High resolution ultrasonography of the tibial nerve in diabetic peripheral neuropathy

BACKGROUND Patients with diabetic peripheral neuropathy (DPN) suffer from numbness, burning feet, lightning pain, and pins-and-needles sensations. Recently, High resolution ultrasonography is commonly used for evaluation of peripheral nerve diseases because of its easy availability, time saving and non-invasiveness of the procedure. This study intended to compare the cross sectional area (CSA) of posterior tibial nerve (PTN) in type 2 diabetic patients with peripheral neuropathy with that of non-diabetic healthy adults using high resolution ultrasonography (HRU) and study the role of increase in HbA1c level and severity of DPN comparing with CSA of PTN. METHODS A cross sectional comparative descriptive study was conducted from November 2018 to May 2020 with 50 type 2 diabetic patients and 50 healthy adults. 50 type 2 diabetic patients, clinically diagnosed with DPN were analysed and using the Toronto Clinical Neuropathy Score (TCNS) System, the severity of neuropathy was determined. HbA1c level and other demographic data were collected. 50 healthy adults were taken as controls. The CSA of posterior tibial nerve was measured 3 cm proximal to the medial malleolus in both lower limbs using HRU. RESULTS The mean CSA of posterior tibial nerve in healthy subjects was 6.0 + / - 0.142 mm2 , and in diabetic patients with peripheral neuropathy was 11.77 + / - 0.291 mm2 . Upon comparing the mean CSA of posterior tibial nerve of diabetic subjects with peripheral neuropathy and control subjects were statistically significant (P < 0.001) in unpaired ‘t’ test. In our study, CSA of the posterior tibial nerve correlated significantly with TCNS and HbA1c levels, at P < 0.001. CONCLUSIONS This study showed that there is a significant difference between the cross sectional areas of posterior tibial nerve in diabetic subjects with peripheral neuropathy and healthy adult subjects. HRU can detect cross sectional area changes in the posterior tibial nerve early. Thus, ultrasonography can be used as a good screening tool in these patients. KEYWORDS Diabetic Peripheral Neuropathy, Posterior Tibial Nerve, High Resolution Ultrasonography

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MR T2 value of the tibial nerve can be used as a potential non-invasive and quantitative biomarker for the diagnosis of diabetic peripheral neuropathy

European Radiology ◽

10.1007/s00330-017-5043-1 ◽

2017 ◽

Vol 28 (3) ◽

pp. 1234-1241 ◽

Cited By ~ 5

Author(s):

Dongye Wang ◽

Chuan Wang ◽

Xiaohui Duan ◽

Zehong Yang ◽

Zhiqiang Bai ◽

...

Keyword(s):

Peripheral Neuropathy ◽

Diabetic Peripheral Neuropathy ◽

Tibial Nerve ◽

Non Invasive

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Application of High-Resolution Ultrasound on Diagnosing Diabetic Peripheral Neuropathy

Diabetes Metabolic Syndrome and Obesity Targets and Therapy ◽

10.2147/dmso.s292991 ◽

2021 ◽

Vol Volume 14 ◽

pp. 139-152 ◽

Cited By ~ 1

Author(s):

Hailun Huang ◽

Shan Wu

Keyword(s):

Peripheral Neuropathy ◽

High Resolution ◽

Diabetic Peripheral Neuropathy

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Spectrum of High Resolution Ultrasonography and Color Doppler Findings in Peripheral Neuropathy

Asian Journal of Medical Radiological Research ◽

10.21276/ajmrr.2019.7.2.7 ◽

2019 ◽

Vol 7 (2) ◽

pp. 26-31

Author(s):

B.L. Kumawat ◽

◽

Manisha Sharma ◽

C.M. Sharma ◽

Aakanksha Agarwal ◽

...

Keyword(s):

Peripheral Neuropathy ◽

High Resolution ◽

Color Doppler ◽

High Resolution Ultrasonography

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Comment on: Riazi et al. Can Ultrasound of the Tibial Nerve Detect Diabetic Peripheral Neuropathy? A Cross-Sectional Study. Diabetes Care 2012;35:2575-2579

Diabetes Care ◽

10.2337/dc13-0176 ◽

2013 ◽

Vol 36 (6) ◽

pp. e82-e82

Author(s):

D. S. Nickerson

Keyword(s):

Peripheral Neuropathy ◽

Diabetes Care ◽

Diabetic Peripheral Neuropathy ◽

Tibial Nerve ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional

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Mechanical Allodynia Predicts Better Outcome of Surgical Decompression for Painful Diabetic Peripheral Neuropathy

Journal of Reconstructive Microsurgery ◽

10.1055/s-0038-1636938 ◽

2018 ◽

Vol 34 (06) ◽

pp. 446-454 ◽

Cited By ~ 1

Author(s):

Chenlong Liao ◽

D. Nickerson ◽

Massimiliano Visocchi ◽

Min Yang ◽

Pengfei Liu ◽

...

Keyword(s):

Peripheral Neuropathy ◽

Surgical Outcome ◽

Diabetic Peripheral Neuropathy ◽

Mechanical Allodynia ◽

Depression Scale ◽

Pain Reduction ◽

Control Group ◽

Cross Sectional ◽

Painful Diabetic Peripheral Neuropathy ◽

High Resolution Ultrasonography

Background To determine the role of mechanical allodynia (MA) in predicting good surgical outcome for painful diabetic peripheral neuropathy (DPN). Materials and Methods Data of 192 patients with painful DPN were collected in this study, with 148 surgical patients and 44 patients in the control group. Both groups were further divided into subgroups based on the presence of MA on admission. Clinical evaluations including the visual analog scale (VAS), the Hospital Anxiety and Depression Scale (HADS), nerve conduction velocity (NCV), and high-resolution ultrasonography (cross-sectional area, CSA) were performed preoperatively and postoperatively. Results The levels of VAS and HADS and the results of NCV and CSA were improved in the surgical group (p < 0.05). In the surgical subgroups, pain reduction, psychiatric amelioration, improvement in NCVs, and the restoration of the CSA were observed in patients with signs of MA (p < 0.05), whereas only pain reduction, psychiatric amelioration, and restoration of the CSA were noted in patients without signs of MA (p > 0.05). Furthermore, better pain reduction was achieved in patients with MA when compared with those without MA (p < 0.05). Conclusions MA is proved to be a reliable predictor of good surgical outcome for painful DPN.

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Lower extremity MRI following 10-week supervised exercise intervention in patients with diabetic peripheral neuropathy

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2021-002312 ◽

2021 ◽

Vol 9 (1) ◽

pp. e002312

Author(s):

Ryan Brown ◽

Azadeh Sharafi ◽

Jill M Slade ◽

Antonio Convit ◽

Nathan Davis ◽

...

Keyword(s):

Peripheral Neuropathy ◽

Lower Extremity ◽

Diabetic Peripheral Neuropathy ◽

Intervention Program ◽

Exercise Intervention ◽

Tibial Nerve ◽

Control Period ◽

Response To Therapy ◽

Measurement Sensitivity ◽

Supervised Exercise

IntroductionThe purpose of this study was to characterize using MRI the effects of a 10-week supervised exercise program on lower extremity skeletal muscle composition, nerve microarchitecture, and metabolic function in individuals with diabetic peripheral neuropathy (DPN).Research design and methodsTwenty participants with DPN completed a longitudinal trial consisting of a 30-day control period, during which subjects made no change to their lifestyle, followed by a 10-week intervention program that included three supervised aerobic and resistance exercise sessions per week targeting the upper and lower extremities. The participants’ midcalves were scanned with multinuclear MRI two times prior to intervention (baseline1 and baseline2) and once following intervention to measure relaxation times (T1, T1ρ, and T2), phosphocreatine recovery, fat fraction, and diffusion parameters.ResultsThere were no changes between baseline1 and baseline2 MRI metrics (p>0.2). Significant changes (p<0.05) between baseline2 and postintervention MRI metrics were: gastrocnemius medialis (GM) T1 –2.3%±3.0% and soleus T2 –3.2%±3.1%. Trends toward significant changes (0.05<p<0.1) between baseline2 and postintervention MRI metrics were: calf adipose infiltration –2.6%±6.4%, GM T1ρ –4.1%±7.7%, GM T2 –3.5%±6.4%, and gastrocnemius lateral T2 −4.6±7.4%. Insignificant changes were observed in gastrocnemius phosphocreatine recovery rate constant (p>0.3) and tibial nerve fractional anisotropy (p>0.6) and apparent diffusion coefficient (p>0.4).ConclusionsThe 10-week supervised exercise intervention program successfully reduced adiposity and altered resting tissue properties in the lower leg in DPN. Gastrocnemius mitochondrial oxidative capacity and tibial nerve microarchitecture changes were not observed, either due to lack of response to therapy or to lack of measurement sensitivity.

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