| Objective:To investigate the diagnostic value of shear wave elastography(SWE)in diabetic peripheral neuropathy(DPN)in type 2 diabetes mellitus(T2DM).Method:1.Case collection and grouping:68 hospitalized patients,diagnosed with type 2 diabetes mellitus,were collected in April 2016-February 2017 in Hunan Provincial People's Hospital,Department of Endocrinology.The bilateral median nerves of these patients were examined by electrophysiological examinations(EMG),respectively.According to the results of EMG and the clinical symptoms of them,these patients were divided into DPN group,non-DPN group,of which,DPN group of 38 patients,non-DPN group of 30 patients.30 normal volunteers whom without diabetes,cervical spondylosis,rheumatism and other diseases which can cause peripheral neuropathy were included as a control group.There was no significant difference in sex ratio,age,height,weight and body mass index among the three groups.A total of 180 median nerves were included in the analysis,each group of 60.2.Inspection method:Using 14L5 linear probe(probe frequency of 5?14MHz),to find the median nerve at the crosscutting of the wrist.On the wrist stripes above 5 cm,turn the probe 90 degrees to obtain the two-dimensional image in the longitudinal section of the median nerve.Median nerve thickness were measured respectively in this point,up and down about 2cm of this position,and the average value of the three date obtain were obtained.In the same section,the probe was gently placed on the arm of the examiner,and then start the elastic imaging.In order to control the quality,we choose the stable form of SWE propagation wave,and the wave spacing is uniform.In the stable image of the waveform,in the region of interest(ROI),a 2 mm diameter circle was used as the measurement area,three points were measured along the median nerve,and the mean date was calculated for analysis.3.Statistical analysis:The comparisons among the three measurement parameters were analyzed by ANOVA(S-N-K method).The comparison between the two metrological parameters was performed using a two-sample T-test.Drawing the ROC curve to analyze the sensitivity,specificity,trueness and best cutoff value of the flexographic value.Result:1.All the median nerves were obtained a good elasticity image.The shape of SWE propagation wave is stable.The propagation velocity of the shear wave in the median nerve is faster than that of the surrounding tissue.2.The difference of median elasticity among the three groups was statistically significant(P<0.001).The elasticity value of each group was:62.41±15.98 kPa in DPN group,42.94±13.12 kPa in non DPN group,28.85±6.82 kPa in control group.The average thickness of the median nerve were:3.20±0.49mm in DPN group,2.77±0.31mm in non DPN group,2.68±0.28mm in control group.The difference of nerve thickness between DPN group and non-DPN group and control group was statistically significant(P non DPN<0.001,P control<0.001).There was no significant difference between DPN group and control group of the nerve thickness.There was no significant difference in the elasticity and thickness of MN between the left and right sides of all the subjects,the mean elasticity of the left side was 42.97±17.39 kPa and the average elasticity of the right was 46.55±19.03 kPa.The mean MN thickness of Left and right hand were:2.84±0.45mm of left,2.92±0.42mm of right.3.ROC statistical analysis:The optimal cutoff value is 52.55 kPa,the area under the curve is 0.831,the confidence interval is(0.761?0.901),the sensitivity is 0.75,the specificity is 0.75,the Youden index is 0.5.The above results show that when we take 52.55kPa as a diagnostic standard of DPN with a high accuracy and authenticity.The area under the average thickness measurement curve is 0.776,the 95%confidence interval is(0.691-0.86),the best cutoff is 3.05,the sensitivity is 0.667,the specificity is 0.743,the Youden index is 0.42.4.By comparing the course of DPN and non-DPN diabetic patients and the comparison of glycosylated hemoglobin in this study,The duration of DPN group was longer than that of DPN group(P<0.001),but there was no significant difference between glycosylated hemoglobin in the two groups.Conclusions:1.SWE has high quality imaging in the median nerve,and can be a quantitative analysis method of neuropathy in type 2 diabetic patients.According to the color coded image of SWE,the median nerve color of each group was:red and yellow of DPN group,yellow of non DPN group,light blue of the control group.There was no significant difference in the left and right MN in elasticity and thickness.Elasticity of the accuracy,sensitivity,specificity are higher than thickness measurement.2.Compared with non-DPN group and control group,the median nerve of DPN group was thicker,and the elasticity was increased,which is consistent with the pathological changes of diabetic peripheral nerves(edema of the nerve,increased pressure).There was no significant difference in thickness between non-DPN group and control group,but the difference in elasticity was statistically significant.Suggesting that elastic imaging technology can be used to detect early lesions of the peripheral nerve,can provide additional informationfor clinical diagnosis,electrophysiological diagnosis,may become the future diagnosis method of DPN. |
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