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Diffusion-weighted MR imaging and utility of ADC measurements in characterizing nerve and muscle changes in diabetic patients on ankle DWI studies: a cross-sectional study

  • Musculoskeletal
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Abstract

Objective

To evaluate the utility of apparent diffusion coefficient (ADC) measurements from ankle MRI diffusion-weighted imaging (DWI) studies in identifying neuropathic changes in diabetic patients.

Methods

In total, 109 consecutive ankle MRI scans (n = 101 patients) at a single tertiary care county hospital from November 1, 2019, to July 11, 2021, who met the inclusion criteria were identified. Patients were divided into 2 cohorts: diabetic (n = 62) and non-diabetic (n = 39). Demographics, HgbA1c, neuropathy diagnosis, and image quality data were collected. Abductor hallucis (AH) ADC mean and minimum (min) values and posterior tibial nerve (PTN) ADC mean and minimum values were measured. Student t-test and Pearson’s correlation coefficient analysis were performed using R.

Results

Diabetic patients had significantly higher mean and min ADC values (× 10−3 mm2/s) of the AH muscle (mean: 1.77 vs 1.39, p < 0.001; min: 1.51 vs 1.06, p < 0.001) and PTN (mean: 1.65 vs 1.18, p < 0.001; min: 1.33 vs 0.95, p < 0.001) compared to non-diabetic patients. HgbA1c positively correlated with AH and PTN ADC mean values (AH: p = 0.036; PTN: p = 0.004).

Conclusion

Our data suggests that an increasing diffusivity of water as quantified by ADC across neuronal and muscular membranes is a consequence of the pathophysiology of the disease. Thus, ankle MRI-DWI studies are useful in identifying neuropathic changes in diabetic patients and quantifying the severity noninvasively.

Key Points

• Diabetic patients had significantly higher mean and minimum ADC values of the abductor hallucis muscle and posterior tibial nerve compared to non-diabetic patients.

• HgbA1c positively correlated with ADC mean values (AH: p = 0.036; PTN: p = 0.004) suggesting that an increasing diffusivity of water across neuronal and muscular membranes is a consequence of the pathophysiology of diabetic neuropathy.

• Ankle MRI DWI can be used clinically to non-invasively identify neuropathic changes due to diabetes mellitus.

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Abbreviations

AH:

Abductor hallucis

DM:

Diabetes mellitus

MRN:

Magnetic resonance neurography

PTN:

Posterior tibial nerve

ROS:

Reactive oxygen species

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Funding

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

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Author notes

  1. Joshua Amaya and Brian Lue are co-first authors.

Authors and Affiliations

  1. Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9178, USA

    Joshua Amaya, Brian Lue, Flavio Duarte Silva, Yin Xi & Avneesh Chhabra

  2. Department of Orthopedic Surgery, UT Southwestern Medical Center, Dallas, TX, USA

    Katherine Raspovic & Avneesh Chhabra

  3. Adjunct Faculty, Johns Hopkins University, MD; University of Dallas, Tx; and Walton Centre for Neuroscience, Liverpool, UK

    Avneesh Chhabra

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  1. Joshua Amaya
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Correspondence to Avneesh Chhabra.

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Guarantor

The scientific guarantor of this publication is Avneesh Chhabra, MD, MBA.

Conflict of interest

Avneesh Chhabra: Consultant: ICON Medical and TREACE Medical Concepts Inc., Book Royalties: Jaypee, Wolters, Speaker: Siemens, Medical advisor, and research grant: Image biopsy Inc. Additionally, Avneesh Chhabra is a Deputy Editor of European Radiology. He has not taken part in the review or selection process of this article. Others: None.

Statistics and biometry

One of the authors has significant statistical expertise. No complex statistical methods were necessary for this paper.

Informed consent

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

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• Retrospective

• cross-sectional study

• performed at one institution

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Amaya, J., Lue, B., Silva, F.D. et al. Diffusion-weighted MR imaging and utility of ADC measurements in characterizing nerve and muscle changes in diabetic patients on ankle DWI studies: a cross-sectional study. Eur Radiol 33, 4855–4863 (2023). https://doi.org/10.1007/s00330-023-09466-7

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  • DOI: https://doi.org/10.1007/s00330-023-09466-7

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