Skip to main content

Advertisement

SpringerLink
Log in

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 Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price includes VAT (France)

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. Tesfaye S, Selvarajah D (2012) Advances in the epidemiology, pathogenesis and management of diabetic peripheral neuropathy. Diabetes Metab Res Rev 28(Suppl 1):8–14

    Article  PubMed  Google Scholar 

  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 62:254–260

    Article  CAS  PubMed  Google Scholar 

  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 42:157–164

    Article  PubMed  Google Scholar 

  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 282:494–501

    Article  PubMed  Google Scholar 

  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 60:898–904

    Article  CAS  PubMed  Google Scholar 

  6. Sumner CJ, Sheth S, Griffin JW, Cornblath DR, Polydefkis M (2003) The spectrum of neuropathy in diabetes and impaired glucose tolerance. Neurology 60:108–111

    Article  CAS  PubMed  Google Scholar 

  7. Boulton AJ, Malik RA, Arezzo JC, Sosenko JM (2004) Diabetic somatic neuropathies. Diabetes Care 27:1458–1486

    Article  PubMed  Google Scholar 

  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 210:137–143

    Article  CAS  PubMed  Google Scholar 

  9. Stoll G, Bendszus M, Perez J, Pham M (2009) Magnetic resonance imaging of the peripheral nervous system. J Neurol 256:1043–1051

    Article  PubMed  Google Scholar 

  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 262:161–171

    Article  PubMed  Google Scholar 

  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 24:1145–1152

    Article  PubMed  Google Scholar 

  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 45:855–862

    Article  PubMed  Google Scholar 

  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 25:1497–1503

    Article  PubMed  Google Scholar 

  14. Eaton RP, Qualls C, Bicknell J et al (1996) Structure-function relationships within peripheral nerves in diabetic neuropathy: the hydration hypothesis. Diabetologia 39:439–446

    Article  CAS  PubMed  Google Scholar 

  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 199:407–412

    Article  PubMed  Google Scholar 

  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 25:463–471

    Article  PubMed  Google Scholar 

  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 64:199–207

    Article  CAS  PubMed  Google Scholar 

  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):1281–1289

    Article  CAS  PubMed  Google Scholar 

  19. Tesfaye S, Boulton AJ, Dyck PJ et al (2010) Diabetic neuropathies: update on definitions, diagnostic criteria, estimation of severity, and treatments. Diabetes Care 33:2285–2293

    Article  PubMed  PubMed Central  Google Scholar 

  20. Rogers LC, Frykberg RG, Armstrong DG et al (2011) The Charcot foot in diabetes. Diabetes Care 34:2123–2129

    Article  PubMed  PubMed Central  Google Scholar 

  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 34:721–723

    Article  PubMed  PubMed Central  Google Scholar 

  22. Does MD, Snyder RE (1996) Multiexponential T2 relaxation in degenerating peripheral nerve. Magnet Reson Med 35:207–213

    Article  CAS  Google Scholar 

  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 123:1778–1788

    Article  CAS  PubMed  Google Scholar 

  24. Apfel SC (1999) Nerve regeneration in diabetic neuropathy. Diabetes, Obesity Metab 1:3–11

    Article  CAS  Google Scholar 

  25. Bae JS, Kim BJ (2007) Subclinical diabetic neuropathy with normal conventional electrophysiological study. J Neurol 254:53–59

    Article  PubMed  Google Scholar 

  26. Bloomgarden ZT (2008) Diabetic neuropathy. Diabetes Care 31:616–621

    Article  PubMed  Google Scholar 

  27. Takagi T, Nakamura M, Yamada M et al (2009) Visualization of peripheral nerve degeneration and regeneration: monitoring with diffusion tensor tractography. Neuroimage 44:884–892

    Article  PubMed  Google Scholar 

  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 27:3523–3531

    Article  PubMed  Google Scholar 

  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 267:503–513

    Article  PubMed  Google Scholar 

  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 15:27

    Article  Google Scholar 

Download references

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).

Author information

Author notes

  1. Dongye Wang and Chuan Wang contributed equally to this paper.

Authors and Affiliations

  1. Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou, Guangdong, 510120, China

    Dongye Wang, Xiaohui Duan, Zehong Yang, Zhiqiang Bai, Huijun Hu & Jun Shen

  2. Department of Endocrinology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou, Guangdong, 510120, China

    Chuan Wang & Li Yan

Authors
  1. Dongye Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chuan Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Xiaohui Duan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Zehong Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Zhiqiang Bai
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Huijun Hu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Li Yan
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jun Shen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Li Yan or Jun Shen.

Ethics declarations

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

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wang, D., Wang, C., Duan, X. et al. 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. Eur Radiol 28, 1234–1241 (2018). https://doi.org/10.1007/s00330-017-5043-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-017-5043-1

Keywords

Search

Navigation