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European Radiology

, Volume 28, Issue 3, pp 1234–1241 | Cite as

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

  • Dongye Wang
  • Chuan Wang
  • Xiaohui Duan
  • Zehong Yang
  • Zhiqiang Bai
  • Huijun Hu
  • Li YanEmail author
  • Jun ShenEmail author
Neuro

Abstract

Objective

To determine the role of quantitative tibial nerve T2 value in the diagnosis of diabetic peripheral neuropathy (DPN).

Methods

MR imaging and T2 mapping of the tibial nerve were performed in 22 diabetic patients with DPN, 20 diabetic patients without DPN and 20 healthy controls. Nerve T2 values were measured, and compared using the Mann-Whitney U test. Receiver operating characteristic (ROC) curve analysis was used to determine the diagnostic ability of T2 value to identify DPN.

Results

Nerve T2 value was 55.06 ± 4.05 ms, 48.91 ± 3.06 ms and 45.61 ± 1.86 ms in patients with DPN, patients without DPN and controls, respectively. Patients with DPN had significantly higher nerve T2 values than patients without DPN (P < 0.001). Nerve T2 values in patients without DPN were higher than in controls (P < 0.001). ROC analysis showed that T2 values had a diagnostic sensitivity of 81.8 %, specificity of 89.2 % and area under the curve of 0.922 for identifying patients with DPN from patients without DPN plus controls when the cutoff point was 51.34 ms.

Conclusion

T2 value of the tibial nerve can be used as an alternative, non-invasive quantitative parameter to assess DPN in diabetic patients.

Key points

Tibial nerves in patients with DPN showed T2 hyperintensity and enlargement.

Tibial nerves in patients with DPN had an increased T2 value.

T2 value might be used as a quantitative biomarker for DPN.

Keywords

Peripheral nervous system diseases Diabetes mellitus Diabetic neuropathies Magnetic resonance imaging Tibial nerve 

Notes

Funding

This study received funding from the Project Supported by Guangdong Province Universities and Colleges Pearl River Scholar Funded Scheme (2017), National Natural Science Foundation of China (Grant Nos: 81371607, 81571739), National Basic Research Program (Grant No: 2015CB755500), Natural Science Foundation of Guangdong Province of China (Grant No: 2014A030312018), Elite Young Scholars Program of Sun Yat-Sen Memorial Hospital (J201403) and the Medical Scientific Research Foundation of Guangdong Province of China (Grant No: A2015276).

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Jun Shen.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

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

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• prospective

• case-control study

• performed at one institution

References

  1. 1.
    Tesfaye S, Selvarajah D (2012) Advances in the epidemiology, pathogenesis and management of diabetic peripheral neuropathy. Diabetes Metab Res Rev 28(Suppl 1):8–14CrossRefPubMedGoogle Scholar
  2. 2.
    Tavakoli M, Mitu-Pretorian M, Petropoulos IN et al (2013) Corneal confocal microscopy detects early nerve regeneration in diabetic neuropathy after simultaneous pancreas and kidney transplantation. Diabetes 62:254–260CrossRefPubMedGoogle Scholar
  3. 3.
    Dyck PJ, Overland CJ, Low PA et al (2010) Signs and symptoms versus nerve conduction studies to diagnose diabetic sensorimotor polyneuropathy: Cl vs. NPhys trial. Muscle Nerve 42:157–164CrossRefPubMedGoogle Scholar
  4. 4.
    Dikici AS, Ustabasioglu FE, Delil S et al (2017) Evaluation of the Tibial Nerve with Shear-Wave Elastography: A Potential Sonographic Method for the Diagnosis of Diabetic Peripheral Neuropathy. Radiology 282:494–501CrossRefPubMedGoogle Scholar
  5. 5.
    Shy ME, Frohman EM, So YT et al (2003) Quantitative sensory testing: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 60:898–904CrossRefPubMedGoogle Scholar
  6. 6.
    Sumner CJ, Sheth S, Griffin JW, Cornblath DR, Polydefkis M (2003) The spectrum of neuropathy in diabetes and impaired glucose tolerance. Neurology 60:108–111CrossRefPubMedGoogle Scholar
  7. 7.
    Boulton AJ, Malik RA, Arezzo JC, Sosenko JM (2004) Diabetic somatic neuropathies. Diabetes Care 27:1458–1486CrossRefPubMedGoogle Scholar
  8. 8.
    Wessig C, Jestaedt L, Sereda MW, Bendszus M, Stoll G (2008) Gadofluorine M-enhanced magnetic resonance nerve imaging: comparison between acute inflammatory and chronic degenerative demyelination in rats. Exp Neurol 210:137–143CrossRefPubMedGoogle Scholar
  9. 9.
    Stoll G, Bendszus M, Perez J, Pham M (2009) Magnetic resonance imaging of the peripheral nervous system. J Neurol 256:1043–1051CrossRefPubMedGoogle Scholar
  10. 10.
    Liao CD, Zhang F, Guo RM et al (2012) Peripheral nerve repair: monitoring by using gadofluorine M-enhanced MR imaging with chitosan nerve conduits with cultured mesenchymal stem cells in rat model of neurotmesis. Radiology 262:161–171CrossRefPubMedGoogle Scholar
  11. 11.
    Zhang X, Zhang F, Lu L, Li H, Wen X, Shen J (2014) MR imaging and T2 measurements in peripheral nerve repair with activation of Toll-like receptor 4 of neurotmesis. Eur Radiol 24:1145–1152CrossRefPubMedGoogle Scholar
  12. 12.
    Chen YY, Zhang X, Lin XF et al (2017) DTI metrics can be used as biomarkers to determine the therapeutic effect of stem cells in acute peripheral nerve injury. J Magn Reson Imaging 45:855–862CrossRefPubMedGoogle Scholar
  13. 13.
    Schwarz D, Weiler M, Pham M et al (2015) Diagnostic Signs of Motor Neuropathy in MR Neurography: Nerve Lesions and Muscle Denervation. Eur Radiol 25:1497–1503CrossRefPubMedGoogle Scholar
  14. 14.
    Eaton RP, Qualls C, Bicknell J et al (1996) Structure-function relationships within peripheral nerves in diabetic neuropathy: the hydration hypothesis. Diabetologia 39:439–446CrossRefPubMedGoogle Scholar
  15. 15.
    Thakkar RS, Del Grande F, Thawait GK, Andreisek G, Carrino JA, Chhabra A (2012) Spectrum of high-resolution MRI findings in diabetic neuropathy. AJR Am J Roentgenol 199:407–412CrossRefPubMedGoogle Scholar
  16. 16.
    Wang D, Zhang X, Lu L et al (2015) Assessment of diabetic peripheral neuropathy in streptozotocin-induced diabetic rats with magnetic resonance imaging. Eur Radiol 25:463–471CrossRefPubMedGoogle Scholar
  17. 17.
    England JD, Gronseth GS, Franklin G et al (2005) Distal symmetric polyneuropathy: a definition for clinical research: report of the American Academy of Neurology, the American Association of Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation. Neurology 64:199–207CrossRefPubMedGoogle Scholar
  18. 18.
    Feldman EL, Stevens MJ, Thomas PK et al (1994) A practical two-step quantitative clinical and electrophysiological assessment for the diagnosis and staging of diabetic neuropathy. Diabetes Care 17(11):1281–1289CrossRefPubMedGoogle Scholar
  19. 19.
    Tesfaye S, Boulton AJ, Dyck PJ et al (2010) Diabetic neuropathies: update on definitions, diagnostic criteria, estimation of severity, and treatments. Diabetes Care 33:2285–2293CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Rogers LC, Frykberg RG, Armstrong DG et al (2011) The Charcot foot in diabetes. Diabetes Care 34:2123–2129CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Pham M, Oikonomou D, Baumer P et al (2011) Proximal neuropathic lesions in distal symmetric diabetic polyneuropathy: findings of high-resolution magnetic resonance neurography. Diabetes Care 34:721–723CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Does MD, Snyder RE (1996) Multiexponential T2 relaxation in degenerating peripheral nerve. Magnet Reson Med 35:207–213CrossRefGoogle Scholar
  23. 23.
    Behr B, Schnabel R, Mirastschijski U, Ibrahim B, Angenstein F, Schneider W (2009) Magnetic resonance imaging monitoring of peripheral nerve regeneration following neurotmesis at 4.7 Tesla. Plast Reconstr Surg 123:1778–1788CrossRefPubMedGoogle Scholar
  24. 24.
    Apfel SC (1999) Nerve regeneration in diabetic neuropathy. Diabetes, Obesity Metab 1:3–11CrossRefGoogle Scholar
  25. 25.
    Bae JS, Kim BJ (2007) Subclinical diabetic neuropathy with normal conventional electrophysiological study. J Neurol 254:53–59CrossRefPubMedGoogle Scholar
  26. 26.
    Bloomgarden ZT (2008) Diabetic neuropathy. Diabetes Care 31:616–621CrossRefPubMedGoogle Scholar
  27. 27.
    Takagi T, Nakamura M, Yamada M et al (2009) Visualization of peripheral nerve degeneration and regeneration: monitoring with diffusion tensor tractography. Neuroimage 44:884–892CrossRefPubMedGoogle Scholar
  28. 28.
    Wu C, Wang G, Zhao Y et al (2017) Assessment of tibial and common peroneal nerves in diabetic peripheral neuropathy by diffusion tensor imaging: a case control study. Eur Radiol 27:3523–3531CrossRefPubMedGoogle Scholar
  29. 29.
    Kijowski R, Blankenbaker DG, Munoz Del Rio A, Baer GS, Graf BK (2013) Evaluation of the articular cartilage of the knee joint: value of adding a T2 mapping sequence to a routine MR imaging protocol. Radiology 267:503–513CrossRefPubMedGoogle Scholar
  30. 30.
    Wassmuth R, Prothmann M, Utz W et al (2013) Variability and homogeneity of cardiovascular magnetic resonance myocardial T2-mapping in volunteers compared to patients with edema. J Cardiovas Magnet Reson: Off J Soc Cardiovasc Magnet Reson 15:27CrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2017

Authors and Affiliations

  1. 1.Department of Radiology, Sun Yat-Sen Memorial HospitalSun Yat-Sen UniversityGuangzhouChina
  2. 2.Department of Endocrinology, Sun Yat-Sen Memorial HospitalSun Yat-Sen UniversityGuangzhouChina

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