Study On The Tibial Nerve In Patients With Type 2 Diabetes Peripheral Neuropathy By Multimodal Ultrasound

Objective:In this study,we used a variety of imaging methods of high-frequency ultrasound to observe the sonographic changes of the tibial nerve in patients with type 2 diabetic peripheral neuropathy(Diabetic Peripheral Neuropathy,DPN)from different angles.The study aims to explore the diagnostic value of(multimode ultrasound,m US)in diagnosing tibial nerve lesions caused by DPN and to provide a reliable radiological basis for the clinical diagnosis of DPN.Materials and Methods:According to the inclusion and exclusion criteria,this study collected 118 patients with type 2 diabetes who were treated at Weihai City Center Hospital Affiliated to Qingdao University between June and December 2022 and randomly selected 30 healthy volunteers without a history of diabetes or peripheral neuropathy and no clinical symptoms as the study subjects.All 118 patients with type 2 diabetes underwent neuro-electrophysiological examination(NEE)and 30 patients with positive NEE results and peripheral neuropathy clinical symptoms were selected as the DPN group(Group A).30 type 2 diabetes patients with negative NEE results and no peripheral neuropathy clinical symptoms were selected as the Non-DPN group(Group B).30 healthy volunteers were selected as the control group(Group C)at the same time.The basic information,ultrasonic measurement values,sonographic images,and elastic values between the three groups were compared for statistical differences.The sonographic images and measurement values between the same groups were compared for statistical differences.Work characteristic curves were plotted,and the area under the curve was calculated to analyze the clinical value of the severity of nerve damage in type 2 diabetes patients.Results:1.According to the clinical history of the disease and NEE grouping,there were no statistical differences in age,gender,and body mass index among the three groups(P>0.05),but there were statistical differences in the duration of diabetes,maximum blood glucose,fasting blood glucose and glycosylated hemoglobin(P<0.05).2.The tibial nerve waist segment and internal tibia upper segment in groups A and B were more blurred than group C,with thickened nerve sheaths,blurred mesh-like structures,and unclear boundary with surrounding tissues.Group A was more significant than group B.3.Comparison of the tibial nerve waist segment,internal tibia upper segment anteriorposterior diameter,left-right diameter,and cross-sectional area(CSA)among the three groups,there were no statistical differences in the anteroposterior diameter of the upper medial malleolas(P> 0.05),while the others were statistically significant(P< 0.05),with group A higher than group B and group B higher than group C.Within each group,comparison of the tibial nerve waist segment,internal tibia upper segment anterior-posterior diameter,left-right diameter,and CSA showed statistical significance(P<0.05).Comparison of the two-dimensional measurement values of the tibial nerve between the left and right sides of the same subject showed no statistical significance(P>0.05).4.Group A showed short linear blood flow signals in the internal and surrounding areas of the tibial nerve.Some subjects in groups B and C showed weak blood flow signals in the form of dots or short lines,and some showed no obvious blood flow signals,with no statistical significance.Both group A and group B had higher shear wave velocity(SWV)than group C,with group A having higher SWV than group B,and with statistical significance(P<0.05).Comparison of the SWV of the tibial nerve waist segment and internal tibia upper segment within each group showed statistical significance(P<0.05),and the SWV of the internal tibia upper segment tibial nerve was higher than the waist segment tibial nerve in all three groups,with statistical significance(P<0.05).Comparison of the SWV of the tibial nerve between the left and right sides of the same subject showed no statistical significance(P>0.05).5.m US imaging has high sensitivity,specificity,and accuracy compared to any single imaging method.Conclusion:The diameter of the tibial nerve(both anterior-posterior and left-right),cross-sectional area,and the severity of diabetic peripheral neuropathy(DPN)are positively correlated with the duration of type 2 diabetes.The more severe the DPN,the more obvious the changes in the two-dimensional sonography of the tibial nerve.Patients with diabetes have slightly increased blood flow signals in the tibial nerve compared to healthy individuals.Elastic imaging(SWV)is positively correlated with the severity of DPN,and the more severe the damage to the tibial nerve,the higher the SWV.m US technology has high diagnostic value and clinical significance in screening DPN high-risk groups of type 2diabetes,and can improve the sensitivity,accuracy and specificity of screening results.