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

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 HbA_1c 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 HbA_1c. 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 HbA_1c 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 HbA_1c. 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

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