Department of Radiodiagnosis, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India.
Department of Neurology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India.
Br J Radiol. 2021 May 1;94(1121):20200173. doi: 10.1259/bjr.20200173. Epub 2021 Mar 18.
The aim of this observational study was ultrasound evaluation of peripheral nerves cross-sectional area (CSA) in subjects with probable diabetic peripheral sensorimotor neuropathy (DPN). CSA was analyzed with reference to clinical and nerve conduction study's (NCS) parameters for early diagnosis and pattern of involvement.
A total of 50 patients with probable DPN due to Type 2 diabetes and 50 age-matched healthy controls underwent sonographic examinations of ulnar nerve at the lower arm, median nerve proximal to carpal tunnel, the common peroneal nerve proximal to fibular head, tibial nerve proximal to the tarsal tunnel, and sural nerve at lower third leg.
CSA was increased in cases of DPN as compared to healthy controls. Area changes were more marked with demyelinating pattern. Probable DPN cases with normal NCS had significantly higher number of peripheral nerves showing increased CSA as compared to healthy control. A cut-off of 4 nerve thickening showed a sensitivity of 86 %, and specificity of 56%. The neuropathy pattern in the lower limb was axonal, whereas in the upper limb, it was demyelinating with the majority showing sonographic feature of associated compressive neuropathy.
There is an increase in CSA of peripheral nerve in diabetic patients. It can be used as a morphological marker for classifying DPN with changes being picked up earlier to NCS abnormality. Clinical neurological presentation in probable DPN can also be due to compressive neuropathy in early phases, and ultrasound can be a useful tool.
Early pick up of DPN cases shall be useful for early therapy and motivating the patients to actively participate in the treatment. Morphological changes on ultrasonography precedes the electrodiagnostic change in DPN. Symptoms of DPN is not only due to metabolic changes but also compressive neuropathy.
本观察性研究旨在通过超声评估疑似糖尿病周围感觉运动神经病（DPN）患者的周围神经横截面积（CSA）。通过分析 CSA 与临床和神经传导研究（NCS）参数的关系，实现早期诊断和受累模式。
共纳入 50 例因 2 型糖尿病引起的疑似 DPN 患者和 50 名年龄匹配的健康对照者，对其进行超声检查，包括前臂的尺神经、腕管近端的正中神经、腓骨头近端的腓总神经、跗管近端的胫神经和小腿下段的腓肠神经。
与健康对照组相比，DPN 患者的 CSA 增加。脱髓鞘模式下的面积变化更为显著。与健康对照组相比，NCS 正常的疑似 DPN 患者中，有更多的周围神经 CSA 增加。4 根神经增厚的截断值显示出 86%的敏感性和 56%的特异性。下肢的神经病变模式为轴索性，而上肢为脱髓鞘性，大多数表现为与压迫性神经病相关的超声特征。
糖尿病患者的周围神经 CSA 增加。它可作为分类 DPN 的形态学标志物，能够比 NCS 异常更早地发现变化。疑似 DPN 的临床神经表现也可能是早期压迫性神经病引起的，超声可以作为一种有用的工具。
早期发现 DPN 病例有助于早期治疗并促使患者积极参与治疗。超声检查的形态学变化先于 DPN 的电诊断变化。DPN 的症状不仅是由于代谢变化引起的，还可能与压迫性神经病有关。
