Morphological and Functional Changes in the Diabetic Peripheral Nerve

2005 ◽  
Vol 95 (5) ◽  
pp. 433-437 ◽  
Author(s):  
Doohi Lee ◽  
Damien M. Dauphinée
Keyword(s):  
Peripheral Nerve ◽  
Tibial Nerve ◽  
Imaging Techniques ◽  
Cross Sectional Area ◽  
Diabetic Patients ◽  
Tarsal Tunnel ◽  
Sectional Area ◽  
Cross Sectional ◽  
Functional Changes ◽  
Chronic Nerve Compression

It has been hypothesized that in individuals with diabetes mellitus the peripheral nerve is swollen owing to increased water content related to increased aldose reductase conversion of glucose to sorbitol. It has further been hypothesized that the tibial nerve in the tarsal tunnel is at risk for chronic nerve compression related to this swelling. We used diagnostic ultrasound to evaluate this hypothesis. Cross-sectional areas of the tibial nerve were measured in diabetic patients with neuropathy and compared with previously reported measurements in nondiabetic patients and diabetic patients without neuropathy. We used the Pressure-Specified Sensory Device (Sensory Management Services LLC, Baltimore, Maryland) to document the presence of neuropathy in 24 diabetic patients (48 limbs). Previous studies have found that the cross-sectional area of the tibial nerve in nondiabetic patients and in diabetic patients without neuropathy is not significantly different. We found that the mean cross-sectional area of the tibial nerve in diabetic patients with neuropathy is significantly greater than that in diabetic patients without neuropathy (24.0 versus 12.0 mm2). Our study highlights the value of newer ultrasound imaging techniques in identifying morphological change in the tibial nerve and confirms that the tibial nerve in the tarsal tunnel is swollen, consistent with chronic compression, in diabetic patients with neuropathy. (J Am Podiatr Med Assoc 95(5): 433–437, 2005)

High resolution ultrasonography of peripheral nerves in diabetic patients to evaluate nerve cross sectional area with clinical profile

2021 ◽  
Vol 94 (1121) ◽  
pp. 20200173
Author(s):  
Shamrendra Narayan ◽  
Amit Goel ◽  
Ajai Kumar Singh ◽  
Anup Kumar Thacker ◽  
Neha Singh ◽  
...  
Keyword(s):  
Peripheral Nerves ◽  
Cross Sectional Area ◽  
Diabetic Patients ◽  
Tarsal Tunnel ◽  
Healthy Controls ◽  
Sectional Area ◽  
Cross Sectional ◽  
Early Therapy ◽  
Ultrasound Evaluation ◽  
Compressive Neuropathy

Objectives: The aim of this observational study was ultrasound evaluation of peripheral nerves cross-sectional area (CSA) in subjects with probable diabetic peripheral sensorimotor neuropathy (DPN). CSA was analyzed with reference to clinical and nerve conduction study’s (NCS) parameters for early diagnosis and pattern of involvement. Methods: A total of 50 patients with probable DPN due to Type 2 diabetes and 50 age-matched healthy controls underwent sonographic examinations of ulnar nerve at the lower arm, median nerve proximal to carpal tunnel, the common peroneal nerve proximal to fibular head, tibial nerve proximal to the tarsal tunnel, and sural nerve at lower third leg. Results: CSA was increased in cases of DPN as compared to healthy controls. Area changes were more marked with demyelinating pattern. Probable DPN cases with normal NCS had significantly higher number of peripheral nerves showing increased CSA as compared to healthy control. A cut-off of >4 nerve thickening showed a sensitivity of 86 %, and specificity of 56%. The neuropathy pattern in the lower limb was axonal, whereas in the upper limb, it was demyelinating with the majority showing sonographic feature of associated compressive neuropathy. Conclusion: There is an increase in CSA of peripheral nerve in diabetic patients. It can be used as a morphological marker for classifying DPN with changes being picked up earlier to NCS abnormality. Clinical neurological presentation in probable DPN can also be due to compressive neuropathy in early phases, and ultrasound can be a useful tool. Advances in knowledge: Early pick up of DPN cases shall be useful for early therapy and motivating the patients to actively participate in the treatment. Morphological changes on ultrasonography precedes the electrodiagnostic change in DPN. Symptoms of DPN is not only due to metabolic changes but also compressive neuropathy.

Peripheral Nerves: Not Only Cross-sectional Area in the Era of Radiomics

2020 ◽  
Vol 24 (02) ◽  
pp. 175-180
Author(s):  
Alberto Stefano Tagliafico ◽  
Raquel Prada González ◽  
Federica Rossi ◽  
Bianca Bignotti ◽  
Carlo Martinoli
Keyword(s):  
Nervous System ◽  
Peripheral Nerve ◽  
Peripheral Nervous System ◽  
Internal Control ◽  
Peripheral Nerves ◽  
Imaging Techniques ◽  
Cross Sectional Area ◽  
Sectional Area ◽  
Musculoskeletal Radiology ◽  
Cross Sectional

AbstractThe peripheral nervous system is increasingly being investigated using medical imaging as a complement or in association with electrodiagnostics tests. The application of imaging techniques, such as ultrasound (US) and magnetic resonance imaging (MRI), allows detailed visualization of the peripheral nervous system. According to the European Society of Musculoskeletal Radiology, the use of US for nerve evaluation is strongly encouraged. In addition, the role of US is further enhanced by the wide application of US-guided techniques to diagnose or to treat peripheral nerve disorders.Standard evaluation of peripheral nerves on US usually relies on cross-sectional area evaluation with different cutoff values in the osteofibrous tunnels and outside them. In several anatomical areas, side-to-side comparison is highly recommended because it helps distinguish subtle variations by using the unaffected limb as an internal control.US is widely used to perform US-guided interventional procedures on peripheral nerves. The recent development of radiomics and machine and deep learning applied to peripheral nerves may reveal new insights beyond the capabilities of the human eye. Radiomics may have a role in expanding the diagnostic capabilities of US and MRI in the study of peripheral nerve pathology, especially when the cross-sectional area is not markedly increased.

High Resolution Ultrasound of the Tibial Nerve in Diabetic Peripheral Neuropathy

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Eman Soliman Metwally ◽  
Khaled Ahmed Mohamed Ali ◽  
Reham Shaaban Ahmed Abdel-Baqy
Keyword(s):  
Peripheral Neuropathy ◽  
Diabetic Peripheral Neuropathy ◽  
Tibial Nerve ◽  
Morphological Changes ◽  
Cross Sectional Area ◽  
Lower Limbs ◽  
Diabetic Patients ◽  
Main Role ◽  
Sectional Area ◽  
Cross Sectional

Abstract Background The main role of this study was to highlight the value of musculoskeletal ultrasound in the diagnosis of nerve affection in patients with diabetic peripheral neuropathy. This was evident by the significant correlation between cross sectional area and all study parameters with sensitivity and specificity of 90% and 100% respectively. Objectives Our study aims to highlight the value of newer ultrasound imaging techniques in identifying morphological changes of the tibial nerve in the patients with diabetic peripheral neuropathy. Patients and Methods During a period of ten months duration started in November 2019, 40 subjects were enrolled in this study. 20 diabetic patients with clinical manifestations of DPN had undergone nerve conduction study of both lower limbs then compared to 20 healthy control subjects as regard the ultrasound examination of TN bilaterally. The study was conducted according to the stipulations of the ASU ethical and scientific committee. The privacy of participants and confidentiality of data were guaranteed during the various phases of the study. Results We found that the cross sectional area (CSA) in patients with diabetic peripheral neuropathy (DPN) is significantly larger than the healthy controls. A positive significant correlation was found between CSA and duration of diabetes, HbA1c% and tibial nerve (TN) latency while a negative significant correlation was found with TN amplitude and conduction velocity. Conclusion Despite giving significantly larger values in cases than controls, MTNF was found to non-significantly correlated with all studied parameters. In view of the above data, CSA can be adopted as a reliable screening and diagnostic tool for DPN but further work-up is needed to assess its role in the follow up of the disease process. On the other hand, MTNF can be used for description of the morphological changes in a diabetic nerve.

scholarly journals Ultrasound Assessment of the Median Nerve Does Not Adequately Discriminate the Carpal Tunnel Syndrome among Patients Diagnosed with Diabetes

Diabetology ◽  
2021 ◽  
Vol 2 (4) ◽  
pp. 226-231
Author(s):  
Carlos Antonio Guillen-Astete ◽  
Monica Luque-Alarcon ◽  
Nuria Garcia-Montes
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Cross Sectional Area ◽  
Diabetic Patients ◽  
Sectional Area ◽  
Cross Sectional ◽  
Patients With Diabetes ◽  
Ultrasound Assessment ◽  
Tunnel Syndrome

Background: Carpal tunnel syndrome is the most prevalent peripheral nerve entrapment condition of the upper limb. Among metabolic risk factors, diabetes is considered the most relevant. Although wrist ultrasound assessment of the median nerve has demonstrated a good correlation with the gold standard for the diagnosis of this syndrome, neurophysiological study, its usefulness in patients with diabetes is questionable because the compressive phenomenon is not the predominant one. Method: We conducted a retrospective study to compare the clinical and median nerve ultrasound features of patients with carpal tunnel syndrome previously diagnosed or not diagnosed with diabetes. Additionally, a linear multivariate regression analysis was performed to determine to what extent the cross-sectional area of the median nerve was dependent on the condition of diabetes by fixing other variables such as sex, age, or time of evolution. Results: We included 303 records of patients (mean age 44.3 ± 11.7 years old, 57.89% female, mean of time of evolution 13.6 ± 8.3 months) from 2012 to 2020. The cross-sectional area of the median nerve was 10.46 ± 1.44 mm2 in non-diabetic patients and 8.92 ± 0.9 mm2 in diabetic patients (p < 0.001). Additionally, diabetic patients had a shorter time of evolution (7.91 ± 8.28 months vs. 14.36 ± 0.526 months, p < 0.001). In the multivariate analysis, the resultant model (fixed R-square = 0.659, p = 0.003) included a constant of the following four variables: the evolution time (Beta coeff. = 0.108, p < 0.001 95% CI 0.091 to 0.126, standardized coeff. = 0.611), the condition of diabetes (Beta coeff. = −0.623, p < 0.001 95% CI −0.907 to −0.339, standardized coeff. = −0.152), the severity (Beta coeff. = 0.359, p = 0.001 95% CI 0.147 to 0.571, standardized coeff. = 0.169), and the masculine sex (Beta coeff. = 0.309, p = 0.003, 95% CI 0.109 to 0.509, standardized coeff. = 0.103). Conclusions: Ultrasound assessment of the median nerve in patients with diabetes is not a useful tool to confirm whether carpal tunnel syndrome should be diagnosed or not diagnosed.

P-NU005. Nerve cross-sectional area as a surrogate marker of peripheral nerve degeneration in amyotrophic lateral sclerosis

2021 ◽  
Vol 132 (8) ◽  
pp. e118
Author(s):  
Toh Tsun Haw ◽  
Nur Adilah Abdul Aziz ◽  
Mohd Azly Yahaya ◽  
Ee Chin Loh ◽  
David Capelle ◽  
...  
Keyword(s):  
Amyotrophic Lateral Sclerosis ◽  
Peripheral Nerve ◽  
Surrogate Marker ◽  
Cross Sectional Area ◽  
Nerve Degeneration ◽  
Sectional Area ◽  
Cross Sectional ◽  
Lateral Sclerosis

scholarly journals High-resolution ultrasound in the assessment of peripheral nerves in leprosy: A comparative cross-sectional study

2021 ◽  
Vol 0 ◽  
pp. 1-8
Author(s):  
Kalathummarath Sreejith ◽  
Sarita Sasidharanpillai ◽  
Kidangazhiathmana Ajithkumar ◽  
Reeba Mary Mani ◽  
Anuradha Thalian Chathoth ◽  
...  
Keyword(s):  
High Resolution ◽  
Peripheral Nerve ◽  
Clinical Examination ◽  
Peripheral Nerves ◽  
Cross Sectional Area ◽  
Nerve Function ◽  
Sectional Area ◽  
Cross Sectional ◽  
Function Impairment ◽  
The Cross

Background: Detection of peripheral nerve thickening and nerve function impairment is crucial in the diagnosis and the management of leprosy. Aims and objectives: (1) To document the cross-sectional area, echotexture and blood flow of peripheral nerves in healthy controls and leprosy cases using high-resolution ultrasound, (2) to compare the sensitivities of clinical examination and high-resolution ultrasound in detecting peripheral nerve thickening in leprosy. Methods: Peripheral nerves of 30 leprosy patients and 30 age- and sex-matched controls were evaluated clinically and by high-resolution ultrasound. When the cross-sectional area of a peripheral nerve on high-resolution ultrasound in a leprosy patient was more than the calculated upper bound of the 95% confidence interval for mean for that specific nerve in controls, that particular peripheral nerve was considered to be enlarged. Results: Cross-sectional areas more than 7.1 mm2 for the radial nerve, 8.17 mm2 for ulnar, 10.17 mm2 for median, 9.50 mm2 for lateral popliteal and 11.21mm2 for the posterior tibial nerve were considered as nerve thickening on high-resolution ultrasound. High-resolution ultrasound detected 141/300 (47%) nerves enlarged in contrast to the 60 (20%) diagnosed clinically by palpation (P < 0.001). Clinical examination identified thickening in 31/70 (44.3%) nerves in cases with impairment of nerve function and 29/230 (12.6%) in the absence of nerve function impairment. High-resolution ultrasound detected thickening in 50/70 (71.4%) nerves with impairment of function and in 91/230 (39.6%) nerves without any impairment of function. Limitation: A single-centre study design was the major study limitation. Conclusion: High-resolution ultrasound showed greater sensitivity than clinical examination in detecting peripheral nerve thickening in leprosy cases. High-resolution ultrasound, may therefore improve the sensitivity of the diagnostic criterion of peripheral nerve enlargement in the diagnosis and classification of leprosy.

scholarly journals The use of SPHARM-PDM and mean latitude axis to evaluate airway changes

2016 ◽  
Vol 86 (6) ◽  
pp. 943-948 ◽  
Author(s):  
Tung Nguyen ◽  
Ceib Phillips ◽  
Beatriz Paniagua
Keyword(s):  
Shape Change ◽  
Imaging Techniques ◽  
Cross Sectional Area ◽  
Cone Beam ◽  
Imaging Method ◽  
Sectional Area ◽  
Volume Changes ◽  
Cross Sectional ◽  
Pharyngeal Airway ◽  
Bilateral Sagittal Split Osteotomy

ABSTRACT Objective: To introduce new 3-D imaging techniques to characterize shape and volume changes of the oropharyngeal space after bilateral sagittal split osteotomy (BSSO) advancement. Materials and Methods: Longitudinal cone-beam computed tomography (CBCT) scans were obtained for 20 patients undergoing BSSO advancement at three time points (T1 = presurgery, T2 = splint removal, and T3 = 1 year after surgery). Segmentation of the airway was performed using the following boundaries: hard palate/posterior nasal spine superiorly and lower border of C3 to the base of the epiglottis inferiorly. For shape measurements, point-based correspondent models and mean latitude axis were obtained for all the data using SPHARM-PDM software. All 3-D correspondent models were rigidly registered using Procrustes alignment. Absolute distance maps and corresponding vector maps were calculated to show shape and vector differences between each correspondent point. Mean latitude axis is a new imaging method to calculate minimum cross-sectional areas along the long axis of the airway independent of head position/alignment. Results: The airway volume increased (P &lt; .01) after BSSO advancement (2973.9 mm3 ± 27882.0) and was stable (−439.9 mm3 ± 3308.8) 1 year post-op. 3-D color maps and semitransparency overlays showed more lateral than anteroposterior expansion of the airway after BSSO advancement. Mean latitude axis was used to measure minimum cross-sectional area, showing a statistically significant increase (52.7 mm2 ± 46.7) (P &lt; .01) after surgery and remained stable (−10.3 mm2 ± 43.3) 1 year after surgery. Conclusions: SPHARM-PDM and mean latitude axis are useful tools to assess airway shape change. BSSO advancement produces a significant increase in pharyngeal airway volume and minimum cross-sectional area. The airway space increased more transversely than anteroposteriorly.

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