Ultrasound features of diabetic peripheral neuropathy

Abstract

Introduction. Diagnosis of diabetic peripheral neuropathy (DPN) on a clinical basis alone is inaccurate. Ultrasound (US) abnormalities of DPN have been reported. This study describes the qualitative and quantitative US features of DPN in type 2 diabetes mellitus (T2DM) patients with and without symptomatic DPN. Material and Methods: This retrospective cross-sectional study in T2DM patients assessed the proximal and distal segments of the median and tibial nerves with grayscale and color Doppler US. The qualitative US features recorded were loss of the epineurium margin, blurring of the honeycomb structure, and intraneural vascularity. The diameter of the cross-sectional area (CSA) was also quantified. Patients were grouped according to the presence or absence of DPN clinical symptoms such as dysesthesia and/or pain. Results: Eighty patients were included. Forty (50%) reported dysesthesia and/or neuropathic pain. The time since T2DM diagnosis was a mean of 11.4 years. Loss of the epineurium margin was the most prevalent feature, followed by blurring of the honeycomb structure and the presence of intraneural vascularity. CSA enlargement was found in the proximal segment of the median nerve in patients with symptomatic DPN. In T2DM patients without DPN symptoms, the CSA was almost normal. The CSA was normal in the distal segment in both groups. In contrast, a comparable CSA increase of the tibial nerve was found in both nerve segments in T2DM patients with and without DPN symptoms. Conclusion: This study is the first in Mexico to demonstrate the demonstrate the qualitative and quantitative ultrasonographic features of DPN in T2DM patients with or without neuropathic symptoms.

Keywords

• Diabetic neuropathy. Median nerve. Tibial nerve. Peripheral neuropathy. Type 2 diabetes mellitus.