Evaluation of tibial nerve stiffness by elastography in distinguishing diabetic polyneuropathy and small fibre neuropathy in patients with type 2 diabetes

Abstract

Background & Objective: We investigated the comparison of shear wave elastography (SWE) method with electromyography (EMG) in diabetic polyneuropathy (DPN) cases in patients with type 2 diabetes mellitus (T2 DM) and evaluated the diagnosis of small fiber neuropathy (SFN) with SWE, which was normal in EMG.

Methods: Fifty T2 DM patients and 16 healthy controls were included in the study. Patients were divided into 3 groups according to EMG results; i.e., the group respectively with small fiber neuropathy, sensory axonal neuropathy, and sensorimotor neuropathy. Sonographic measurements were made at the poplitial fossa and medial malleolus level in the study groups, and the results were evaluated statistically.

Results: Fifty T2DM patients and 16 control group patients were included in the study. In the tibial nerve measurements from the popliteal fossa level of the patients, a significant difference was observed in the area under the curve between the control group and the SFN on the right side (p=0.044). In the measurements of the patients from the medial malleolus level, a significant difference was observed in the shear wave velocity on the right side between the control and SFN groups, and also between the SFN group and the sensorimotor neuropathy group (p=0.047).

Conclusion: In this study, significant differences were found between DPN patients and healthy controls when evaluated with cross-sectional area. Thus, SWE may be an alternative objective diagnostic method even in cases where DPN cannot be diagnosed with electrophysiological tests.