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Quantitative assessment of diabetic amyotrophy using magnetic resonance neurography—a case-control analysis

  • Rocco Hlis
  • Feng Poh
  • Meredith Bryarly
  • Yin Xi
  • Avneesh ChhabraEmail author
Magnetic Resonance
  • 26 Downloads

Abstract

Objectives

To quantitatively characterize diabetic amyotrophy (DA), or diabetic lumbosacral radiculoplexopathy, and compare with controls using magnetic resonance neurography (MRN).

Methods

Forty controls and 23 DA cases were analyzed qualitatively and quantitatively. Cross-sectional areas (CSAs) of bilateral L3 through S2 lumbosacral nerve roots, femoral nerves, and sciatic nerves (proximal and distal measurements) were measured. A linear model was used to assess the nerve location and case/control effect on angle-corrected CSAs. Intra- and inter-reader analysis was performed using intraclass correlation (ICC).

Results

In DA cases, abnormalities of the lumbosacral nerve roots, sciatic, femoral, and obturator nerves were seen in 21/23, 16/23, 21/23, and 9/23, respectively. Denervation abnormalities of multiple abdominopelvic muscles were seen. Quantitatively, the CSA of all measured LS plexus nerve roots and bilateral femoral nerves were significantly larger in DA cases vs. controls by 45% (95% CI, (30%, 49%); p < 0.001). The ICC was moderate for inter-rater analysis = 0.547 (95% CI, 0.456–0.626) and excellent for intra-rater analysis = 0.90 (95% CI, 0.89–92).

Conclusions

Multifocal neuromuscular lesions related to diabetic amyotrophy were qualitatively and quantitatively detected on MRN. Qualitative abnormalities distinguished cases from controls, and nerve CSAs of cases were significantly larger than those of controls. Therefore, MRN may be employed as a non-invasive diagnostic tool for the evaluation of diabetic amyotrophy.

Key Points

• Qualitative abnormalities of lumbosacral nerve roots, their peripheral branches, and muscles are seen in DA.

• The lumbosacral nerve roots and their peripheral branches in diabetic amyotrophy cases are significantly larger in cross-sectional area than non-diabetic subjects by 45% (95 CI, 30%, 49%; p < 0.001).

• The ICC was moderate for inter-rater analysis = 0.547 (95% CI, 0.456–0.626) and excellent for intra-rater analysis = 0.90 (95% CI, 0.89–92).

Keywords

Magnetic resonance imaging Diabetic amyotrophy Lumbosacral plexus Diabetic neuropathies 

Abbreviations

CSA

Cross-sectional area

DA

Diabetes amyotrophy

DRG

Dorsal nerve root ganglion

EMG

Electromyography

ICC

Intraclass correlation coefficient

LS

Lumbosacral

MRI

Magnetic resonance imaging

MRN

Magnetic resonance neurography

NCS

Nerve conduction studies

Notes

Funding

The authors state that this work has not received any funding.

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Avneesh Chhabra.

Conflict of interest

Avneesh Chhabra declares relationships with the following companies: consultant for ICON Medical and receives royalties from Jaypee and Wolters. All other authors have no relationships to declare.

Statistics and biometry

Yin Xi, PhD (University of Texas Southwestern Medical Center), has significant statistical expertise.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• cross-sectional study

• performed at one institution

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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  1. 1.UT Southwestern Medical CenterDallasUSA
  2. 2.Medi-Rad Associates Ltd, Radiologic ClinicMt Elizabeth HospitalSingaporeSingapore

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