Diagnostic performance of two-dimensional shear wave elastography for evaluating tibial nerve stiffness in patients with diabetic peripheral neuropathy
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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).
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.
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.
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.
• 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.
KeywordsDiabetic neuropathies Tibial nerve Elasticity imaging techniques
Two-dimensional shear wave elastography
Area under the curve
Diabetic peripheral neuropathy
Intraclass correlation coefficient
Negative likelihood ratio
Positive likelihood ratio
Nerve conduction study
Receiver operator characteristic
Region of interest
This study has received funding by the National Natural Science Foundation of China (no. 81471713).
Compliance with ethical standards
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.
Written informed consent was obtained from all subjects (patients) in this study.
Institutional Review Board approval was obtained.
• Diagnostic or prognostic study
• Performed at one institution
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