High Resolution Ultrasound of the Tibial Nerve in Diabetic Peripheral Neuropathy

Abstract

Background The main role of this study was to highlight the value of musculoskeletal ultrasound in the diagnosis of nerve affection in patients with diabetic peripheral neuropathy. This was evident by the significant correlation between cross sectional area and all study parameters with sensitivity and specificity of 90% and 100% respectively. Objectives Our study aims to highlight the value of newer ultrasound imaging techniques in identifying morphological changes of the tibial nerve in the patients with diabetic peripheral neuropathy. Patients and Methods During a period of ten months duration started in November 2019, 40 subjects were enrolled in this study. 20 diabetic patients with clinical manifestations of DPN had undergone nerve conduction study of both lower limbs then compared to 20 healthy control subjects as regard the ultrasound examination of TN bilaterally. The study was conducted according to the stipulations of the ASU ethical and scientific committee. The privacy of participants and confidentiality of data were guaranteed during the various phases of the study. Results We found that the cross sectional area (CSA) in patients with diabetic peripheral neuropathy (DPN) is significantly larger than the healthy controls. A positive significant correlation was found between CSA and duration of diabetes, HbA1c% and tibial nerve (TN) latency while a negative significant correlation was found with TN amplitude and conduction velocity. Conclusion Despite giving significantly larger values in cases than controls, MTNF was found to non-significantly correlated with all studied parameters. In view of the above data, CSA can be adopted as a reliable screening and diagnostic tool for DPN but further work-up is needed to assess its role in the follow up of the disease process. On the other hand, MTNF can be used for description of the morphological changes in a diabetic nerve.