Role of Ultrasonography as a Screening Tool for Peripheral Neuropathy in Diabetic Patients

Abstract

Background: The burden of diabetes is increasing all over the world, and so are its associated complications. One of the most debilitating sequelae of diabetes is diabetic peripheral neuropathy, which needs early diagnosis through screening, and high-resolution ultrasonography can act as a significant screening and diagnostic tool in its assessment.
Methods: The sonographic examination was performed with the Samsung RS85 Prestige System using an LA2-14A linear array transducer. Four peripheral nerves were examined: the ulnar nerve, the median nerve in the upper limb, the tibial nerve, and the sural nerve in the lower limb. Parameters evaluated for each nerve were cross-sectional area, thickness, echogenicity, and swelling.
Results: The cross-sectional area of the involved nerves was found to be increased in patients with diabetic peripheral neuropathy. Affected nerves were swollen, thickened, and hypoechoic compared to the healthy group. Among the four nerves, the sural nerve shows high sensitivity (100%) and specificity (98%), having a cut-off value of 4.0 mm², which can be considered a diagnostic and screening parameter when assessing diabetic peripheral neuropathy.
Conclusion: High-resolution peripheral nerve ultrasonography can be reliably used as an efficient screening tool for diabetic peripheral neuropathy in diabetic patients. It can be used in association with other available tests for diabetic peripheral neuropathy and can be better tolerated by patients because of its non-invasive nature.