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Ultraschall Med
DOI: 10.1055/a-2589-8675
Original Article

Significance of high-resolution ultrasound imaging and elastography as early predictors of diabetic peripheral neuropathy

Bedeutung von hochauflösendem Ultraschall und Elastografie als frühe Prädiktoren einer diabetischen Polyneuropathie
Ahmed Elshimy 
1   Radiology Department, Ain Shams University Faculty of Medicine, Cairo, Egypt (Ringgold ID: RIN68792)
,
Ghada Elshimy
2   Endocrinology, Augusta University Medical College of Georgia, Augusta, United States (Ringgold ID: RIN160343)
,
Ahmed Mohamed Abouelhoda 
1   Radiology Department, Ain Shams University Faculty of Medicine, Cairo, Egypt (Ringgold ID: RIN68792)
,
Ahmed Abdellatif Awad
3   Physical Medicine, Rheumatology and Rehabilitation, Ain Shams University Faculty of Medicine, Cairo, Egypt (Ringgold ID: RIN68792)
,
Omar Farouk 
1   Radiology Department, Ain Shams University Faculty of Medicine, Cairo, Egypt (Ringgold ID: RIN68792)
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Abstract

Purpose

To evaluate the significance of high-resolution ultrasound (HRUS) and shear wave elastography (SWE) in the diagnosis of diabetic peripheral neuropathy (DPN) to clarify their possible roles as early predictors of the occurrence of this important complication.

Materials and Methods

The study included 90 patients with diabetes mellitus with different clinical stages of DPN as well as 30 healthy controls. A full history, clinical examination, and assessment of both the Toronto Clinical Neuropathy Score (TCNS) and HbA1c were performed, followed by real-time HRUS and SWE examinations of their right and left tibial and median nerves to assess their cross-sectional area (CSA) and nerve stiffness, respectively.

Results

The CSA and stiffness of tibial and median nerves were significantly increased in patients with diabetes compared to controls, with higher values associated with the severity of their DPN. Both parameters were correlated with each other and with the duration of the disease, TCNS, and HbA1c. The CSA cut-off value of both tibial and median nerves to detect DPN in patients was 13.5 mm2, meanwhile, the SWE cut-off values were 68.5 and 61.5 KPa, respectively. SWE showed a higher AUC than CSA for the prediction of DPN.

Conclusion

Measurement of the CSA and stiffness of the peripheral nerves could be a reliable tool for early detection of DPN. Therefore, we recommend adding these noninvasive diagnostic parameters as complementary diagnostic tools to the routine follow-up schedule of diabetic complications, especially in long-standing cases.

Zusammenfassung

Ziel

Bewertung der Bedeutung des hochauflösenden Ultraschalls (HRUS) und der Scherwellen-Elastografie (SWE) bei der Diagnose der diabetischen Polyneuropathie (DPN), um deren mögliche Eignung als frühe Prädiktoren für das Auftreten dieser wichtigen Komplikation zu klären.

Material und Methoden

Die Studie umfasste 90 Patienten mit Diabetes mellitus in unterschiedlichen klinischen Stadien der DPN sowie 30 gesunde Kontrollpersonen. Es wurden eine vollständige Anamnese, eine klinische Untersuchung und eine Bewertung anhand des “Toronto Clinical Neuropathy Score” (TCNS) und des HbA1c durchgeführt, gefolgt von Echtzeit-HRUS- und SWE-Untersuchungen der beidseitigen Nervi tibiales und Nervi mediani, um deren Querschnittsfläche (CSA) bzw. Nervensteifigkeit zu bestimmen.

Ergebnisse

Die CSA und die Steifigkeit von N. tibialis und N. medianus waren bei Patienten mit Diabetes im Vergleich zu den Kontrollen signifikant erhöht, wobei höhere Werte mit dem Schweregrad der DPN in Zusammenhang standen. Beide Parameter korrelierten untereinander und mit der Dauer der Erkrankung, dem TCNS und dem HbA1c. Für die Erkennung von DPN bei Patienten lag der CSA-Grenzwert sowohl für die N. tibialis als auch für den N. medianus bei 13,5 mm2, während die SWE-Cutoffs bei 68,5 bzw. 61,5 kPa lagen. Die SWE zeigte eine höhere AUC als die CSA für die Vorhersage einer DPN.

Schlussfolgerung

Die Messung von CSA und Steifigkeit der peripheren Nerven könnte ein zuverlässiges Mittel zur Früherkennung einer DPN sein. Daher empfehlen wir, diese nichtinvasiven diagnostischen Parameter als ergänzendes Diagnoseinstrument in den Routine-Nachsorgeplan für diabetische Komplikationen aufzunehmen, insbesondere bei Langzeitfällen.

Keywords

Shear wave elastography - Ultrasound of peripheral nerves - Diabetic polyneuropathy


Publication History

Received: 14 September 2024

Accepted after revision: 02 April 2025

Article published online:
05 May 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

  • References

  • 1 International Diabetes Federation Diabetes Atlas (2021) Diabetes around the world in 2021. Accessed May 01, 2024 at: https://diabetesatlas.org/
    PubMed
  • 2 Falck S, Nail R. Symptoms and complications of diabetes. 2019 Accessed May 01, 2024 at: https://www.medicalnewstoday.com/articles/323644.php
    PubMedSearch in Google Scholar
  • 3 Hick CW, Selvin E. Epidemiology of peripheral neuropathy and lower extremity disease in diabetes. Curr Diab Rep 2019; 19 (10) 86
    CrossrefPubMedSearch in Google Scholar
  • 4 Singh K, Gupta K, Kaur S. High resolution ultrasonography of the tibial nerve in diabetic peripheral neuropathy. J Ultrason 2017; 17: 246-252
    CrossrefPubMedSearch in Google Scholar
  • 5 Kelle B. et al. Diabetic peripheral neuropathy: Correlation between nerve cross-sectional area on ultrasound and clinical features. J Back Musculoskelet Rehabil 2016; 29: 717-722
    CrossrefPubMedSearch in Google Scholar
  • 6 Ibrahim HR. Diagnostic value of shear wave ultrasound elastography of tibial nerve in patients with diabetic peripheral neuropathy. Egypt J Radiol Nucl Med 2022; 53: 102
    CrossrefPubMedSearch in Google Scholar
  • 7 Oglat AA, Abukhalil T. Ultrasound Elastography: Methods, Clinical Applications, and Limitations: A Review Article. Appl. Sci 2024; 14 (10) 4308
    CrossrefPubMedSearch in Google Scholar
  • 8 American Diabetes Association. Glycemic targets: standards of medical care in diabetes – 2020. Diabetes Care 2020; 43 (Suppl. 01) S66-S76
    CrossrefPubMedSearch in Google Scholar
  • 9 Udayashankar D. et al. Applicability of Toronto Clinical Neuropathy Scoring and its correlation with diabetic peripheral neuropathy: A prospective cross-sectional study. J Clin Diagnostic Res 2017; 11 (12) 10-13
    CrossrefPubMedSearch in Google Scholar
  • 10 Chen S. et al. Electrodiagnostic reference values for upper and lower limb nerve conduction studies in adult populations. Muscle Nerve 2016; 54: 371-377
    CrossrefPubMedSearch in Google Scholar
  • 11 Ishibashi F. et al. Elasticity of the tibial nerve assessed by sonoelastography was reduced before the development of neuropathy and further deterioration associated with the severity of neuropathy in patients with type 2 diabetes. J Diabetes Investig 2016; 7: 404-412
    CrossrefPubMedSearch in Google Scholar
  • 12 He Y. et al. Shear wave elastography evaluation of the median and tibial nerve in diabetic peripheral neuropathy. Quant Imaging Med Surg 2019; 9 (02) 273-282
    CrossrefPubMedSearch in Google Scholar
  • 13 Hobson-Webb LD, Massey JM, Juel VC. Nerve ultrasound in diabetic polyneuropathy: correlation with clinical characteristics and electrodiagnostic testing. Muscle Nerve 2013; 47: 379-384
    CrossrefPubMedSearch in Google Scholar
  • 14 Watanabe T. et al. Sonographic evaluation of the peripheral nerve in diabetic patients: the relationship between nerve conduction studies, echo intensity, and cross-sectional area. J Ultrasound Med 2010; 29: 697-708
    CrossrefPubMedSearch in Google Scholar
  • 15 Pitarokoili K. et al. Facing the diagnostic challenge: nerve ultrasound in diabetic patients with neuropathic symptoms. Muscle Nerve 2016; 54: 18-24
    CrossrefPubMedSearch in Google Scholar
  • 16 Dikici AS. et al. Evaluation of the tibial nerve with shear-wave elastography: a potential sonographic method for the diagnosis of diabetic peripheral neuropathy. Radiology 2017; 282: 494-501
    CrossrefPubMedSearch in Google Scholar
  • 17 Gadalla AA. et al. Quantitative shear wave elastography assessment of tibial nerve in diagnosis of diabetic peripheral neuropathy. Egypt J Radiol Nucl Med 2022; 53: 131
    CrossrefPubMedSearch in Google Scholar
  • 18 Wang C. et al. Evaluation of the clinical value of shear wave elastography for early detection and diagnosis of diabetic peripheral neuropathy: a controlled preliminary prospective clinical study. BMC Musculoskelet Disord 2022; 23 (01) 1120
    CrossrefPubMedSearch in Google Scholar
  • 19 Huang H. et al. Sensitivity and specificity of high frequency ultrasound score (DCEC) in diabetic peripheral neuropathy. J Diabetes Metab Disord 2022; 21: 1459-1467
    CrossrefPubMedSearch in Google Scholar
  • 20 Ranjan T. et al. Role of high-resolution ultrasonography in the evaluation of the tibial and median nerves in diabetic peripheral neuropathy. J Ultrason 2022; 22: e209-e215
    CrossrefPubMedSearch in Google Scholar
  • 21 Zimmerman M. et al. Carpal tunnel syndrome and diabetes – a comprehensive review. J Clin Med 2022; 11 (06) 1674
    CrossrefPubMedSearch in Google Scholar
  • 22 Wang F. et al. Value of shear wave elastography combined with the Toronto clinical scoring system in diagnosis of diabetic peripheral neuropathy. Medicine (Baltimore) 2021; 100 (35) e27104
    CrossrefPubMedSearch in Google Scholar
  • 23 Pradhan DR. et al. Shear wave elastography of tibial nerve in patients with diabetic peripheral neuropathy-A cross-sectional study. Skeletal Radiol 2024; 53 (03) 547-554
    CrossrefPubMedSearch in Google Scholar