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Diagnostic performance of two-dimensional shear wave elastography for evaluating tibial nerve stiffness in patients with diabetic peripheral neuropathy

  • Ultrasound
  • Published:
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Abstract

Objectives

To evaluate the stiffness of the tibial nerve with two-dimensional shear wave elastography (2D-SWE) and to determine whether 2D-SWE can be used to diagnose diabetic peripheral neuropathy (DPN).

Methods

The study included 70 consecutive diabetic patients with DPN or without DPN and 20 healthy volunteers. The tibial nerve stiffness measured with 2D-SWE was studied. The differences in stiffness values among patients with DPN, patients with clinically defined DPN, patients without DPN, and healthy volunteers based on clinical features and electrodiagnostic tests were evaluated with the Mann–Whitney U test and the Kruskal–Wallis test. Inter- and intraobserver variability was evaluated, and a receiver operator characteristic curve analysis was performed.

Results

The tibial nerve stiffness based on mean (EMean), minimum (EMin), and maximum (EMax) shear elasticity indices was significantly higher in patients with DPN and clinically defined DPN than that in patients without DPN and control subjects (p < 0.05). The area under the curve (AUC) for the SWE measurements of EMean, EMin, and EMax was 0.846, 0.867, and 0.821, respectively. An EMin cutoff value of 45.7 kPa had a sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of 74.0%, 87.6%, 6.0, and 0.3, respectively. The inter- and intraobserver agreements were excellent for the SWE measurements.

Conclusions

Tibial nerve stiffness is significantly higher in diabetic patients with DPN and clinically defined DPN. The EMean and EMin have a good accuracy for identifying DPN. Minor degree of peripheral nerve lesions appear to might exist in patients with clinically defined DPN, not detectable by electrophysiology. 2D-SWE has a potential use for cases with clinically defined DPN and can be detected with 2D-SWE.

Key Points

• 2D-SWE elastography is a noninvasive method that can be used to evaluate precise nerve stiffness for diagnosing DPN.

• Minor degree of neurologic lesion might exist early in patients with clinically defined DPN and can be detected by 2D-SWE.

• E Min and E Mean of SWE elasticity indices have better diagnostic accuracies than E Max for identifying DPN.

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Abbreviations

2D-SWE:

Two-dimensional shear wave elastography

AUC:

Area under the curve

CSA:

Cross-sectional area

DPN:

Diabetic peripheral neuropathy

ICC:

Intraclass correlation coefficient

LR(−):

Negative likelihood ratio

LR(+):

Positive likelihood ratio

NCS:

Nerve conduction study

ROC:

Receiver operator characteristic

ROI:

Region of interest

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Funding

This study has received funding by the National Natural Science Foundation of China (no. 81471713).

Author information

Authors and Affiliations

  1. Department of Ultrasound, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, People’s Republic of China

    Weixi Jiang, Sirun Huang, Hua Teng, Peipei Wang, Meng Wu, Xia Zhou, Qunxia Zhang & Haitao Ran

  2. Department of Endocrinology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China

    Weiwei Xu

Authors
  1. Weixi Jiang
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  2. Sirun Huang
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  3. Hua Teng
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  4. Peipei Wang
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  5. Meng Wu
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  6. Xia Zhou
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  7. Weiwei Xu
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  8. Qunxia Zhang
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  9. Haitao Ran
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Corresponding author

Correspondence to Haitao Ran.

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Guarantor

The scientific guarantor of this publication is Ran Haitao.

Conflict of interest

The authors declare that they have no conflict of interest.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• Prospective

• Diagnostic or prognostic study

• Performed at one institution

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Jiang, W., Huang, S., Teng, H. et al. Diagnostic performance of two-dimensional shear wave elastography for evaluating tibial nerve stiffness in patients with diabetic peripheral neuropathy. Eur Radiol 29, 2167–2174 (2019). https://doi.org/10.1007/s00330-018-5858-4

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  • DOI: https://doi.org/10.1007/s00330-018-5858-4

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