A Preliminary Study On Diagnosing Diabetic Peripheral Neuropathy Detected By Nerve Ultrasound

Objective:Several studies have demonstrated that the prevalence of DPN in diabetic patients was higher than in non-diabetic patients.However,due to the lack of uniform diagnostic criteria and detection methods,the prevalence rate varied widely,ranging from 10% to 96%.Effective screening and early diagnostic methods were extremely important for DPN patients.Ultrasound(US)examination is a convenient method for evaluating peripheral neuropathy.This study aimed to investigate the sensitivity and specificity of nerve ultrasound inspection on diagnosing diabetic peripheral neuropathy(DPN).Method:90 type 2 diabetic patients were divided into the peripheral neuropathy group(DPN),the suspected or subclinical peripheral neuropathy group(SDPN),and control group(CON)that had no DPN or SDPN.Relevant demographic data and nerve conduction velocity(NCV)results were collected.A blinded expert sonographer measured the CSA of PTN at 1,3,and 5 cm proximal to the medial malleolus and the common peroneal nerve(CPN)next to the humeral head.Demographic information,clinical characteristics and NCV results were compared by one-way ANOVA or Kruskal-Wallis H test.Results:Compared to the CON group,the mean CSA of the CPN(13.63 vs.11.12 mm2,P=0.001)and the posterior tibial nerve(PTN)at distances of 1(12.39 vs.10.29 mm2;P<0.0001),3(12.56 vs.10.17 mm2;P<0.0001),and 5 cm(12.85 vs.9.96 mm2;P<0.0001)proximal to the medial malleolus in the DPN group were significantly larger,while the mean CSA of the PTN at distances of 1(11.47 vs.10.29 mm2;P=0.036),3(11.46 vs.10.17 mm2;P=0.035)and 5 cm(11.27 vs.9.96 mm2;P=0.042)proximal to the medial malleolus in the SDPN group were significantly larger.The mean CSA of the CPN(13.64 vs.11.83 mm2;P=0.027)and the PTN at distances of 5 cm(12.85 vs.11.27 mm2;P=0.011)proximal to the medial malleolus in the DPN group were significantly larger compared to the SDPN group.The CSA of PTN measured at 5 cm above the medial malleolus had an optimal threshold value to identify DPN(11.16mm2)as determined using the area under the curve(AUC)analysis.It had a sensitivity of 0.87,a specificity of 0.8,and Youden's index of 0.67.Conclusion:Ultrasonic inspection was an effective,sensitive and reliable method to diagnose DPN.