Sierra-Silvestre Eva, Smith Robert E, Andrade Ricardo J, Kennedy Ben, Coppieters Michel W
School of Health Sciences and Social Work, Griffith University, Brisbane, Australia; Amsterdam Movement Sciences - Program Musculoskeletal Health, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK. Electronic address: https://twitter.com/esiesil.
The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia; The Florey Department of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Australia.
Eur J Radiol. 2024 Dec;181:111721. doi: 10.1016/j.ejrad.2024.111721. Epub 2024 Sep 5.
Diffusion weighted imaging (DWI) has revealed microstructural changes in lower limb nerves in people with diabetic neuropathy. Microstructural changes in upper limb nerves using DWI in people with diabetes have not yet been explored.
This cross-sectional study aimed to quantify and compare the microstructure of the median and ulnar nerve in people without diabetes (n = 10), people with diabetes without distal symmetrical polyneuropathy (DSPN; n = 10), people with DSPN in the lower limbs only (DSPN ; n = 12), and people with DSPN in the upper and lower limbs (DSPN ; n = 9). DSPN diagnosis included electrodiagnosis and corneal confocal microscopy. Tensor metrics, such as fractional anisotropy, radial diffusivity and axial diffusivity, and constrained spherical deconvolution metrics, such as dispersion and complexity, were calculated. Linear mixed-models were used to quantify DWI metrics from multiple models in median and ulnar nerves across the groups, and to evaluate potential differences in metrics at the wrist and elbow based on the principle of a distal-to-proximal disease progression.
Tensor metrics revealed microstructural abnormalities in the median and ulnar nerve in people with DSPN , and also already in DSPN . There were significant negative correlations between electrodiagnostic parameters and tensor metrics. A distal-to-proximal pattern was more pronounced in the median nerve. Non-tensor metrics showed early microstructural changes in people with diabetes without DSPN.
Compared to people without diabetes, microstructural changes in upper limb nerves can be identified in people with diabetes with and without DSPN, even before symptoms occur.
扩散加权成像（DWI）已揭示糖尿病性神经病变患者下肢神经的微观结构变化。糖尿病患者上肢神经使用DWI的微观结构变化尚未得到探索。
这项横断面研究旨在量化和比较无糖尿病者（n = 10）、无远端对称性多发性神经病变（DSPN）的糖尿病患者（n = 10）、仅下肢患有DSPN的患者（DSPN；n = 12）以及上下肢均患有DSPN的患者（DSPN；n = 9）的正中神经和尺神经的微观结构。DSPN诊断包括电诊断和角膜共焦显微镜检查。计算张量指标，如分数各向异性、径向扩散率和轴向扩散率，以及约束球面去卷积指标，如离散度和复杂度。使用线性混合模型量化各组正中神经和尺神经多个模型的DWI指标，并根据远端到近端疾病进展的原则评估手腕和肘部指标的潜在差异。
张量指标显示DSPN患者以及DSPN患者的正中神经和尺神经存在微观结构异常。电诊断参数与张量指标之间存在显著负相关。正中神经中从远端到近端的模式更为明显。非张量指标显示无DSPN的糖尿病患者存在早期微观结构变化。
与无糖尿病者相比，无论有无DSPN，糖尿病患者上肢神经的微观结构变化在症状出现之前即可被识别。
