A study of diffusion tensor imaging of median nerve in diabetic peripheral neuropathy

Ramy Edward,Aussan Al-Athwari,Ahmed M. Abdelalim,Amal S. Ashour,Lamia Afifi

doi:10.1186/s41983-020-00172-5

Ramy Edward, Aussan Al-Athwari + Show 3 more

Open Access

https://doi.org/10.1186/s41983-020-00172-5

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Abstract

ObjectiveTo evaluate the role of diffusion tensor imaging (DTI) in the evaluation of diabetic peripheral neuropathy (DPN) compared to clinical scores and nerve conduction studies (NCS).Patients and methodsWe included 30 patients with diabetes mellitus complaining of neuropathy symptoms and 15 healthy volunteers. All subjects underwent evaluation using 1.5-T DTI of median nerves and NCS. Patients underwent clinical evaluation using the Neuropathy Deficit Score (NDS), Neuropathy Impairment Score in the Lower Limbs (NIS-LL), and Diabetic Neuropathy Examination (DNE) score.ResultsWe found statistically significant differences between healthy volunteers and patients in fractional anisotropy (FA) of the distal segment (P = 0.016) and whole median nerve (P = 0.024), apparent diffusion coefficient (ADC) of proximal (P = 0.027) and distal (P < 0.001) segments, and whole median nerve (P = 0.019). Distal segment FA was significantly correlated with NDS (P = 0.003), DNEs (P = 0.003), sensory amplitude (P = 0.048), and motor CV (P = 0.020). Distal segment ADC was significantly correlated with NDS (P = 0.007), NIS-LL (P = 0.003), DNEs (P = 0.01), and sensory amplitude (P = 0.032). The best cut-off value of distal segment for FA was 0.45 (87% sensitivity, 80% specificity) and of distal segment ADC was 1.217 (80% sensitivity and specificity).ConclusionsOur results suggest that 1.5-T DTI examination of the median nerve can provide useful non-invasive information in patients with DPN.Trial registrationClinicalTrials.gov, NCT03934970. Registered on May 1, 2019

Highlights

Diabetic peripheral neuropathy (DPN) is one of the most commonly reported long-term complications of diabetes mellitus (DM), affecting up to 50% of patients [1]
Distal segment fractional anisotropy (FA) was significantly correlated with Neuropathy Deficit Score (NDS) (P = 0.003), Diabetic Neuropathy Examination (DNE) (P = 0.003), sensory amplitude (P = 0.048), and motor conduction velocity (CV) (P = 0.020)
Our results suggest that 1.5-T diffusion tensor imaging (DTI) examination of the median nerve can provide useful non-invasive information in patients with DPN

Summary

Introduction

Diabetic peripheral neuropathy (DPN) is one of the most commonly reported long-term complications of diabetes mellitus (DM), affecting up to 50% of patients [1]. Clinical neuropathy scoring systems have been used as valid tools in Magnetic resonance diffusion tensor imaging (DTI) has been shown to detect neuropathy even in asymptomatic patients [7]. It uses high-resolution/high-contrast spin echo-type 2D and 3D imaging sequences which include heavy T2 weighting and uniform fat suppression which makes it an excellent technique that enhances peripheral nerve anatomy and pathology [8]. The aim of this study is to evaluate the role of DTI in the detection of peripheral nerve changes in patients with diabetes mellitus in comparison to the nerve conduction studies and clinical neuropathy scoring systems

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