A study of diffusion tensor imaging of median nerve in diabetic peripheral neuropathy

Edward, Ramy; Abdelalim, Ahmed; Ashour, Amal Adnan; Afifi, Lamia; Al-Athwari, Aussan

doi:10.1186/s41983-020-00172-5

Cited by 8 publications

(26 citation statements)

References 20 publications

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“…Question 2 asks whether the populations studied were clearly defined. Many of the earlier studies did not distinguish between type 1 and 2 diabetes, and often did not make clear from the methods section the number of patients from each group, or which patients were on insulin treatment (Koechner et al, 1995 ; Shibata et al, 1998 ; Wu et al, 2017 ; Edward et al, 2020 ) (14/18 complied). Question 8 asks whether different “levels” of exposure where compared, which in this context relates to whether groups were stratified based on severity or duration of neuropathy or diabetes, to make a more convincing link between disease and MR biomarkers (9/18 complied).…”

Section: Resultsmentioning

confidence: 99%

“…Studies have consistently shown a reduction in FA in patients with DPN compared with both healthy controls and diabetic patients without DPN, for the sciatic nerve (Vaeggemose et al, 2017a , b ; Vaeggemose et al, 2020 ), tibial nerve (Vaeggemose et al, 2017a , b ; Wu et al, 2017 ; Vaeggemose et al, 2020 ; Jende et al, 2020a ), and common peroneal nerve (Wu et al, 2017 ), which has been demonstrated at the thigh and ankle level. Edward et al ( 2020 ) also demonstrated reduced FA in the distal median nerve in the wrist. ADC or MD is a measure of the average diffusivity of protons across all directions, with higher values in nerves suggesting some degree of axonal disruption (Tievsky et al, 1999 ).…”

Section: Narrative Reviewmentioning

confidence: 92%

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Magnetic Resonance Imaging as a Biomarker in Diabetic and HIV-Associated Peripheral Neuropathy: A Systematic Review-Based Narrative

et al. 2021

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Background: Peripheral neuropathy can be caused by diabetes mellitus and HIV infection, and often leaves patients with treatment-resistant neuropathic pain. To better treat this condition, we need greater understanding of the pathogenesis, as well as objective biomarkers to predict treatment response. Magnetic resonance imaging (MRI) has a firm place as a biomarker for diseases of the central nervous system (CNS), but until recently has had little role for disease of the peripheral nervous system.Objectives: To review the current state-of-the-art of peripheral nerve MRI in diabetic and HIV symmetrical polyneuropathy. We used systematic literature search methods to identify all studies currently published, using this as a basis for a narrative review to discuss major findings in the literature. We also assessed risk of bias, as well as technical aspects of MRI and statistical analysis.Methods: Protocol was pre-registered on NIHR PROSPERO database. MEDLINE, Web of Science and EMBASE databases were searched from 1946 to 15th August 2020 for all studies investigating either diabetic or HIV neuropathy and MRI, focusing exclusively on studies investigating symmetrical polyneuropathy. The NIH quality assessment tool for observational and cross-sectional cohort studies was used for risk of bias assessment.Results: The search resulted in 18 papers eligible for review, 18 for diabetic neuropathy and 0 for HIV neuropathy. Risk of bias assessment demonstrated that studies generally lacked explicit sample size justifications, and some may be underpowered. Whilst most studies made efforts to balance groups for confounding variables (age, gender, BMI, disease duration), there was lack of consistency between studies. Overall, the literature provides convincing evidence that DPN is associated with larger nerve cross sectional area, T2-weighted hyperintense and hypointense lesions, evidence of nerve oedema on Dixon imaging, decreased fractional anisotropy and increased apparent diffusion coefficient compared with controls. Analysis to date is largely restricted to the sciatic nerve or its branches.Conclusions: There is emerging evidence that various structural MR metrics may be useful as biomarkers in diabetic polyneuropathy, and areas for future direction are discussed. Expanding this technique to other forms of peripheral neuropathy, including HIV neuropathy, would be of value.Systematic Review Registration: (identifier: CRD 42020167322) https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=167322.

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Section: Resultsmentioning

confidence: 99%

Section: Narrative Reviewmentioning

confidence: 92%

Magnetic Resonance Imaging as a Biomarker in Diabetic and HIV-Associated Peripheral Neuropathy: A Systematic Review-Based Narrative

et al. 2021

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“…Ten studies (32%) were performed at a eld strength of 1•5 tesla 17,29,32,35,38,42,44,49,50,52 , twenty one (65%) at 3 tesla 16,19,[26][27][28]30,31,33,34,36,37,[39][40][41]43,[45][46][47][48]51,53 , and one at 7 tesla 18 . The median echo and repetition times were 87ms (IQR 65-91, range 21-103) and 7000ms (IQR 3800-7650, range 1470-10,254), respectively.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…The FA of the median nerve in asymptomatic adults was reported in 29 studies [16][17][18][19][26][27][28][29][30][31][32][33][34][35][37][38][39][40][41][43][44][45][46][47][48][49][50][51]53 .…”

Section: Evidence Synthesis: Asymptomatic Adultsmentioning

confidence: 99%

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Diffusion Tensor Imaging of the Median Nerve: A Systematic Review and Meta-Analysis of Normal Values in Asymptomatic Adults and How They Change in Carpal Tunnel Syndrome

Rojoa

Raheman

Rassam

et al. 2021

Preprint

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Background: Carpal tunnel syndrome (CTS) leads to distortion of axonal architecture, demyelination and fibrosis within the median nerve. Diffusion tensor imaging (DTI) characterises tissue microstructure and generates reproducible proxy measures of nerve ‘health’ which are sensitive to myelination, axon diameter, fibre density and organisation. This meta-analysis summarises the normal DTI values of the median nerve, and how they change in CTS.Methods: This systematic review included studies reporting DTI of the median nerve at the level of the wrist in adults. The primary outcome was to determine the normal fractional anisotropy (FA) and mean diffusivity (MD) of the median nerve. Secondarily, we show how the FA and MD differ between asymptomatic adults and patients with CTS, and how these differences are independent of the acquisition methods.Results: 32 studies of 2643 wrists, belonging to 1575 asymptomatic adults and 1068 patients with CTS were included. The normal FA was 0·58 (95% CI 0·56, 0·59) and the normal MD was 1·138 x10-3 mm2/s (95% CI 1·101, 1·174). Patients with CTS had a significantly lower FA than controls (mean difference 0·12 [95% CI 0·09, 0·16]). Similarly, the median nerve of patients with CTS had a significantly higher mean diffusivity (mean difference 0·16 mm2/s x10-3 [95% CI 0·05, 0·27]). The differences were independent of experimental factors.Conclusion: We provide summary estimates of the normal FA and MD of the median nerve in asymptomatic adults. Furthermore, we show that diffusion throughout the length of the median nerve becomes more isotropic in patients with CTS.

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Electrodiagnostic studies and new diagnostic modalities for evaluation of peripheral nerve disorders

Hannaford,

Paling,

Silsby

et al. 2024

Muscle and Nerve

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Electrodiagnostic studies (EDx) are frequently performed in the diagnostic evaluation of peripheral nerve disorders. There is increasing interest in the use of newer, alternative diagnostic modalities, in particular imaging, either to complement or replace established EDx protocols. However, the evidence to support this approach has not been expansively reviewed. In this paper, diagnostic performance data from studies of EDx and other diagnostic modalities in common peripheral nerve disorders have been analyzed and described, with a focus on radiculopathy, plexopathy, compressive neuropathies, and the important neuropathy subtypes of Guillain‐Barré syndrome, chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), vasculitic neuropathy and diabetic neuropathy. Overall EDx retains its place as a primary diagnostic modality in the evaluated peripheral nerve disorders. Magnetic resonance imaging and ultrasound have developed important complementary diagnostic roles in compressive and traumatic neuropathies and atypical CIDP, but their value is more limited in other neuropathy subtypes. Identification of hourglass constriction in nerves of patients with neuralgic amyotrophy may have therapeutic implications. Investigation of radiculopathy is confounded by poor correlation between clinical features and imaging findings and the lack of a diagnostic gold standard. There is a need to enhance the literature on the utility of these newer diagnostic modalities.

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A study of diffusion tensor imaging of median nerve in diabetic peripheral neuropathy

Cited by 8 publications

References 20 publications

Magnetic Resonance Imaging as a Biomarker in Diabetic and HIV-Associated Peripheral Neuropathy: A Systematic Review-Based Narrative

Magnetic Resonance Imaging as a Biomarker in Diabetic and HIV-Associated Peripheral Neuropathy: A Systematic Review-Based Narrative

Diffusion Tensor Imaging of the Median Nerve: A Systematic Review and Meta-Analysis of Normal Values in Asymptomatic Adults and How They Change in Carpal Tunnel Syndrome

Electrodiagnostic studies and new diagnostic modalities for evaluation of peripheral nerve disorders

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