1038. DOI: 10.3390/neurolint16050078.

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