Value of 2-Dimensional Shear-Wave Elastography in Assessing Tibial Nerve Stiffness in Diabetic Peripheral Neuropathy

The morphological alterations of the tibial nerve in patients with diabetes mellitus, both with and without diabetic peripheral neuropathy (DPN), are challenging to differentiate using B-mode ultrasound. In this study, we assessed the stiffness changes of the tibial nerve by 2-dimensional shear-wave elastography (2D-SWE).

We gathered data from 70 adults with valid 2D-SWE measurements, comprising 25 individuals in DPN Group A who were diagnosed with DPN and had peripheral nerve symptoms in the past 6 months, 15 individuals in DPN Group B who were diagnosed with DPN but had no peripheral nerve symptoms in the past 6 months, 16 individuals with type 2 diabetes but without DPN, and 14 healthy individuals. The maximal thickness, cross-sectional area, and stiffness of the tibial nerve among groups were analyzed.

DPN Group A had higher tibial nerve stiffness than Group B, non-DPN, and control groups (p < .05). The area under the curve (AUC) for 2D-SWE parameters in detecting increased nerve stiffness was 0.956 for G₁ (mean stiffness) and 0.979 for G₃ (distal stiffness), respectively, with optimal cut-off values of 20.01 and 28.41 kPa.

2D-SWE is a promising non-invasive technique for early diagnosis of DPN, effectively reflecting changes in nerve stiffness associated with the condition. This method may enhance clinical interventions aimed at preventing disease progression.