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Relationship between ultrasonographic nerve morphology and severity of diabetic sensorimotor polyneuropathy
Author(s) -
Arumugam T.,
Razali S. N. O.,
Vethakkan S. R.,
Rozalli F. I.,
Shahrizaila N.
Publication year - 2016
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/ene.12836
Subject(s) - medicine , sural nerve , ultrasound , tibial nerve , area under the curve , polyneuropathy , receiver operating characteristic , cubital tunnel , ulnar nerve , surgery , radiology , elbow , stimulation , cubital tunnel syndrome
Background and purpose In the current study, the aim was to characterize the nerve ultrasound cross‐sectional areas ( CSA s) of type 2 diabetic patients with diabetic sensorimotor polyneuropathy ( DSP ) of different severities. Methods A hundred symptomatic DSP patients and 40 age‐matched healthy controls were prospectively recruited. DSP severity was ascertained through the Toronto Clinical Scoring System (TCCS). Nerve electrophysiology and ultrasound were performed on both lower limbs and the non‐dominant upper limb. Results The sural nerve was inexcitable in 19.1% of mild, 40.0% of moderate and 69.0% of severe DSP groups. In contrast, CSA s were measurable in all nerves of DSP patients and were significantly larger compared to controls. Patients with severe DSP had significantly larger ulnar, peroneal, tibial and sural nerves compared to mild DSP patients. By receiver operating characteristic curve analysis, the cut‐off value for the sural nerve at 2 mm 2 was a good discriminator (area under the curve 0.88) between the presence and absence of DSP (sensitivity 0.90; specificity 0.74) but performed less well in discriminating between the severity of DSP (cut‐off 2.75 mm 2 ; area under the curve 0.62; sensitivity 0.59; specificity 0.73). Significant correlations were demonstrated between TCSS scores, most neurophysiology parameters and CSA s of the ulnar, peroneal, tibial and sural nerves. Conclusion Nerve ultrasound in DSP reveals enlarged CSA s and these changes worsen with increasing disease severity, thus serving as a useful diagnostic tool especially when neurophysiology is unrevealing.