Significance of high-resolution ultrasound imaging and elastography as early predictors of diabetic peripheral neuropathy

Abstract To evaluate the significance of high-resolution ultrasound (HRUS) and shear wave elastography (SWE) in the diagnosis of diabetic peripheral neuropathy (DPN) to clarify their possible roles as early predictors of the occurrence of this important complication. The study included 90 patients with diabetes mellitus with different clinical stages of DPN as well as 30 healthy controls. A full history, clinical examination, and assessment of both the Toronto Clinical Neuropathy Score (TCNS) and HbA1c were performed, followed by real-time HRUS and SWE examinations of their right and left tibial and median nerves to assess their cross-sectional area (CSA) and nerve stiffness, respectively. The CSA and stiffness of tibial and median nerves were significantly increased in patients with diabetes compared to controls, with higher values associated with the severity of their DPN. Both parameters were correlated with each other and with the duration of the disease, TCNS, and HbA1c. The CSA cut-off value of both tibial and median nerves to detect DPN in patients was 13.5 mm2, meanwhile, the SWE cut-off values were 68.5 and 61.5 KPa, respectively. SWE showed a higher AUC than CSA for the prediction of DPN. Measurement of the CSA and stiffness of the peripheral nerves could be a reliable tool for early detection of DPN. Therefore, we recommend adding these noninvasive diagnostic parameters as complementary diagnostic tools to the routine follow-up schedule of diabetic complications, especially in long-standing cases.