Evaluation of the Tibial Nerve with Shear-Wave Elastography: A Potential Sonographic Method for the Diagnosis of Diabetic Peripheral Neuropathy

Abstract

Purpose To evaluate the value of shear-wave elastography (SWE) in the detection of diabetic peripheral neuropathy (DPN) of the tibial nerve. Materials and Methods This study was approved by the institutional review board, and written informed consent was obtained from all study participants. The study included 20 diabetic patients with DPN (10 men, 10 women), 20 diabetic patients without DPN (eight men, 12 women), and 20 healthy control subjects (nine men, 11 women). The tibial nerve was examined at 4 cm proximal to the medial malleolus with gray-scale ultrasonography and SWE. The nerve cross-sectional area (in square centimeters) and the mean nerve stiffness (in kilopascals) within the range of the image were recorded. Inter- and intrareader variability, differences among groups, and correlation of clinical and electrophysiologic evaluation were assessed with intraclass correlation coefficients, the Mann Whitney U test, and the Wilcoxon signed rank test. Results Between diabetic patients with and diabetic patients without DPN, mean age (60 years [range, 38-79 years] vs 61 years [range, 46-75 years], respectively), mean duration of diabetes (10 years [range, 1-25 years] vs 10 years [range, 2-26 years]), and mean body mass index (31.4 kg/m [range, 24.7-48.1 kg/m] vs 29.8 kg/m [range, 22.9-44.0 kg/m]) were not significantly different. Diabetic patients without DPN had significantly higher stiffness values on the right side compared with control subjects (P < .001). Patients with DPN had much higher stiffness values on both sides compared with both diabetic patients without DPN (P < .001) and healthy control subjects (P < .001). A cutoff value of 51.0 kPa at 4 cm proximal to the medial malleolus revealed a sensitivity of 90% (95% confidence interval [CI]: 75.4%, 96.7%) and a specificity of 85.0% (95% CI: 74.9%, 91.7%). Conclusion Tibial nerve stiffness measurements appear to be highly specific in the diagnosis of established DPN. The increased stiffness in subjects without DPN might indicate that the nerve is affected by diabetes. RSNA, 2016 Online supplemental material is available for this article.

Assessment of Peripheral Nerves With Shear Wave Elastography in Type 1 Diabetic Adolescents Without Diabetic Peripheral Neuropathy

“…Diabetes mellitus (DM) may change the microstructure of peripheral nerves and result in diabetic peripheral neuropathy (DPN). Nerve conduction studies (NCS) and clinical features of peripheral neuropathies are clues for the diagnosis of DPN . However, microstructural changes in peripheral nerves in type 1 DM are generally subclinical, and advanced stages of DPN can occur later, which have no definitive therapy .…”

“…However, they have substantial limitations, such as radiation exposure, contrast medium injection, accessibility, high cost, and limited use in patients with claustrophia . Ultrasound (US) has been widely used for imaging peripheral neuropathy but has had unsatisfactory results . Shear wave elastography (SWE) is an advanced technique for displaying tissue elasticity by means of high‐frequency US waves in vivo and noninvasively .…”

“…On the other hand, the assessment of peripheral nerves by SWE brings out new problems in clinical practice. There is a tendency to examine peripheral nerves on the longitudinal axis with regard to anisotropy of the peripheral nerves . Also, the elasticity of tissue on the longitudinal axis grows easily and faster compared to the elasticity on the transverse axis .…”

Sciatic nerve stiffness is not changed immediately after a slump neurodynamics technique

“…This technique has very recently been used to reliably measure the stiffness of the median 14 , tibial 15 , and sciatic nerves 16 , in both passive and active conditions. Moreover, shear wave elastography was also used to determine inter-limb differences in the stiffness of peripheral nerves, in people with chronic neuropathies 14,17 . However, it is still to be determined if, and how, neural stiffness is changed by performing neurodynamics techniques.…”

Shear Wave Elastography in the Evaluation of the Kidneys in Pediatric Patients with Unilateral Vesicoureteral Reflux

“…Shear wave elastography (SWE) is a novel elastographic method, which could yield valuable quantitative information regarding stiffness of the examined organ . To date, considerable numbers of studies have demonstrated the effectiveness and feasibility of SWE in the diagnosis of different diseases of various organs . In this study, we evaluated both kidneys of children with unilateral reflux by SWE and compared the findings to DMSA scintigraphy to demonstrate the feasibility of SWE in the diagnosis of renal parenchymal scars.…”