Quantitative assessment of diabetic amyotrophy using magnetic resonance neurography—a case-control analysis
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To quantitatively characterize diabetic amyotrophy (DA), or diabetic lumbosacral radiculoplexopathy, and compare with controls using magnetic resonance neurography (MRN).
Forty controls and 23 DA cases were analyzed qualitatively and quantitatively. Cross-sectional areas (CSAs) of bilateral L3 through S2 lumbosacral nerve roots, femoral nerves, and sciatic nerves (proximal and distal measurements) were measured. A linear model was used to assess the nerve location and case/control effect on angle-corrected CSAs. Intra- and inter-reader analysis was performed using intraclass correlation (ICC).
In DA cases, abnormalities of the lumbosacral nerve roots, sciatic, femoral, and obturator nerves were seen in 21/23, 16/23, 21/23, and 9/23, respectively. Denervation abnormalities of multiple abdominopelvic muscles were seen. Quantitatively, the CSA of all measured LS plexus nerve roots and bilateral femoral nerves were significantly larger in DA cases vs. controls by 45% (95% CI, (30%, 49%); p < 0.001). The ICC was moderate for inter-rater analysis = 0.547 (95% CI, 0.456–0.626) and excellent for intra-rater analysis = 0.90 (95% CI, 0.89–92).
Multifocal neuromuscular lesions related to diabetic amyotrophy were qualitatively and quantitatively detected on MRN. Qualitative abnormalities distinguished cases from controls, and nerve CSAs of cases were significantly larger than those of controls. Therefore, MRN may be employed as a non-invasive diagnostic tool for the evaluation of diabetic amyotrophy.
• Qualitative abnormalities of lumbosacral nerve roots, their peripheral branches, and muscles are seen in DA.
• The lumbosacral nerve roots and their peripheral branches in diabetic amyotrophy cases are significantly larger in cross-sectional area than non-diabetic subjects by 45% (95 CI, 30%, 49%; p < 0.001).
• The ICC was moderate for inter-rater analysis = 0.547 (95% CI, 0.456–0.626) and excellent for intra-rater analysis = 0.90 (95% CI, 0.89–92).
KeywordsMagnetic resonance imaging Diabetic amyotrophy Lumbosacral plexus Diabetic neuropathies
Dorsal nerve root ganglion
Intraclass correlation coefficient
Magnetic resonance imaging
Magnetic resonance neurography
Nerve conduction studies
The authors state that this work has not received any funding.
Compliance with ethical standards
The scientific guarantor of this publication is Avneesh Chhabra.
Conflict of interest
Avneesh Chhabra declares relationships with the following companies: consultant for ICON Medical and receives royalties from Jaypee and Wolters. All other authors have no relationships to declare.
Statistics and biometry
Yin Xi, PhD (University of Texas Southwestern Medical Center), has significant statistical expertise.
Written informed consent was waived by the Institutional Review Board.
Institutional Review Board approval was obtained.
• cross-sectional study
• performed at one institution
- 1.Centers for Disease Control and Prevention (2017) National Diabetes Statistics Report, 2017. Available via https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf. Accessed 4/12/2018
- 2.Tancredi M, Rosengren A, Svensson AM et al (2015) Excess mortality among persons with type 2 diabetes. N Engl J Med 373:1720–1732Google Scholar
- 3.American Diabetes Association (2013) Economic costs of diabetes in the U.S. in 2012. Diabetes Care 36:1033–1046Google Scholar
- 9.London ZN (2016) Safety and pain in electrodiagnostic studies. Muscle Nerve 55:149–159Google Scholar
- 11.Brody LR, Pollock MT, Roy SH, De Luca CJ, Celli B (1991) pH-induced effects on median frequency and conduction velocity of the myoelectric signal. J Appl Physiol (1985) 71:1878–1885Google Scholar
- 12.Kuiken TA, Lowery MM, Stoykov NS (2003) The effect of subcutaneous fat on myoelectric signal amplitude and cross-talk. Prosthet Orthot Int 27:48–54Google Scholar
- 13.Chhabra A, Andreisek G, Soldatos T et al (2011) MR neurography: past, present, and future. AJR Am J Roentgenol 197:583–591Google Scholar
- 15.Pham M, Oikonomou D, Bäumer P et al (2011) Proximal neuropathic lesions in distal symmetric diabetic polyneuropathy: findings of high-resolution magnetic resonance neurography. Diabetes Care 34:721–723Google Scholar
- 20.Lee D, Dauphinée DM (2005) Morphological and functional changes in the diabetic peripheral nerve: using diagnostic ultrasound and neurosensory testing to select candidates for nerve decompression. J Am Podiatr Med Assoc 95:433–437Google Scholar
- 21.Kang S, Kim SH, Yang SN, Yoon JS (2016) Sonographic features of peripheral nerves at multiple sites in patients with diabetic polyneuropathy. J Diabetes Complications 30:518–523Google Scholar
- 23.Yagihashi S, Mizukami H, Sugimoto K (2011) Mechanism of diabetic neuropathy: where are we now and where to go? J Diabetes Investig 2:18–32Google Scholar
- 24.Tang WH, Martin KA, Hwa J (2012) Aldose reductase, oxidative stress, and diabetic mellitus. Front Pharmacol 3:87Google Scholar
- 25.Kawamura N, Dyck PJ, Schmeichel AM, Engelstad JK, Low PA, Dyck PJ (2008) Inflammatory mediators in diabetic and non-diabetic lumbosacral radiculoplexus neuropathy. Acta Neuropathol 115:231–239Google Scholar
- 29.Soldatos T, Andreisek G, Thawait GK et al (2013) High-resolution 3-T MR neurography of the lumbosacral plexus. Radiographics 33:967–987Google Scholar
- 30.Dyck PJ, Norell JE, Dyck PJ (2001) Non-diabetic lumbosacral radiculoplexus neuropathy: natural history, outcome and comparison with the diabetic variety. Brain 124:1197–1207Google Scholar