Evaluation of Tibial nerve morphology by high resolution ultrasonography in diabetic patients with clinically suspected diabetic peripheral neuropathy: A cross sectional study

Abstract

Background: Diabetic peripheral neuropathy is diagnosed by nerve conduction studies by presence of atypical parameters with respect to amplitude, latency as well as conduction velocity of nerve. In adjunct to current screening modalities, use of ultrasonography for evaluation of peripheral neuropathy in diabetic patients has been advocated as a promising diagnostic tool. The purpose of this study is to evaluate & measure Cross-sectional area of tibial nerve & maximum thickness of nerve fascicles of tibial nerve in diabetic patients with clinical suspicion of diabetic peripheral neuropathy by ultrasonography & its correlation with clinical symptoms, duration of diabetes & HbA1c. Materials and methods: This cross-sectional study was conducted in Mahatma Gandhi Medical College and Research Institute from January 2021 to June 2022 amongst 30 clinically suspected diabetic peripheral neuropathy patients. Results: The mean age, Hb1Ac & duration of diabetes was found to be 67.83, 10.08 & 21.27, with a male predominance (26 males & 4 females). Average Cross sectional area of tibial nerve, maximum thickness of nerve fascicles of tibial nerve & average total Toronto clinical neuropathy score was found to be 23.82 mm2, 0.68 mm & 10.23 respectively. Correlation of duration of diabetes, HbA1c as well as Toronto neuropathy score against average Cross sectional area of tibial nerve, average maximum thickness of nerve fascicles of tibial nerve in both limbs was found to be statistically significant with a strong positive correlation. Conclusion: High resolution ultrasonography is efficient in detecting morphological changes in tibial nerve in clinically suspected diabetic neuropathic patients. Cross-sectional area and maximum thickness of nerve fascicles of tibial nerve were found to be significantly higher than typical cut off values used in this study and high-resolution ultrasound is an important tool for diagnosis of diabetic peripheral neuropathy.