Diabetic peripheral neuropathy (DPN) is a common complication of diabetes mellitus (DM). The typical manifestation is a length-dependent "glove and sock" sensation. At present, diagnosis is mainly dependent on clinical manifestations. Since the pathogenesis is not clear, there are no effective treatment measures. Management consists mainly of glucose control, peripheral nerve nutrition, and other measures to delay the progress of the disease; early diagnosis is therefore crucial to improving prognosis and quality of life for patients with DPN. Due to the lack of obvious symptoms in 50% of patients and the low sensitivity of neuro-electrophysiology to small fibers, the missed diagnosis rate is high. Highresolution ultrasound (HRU), as a convenient noninvasive tool, has been proven by many studies to have excellent clinical value in diagnosing DPN. With the development of related new technology, HRU shows promise for the screening, diagnosing, and follow-up of DPN, which could serve as a biomarker and provide new diagnostic insights. In this paper, we review the ability of HRU to detect nerve cross-sectional area and blood flow, and echo and other image changes, and in showing the characteristics of peripheral nerve morphological changes in patients with DPN. We also explore the application of two other recent technological developments-shear wave elastography (SWE) and ultrasound scoring systems-in improving the diagnostic efficiency of HRU in peripheral neuropathy.
Objectives To summarize the ultrasonic characteristics of peripheral nerve damage in type 2 diabetes and to verify the diagnostic value of DCEC score for DPN. Methods A total of 289 patients with type 2 diabetes evaluated peripheral neuropathy with neuroultrasound and nerve conduction at the Affiliated Hospital of Guizhou Medical University from June 2016 to June 2020. According to the diagnostic criteria from 2017 guidelines of China, 289 patients with type 2 diabetes were divided into three groups: DPN group: 203 cases; subclinical group: 48 cases; and non-DPN group: 38 cases. Kruskal Wallis test was used to identify the differences and characteristics of ultrasound scores between the all groups. The best cut-off value, sensitivity and specificity of DCEC score were obtained by receiver operator characteristic curve. Taking the diagnostic standard of diabetes peripheral neuropathy as the “gold standard”, the best diagnostic threshold, sensitivity and specificity were obtained by drawing the ROC curve of DCEC score, and then the diagnostic value of DCEC score for DPN was verified Results Compared with non-DPN group, DCEC score in DPN group was significantly higher (P < 0.05). Otherwise,according to the ROC curve, the best cut-off value of DCEC score for DPN diagnosis was 12.5 (sensitivity 69.7%, specificity 71.1%). Conclusions The DCEC score system can effectively diagnose DPN with length-dependence,mainly including the increase of definition score.
Diabetic peripheral neuropathy is the most prevalent chronic complication of diabetes and is based on sensory and autonomic nerve symptoms. Generally, intensive glucose control and nerve nourishment are the main treatments. However, it is difficult to improve the symptoms for some patients; such cases are defined as refractory diabetic peripheral neuropathy (RDPN). In this paper, we present five patients treated with saline and mecobalamin by ultrasound-guided injection. The Visual Analog Scale and Toronto Clinical Scoring System were used to evaluate the symptoms, and the neuro-ultrasound scoring system and electrophysiological severity scale were evaluated by ultrasound and electrophysiological examination. In brief, ultrasound-guided hydrodissection may be a safe way to treat RDPN.
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