Quantitative shear wave elastography assessment of tibial nerve in diagnosis of diabetic peripheral neuropathy

Background: Diabetic peripheral neuropathy (DPN) is one of the most common complications of diabetes mellitus. Diagnosis of DPN is very important in the prognosis of disease and treatment as early treatment of DPN decreases both short-term and long-term morbidities. SWE elastography is a noninvasive and reproducible method for the precise evaluation of nerve stiffness. Results: Tibial nerve stiffness is notably high at SWE in diabetic patients with DPN (mean shear wave elastography value of RT tibial SWE 75.3 +/- 15.1 kPa) compared to patients without DPN (mean shear wave elastography value of RT tibial SWE 37.8 +/- 11.6 kPa) and nerve stiffness in healthy control subjects (mean shear wave elastography value of RT tibial SWE 24.9 +/- 6.3 kPa). There is a significant increase in the cross-sectional area (CSA) among diabetic patients with DPN (mean cross-sectional area of the right tibial nerve of 17 +/- 1.9 mm(2)) and without DPN (mean cross-sectional area of the right tibial nerve of 14.5 +/- 3.8 mm(2)) in comparison with control subjects (mean cross-sectional area of the right tibial nerve of 13.2 +/- 3.1 mm(2)) in the right side. Borderline significance of the CSA parameters of the tibial nerve study on the left side in different groups. The cutoff point to determine DPN among diabetic patients in the right lower limb is more than 63.8 kPa. With 89% sensitivity and 100% specificity in the detection of DPN on the right side, the SWE has 100% PPV and 95.5% NPV in the detection of DPN on the right side. Conclusion: SWE is an effective assistant method in the diagnosis of DPN and is useful when a suspected neuropathy is not detectable by electrophysiology.