Clinical Application Value Of Two-dimensional Shear Wave Elastography In Type 2 Diabetic Peripheral Neuropathy

Objective:To evaluate the clinical value of 2D-SWE in the diagnosis of type 2 diabetes mellitus(T2DM)peripheral neuropathy(DPN)by two-dimensional shear wave elastography(2D-SWE)to evaluate the hardness of median nerve.Methods:A total of 75 T2 DM patients with or without DPN and 30 healthy volunteers were included in the study.The 2D-SWE technique was used to measure the cross-sectional area(CSA),Young’s modulus value and shear wave propagation velocity(SWV)of the median nerve at 5 cm on the wrist transverse stripes.According to the patient’s clinical characteristics and neurophysiological findings(NCS),patients were divided into clinical features and NCS-positive DPN patients,clinically positive but NCS-negative DPN patients,and patients without DPN.The CSA,Young’s modulus,and SWV of the median nerves in the four groups were compared using one-way ANOVA;intra-and inter-group repeatability tests were performed using intra-group correlation coefficients(ICC)and 95% confidence intervals.(CI)indicates.The diagnostic efficacy of the three parameters of the median nerve was compared using the receiver operating characteristic curve(ROC),the area under the curve(AUROC)was compared,and the optimal cut-off value of the three parameters for the diagnosis of DPN was obtained.Statistically significant difference of P <0.05.Results:1.The clinical characteristics and NCS-positive DPN patients and clinically positive but NCS-negative DPN patients had significantly higher CSA,Young’s modulus and SWV of the median nerve than those without DPN and control subjects(P <0.05).2.The three measurement parameters of the median nerve:CSA,Young’s modulus and SWV,are 0.786,0.907 and 0.952,respectively.Among them,the optimal cutoff value of DPN in T2 DM patients diagnosed by Young’s modulus was 53.3Kpa,and the sensitivity,specificity,positive predictive value and negative predictive value were: 88%,80%,81.5%,86.9%;The optimal cutoff value of DPN in patients with T2 DM was 4.15 m/s,and the sensitivity,specificity,positive predictive value and negative predictive value were 86%,86%,86%,and 86%,respectively.3.The Young’s modulus value of median nerve and the diagnostic efficiency of SWV for T2 DM median neuropathy were better than CSA(Z=2.219,Z=3.636,P<0.05);but the Young’s modulus value of median nerve to T2 DM The diagnostic efficacy of median neuropathy was comparable to that of SWV(Z = 1.248,P > 0.05).Conclusion : T2 DM patients with DPN and clinical features identified DPN have a significant increase in median nerve stiffness.The Young’s modulus value and SWV measured by2D-SWE have good accuracy for diagnosing DPN in patients with T2 DM.Clinically identified patients with DPN may have a slight degree of peripheral nerve damage that is not detected by NCS.2D-SWE can be used in T2 DM patients with clinical features of DPN to help clinicians provide early diagnosis and treatment for this part of the patient by measuring the hardness of their nerves.