Shear wave elastography as a quantitative biomarker of diabetic peripheral neuropathy: A systematic review and meta-analysis

Abstract

BackgroundDiabetic peripheral neuropathy (DPN) is one of the most common chronic complications of diabetes and the strongest initiating risk factor for diabetic foot ulceration. Early diagnosis of DPN through screening measures is, therefore, of great importance for diabetic patients. Recently, shear wave elastography (SWE) has been used as a method that is complementary to neuroelectrophysiological examination in the diagnosis of DPN. We aimed to conduct a meta-analysis based on currently available data to evaluate the performance of tibial nerve stiffness on SWE for diagnosing DPN.MethodsBoth PubMed, EMBASE, the Cochrane Library, and Web of Science were searched for studies that investigated the diagnostic performance of SWE for DPN up to March 1th, 2022. Three measures of diagnostic test performance, including the summary area under receiver operating characteristics curve (AUROC), the summary sensitivity and specificity, and the summary diagnostic odds ratios were used to assess the diagnostic accuracy of SWE. All included studies were published between 2017 and 2021.ResultsSix eligible studies (with 170 DPN patients, 28 clinically defined DPN patients, 168 non-DPN patients, and 154 control participants) that evaluated tibial nerve stiffness were included for meta-analysis. The summary sensitivity and specificity of SWE for tibial nerve stiffness were 75% (95% confidence interval [CI]: 68–80%) and 86% (95% CI: 80–90%), respectively, and the summary AUROC was 0.84 (95% CI: 0.81–0.87), for diagnosing DPN. A subgroup analysis of five two-dimensional SWE studies revealed similar diagnostic performance, showing the summary sensitivity and specificity of 77% (95% CI: 69–83%) and 86% (95% CI: 79–91%), respectively, and a summary AUROC value of 0.86 (95% CI: 0.83–0.89).ConclusionsSWE is found to have good diagnostic accuracy for detecting DPN and has considerable potential as an important and noninvasive adjunctive tool in the management of patients with DPN.

Evaluation of Serum Neurofilament Light Chain and Nerve Ultrasound in Diabetic Neuropathy

“…Additionally, new techniques, like shear wave elastography, which is used to assess nerve stiffness, may provide a better understanding in DPN. 28,29 Preliminary studies have been conducted assessing stiffness of the tibial nerve in DPN, suggesting the tibial nerve may undergo an elastic change as a result of thickening of fibers in the nerve sheath in type 2 diabetes. Thus, shear wave elastography may be more sensitive than standard ultrasound in detecting DPN.…”

“…Nerve ultrasonography may be helpful in detecting DPN, especially if these changes precede abnormalities found during electrodiagnostic testing. Additionally, new techniques, like shear wave elastography, which is used to assess nerve stiffness, may provide a better understanding in DPN 28,29 . Preliminary studies have been conducted assessing stiffness of the tibial nerve in DPN, suggesting the tibial nerve may undergo an elastic change as a result of thickening of fibers in the nerve sheath in type 2 diabetes.…”

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

“…SWE measures nerve stiffness and is also abnormal in DSPN. A recent meta‐analysis combined subjects with DSPN, diabetics with clinical neuropathy but negative NCS, subjects with non‐diabetic neuropathy and healthy controls, 222 finding an overall sensitivity of 75% and specificity of 86% of SWE in diabetic neuropathy. Again, the stiffness cut‐offs (32.7–71.3 kPa; 2.3–4.1 m/s) and SWE technique varied widely, making any assessment of diagnostic utility somewhat limited.…”

In Vivo Effects of Joint Movement on Nerve Mechanical Properties Assessed with Shear-Wave Elastography: A Systematic Review and Meta-Analysis

“…Due to its simplicity and non-invasive character, SWE has already been integrated in many medical disciplines to assess different organs [18,21,22] and musculoskeletal conditions [13,16]. More recently, its application has also been extended to the evaluation of peripheral nerves [16,[23][24][25][26][27][28]. The advantage of SWE lies in its capability of recognizing changes in the mechanical properties of tissues related to injury, degeneration, compression, and tension [13,[28][29][30][31].…”

“…The advantage of SWE lies in its capability of recognizing changes in the mechanical properties of tissues related to injury, degeneration, compression, and tension [13,[28][29][30][31]. In many neural conditions, the nerve shows an increase in its stiffness in the affected area [23][24][25][26][27][28]. Hence, SWE has been proposed as a novel diagnostic tool for carpal tunnel syndrome [23,25,26], diabetic neuropathy [23][24][25]32,33], and other peripheral neuropathies [23,25,27].…”