高频超声及剪切波弹性成像技术对2型糖尿病下肢神经病变的定量评估

Quantitative evaluation of lower limb neuropathy in type 2 diabetes by high-frequency ultrasound and shear wave elastography

目的:探讨剪切波弹性成像(SWE)技术和常规高频超声在糖尿病周围神经病变(DPN)患者胫神经和腓总神经中的应用价值。方法:前瞻性选取120名非DPN的糖尿病患者、120名患DPN的糖尿病患者以及同期门诊就诊的120名健康志愿者。采用常规高频超声测量胫神经和腓总神经的横截面积(CSA),并通过SWE技术测量胫神经及腓总神经的杨氏模量值(Emean)和剪切波速度(SWV)。结果:DPN患者胫神经及腓总神经的CSA、Emean及SWV均显著高于非DPN组及对照组(P<0.001),并且与对照组相比,非DPN患者胫神经及腓总神经的CSA、Emean及SWV也显著增大(P<0.001)。三组患者左、右侧胫神经和腓总神经的所有参数比较无显著差异(P>0.05)。利用胫神经的SWV值来诊断DPN的曲线下面积显著大于CSA和Emean,其诊断敏感性为76%,特异性为94%,诊断DPN的最佳截点值为2.95 m/s。BMI与神经的Emean及SWV呈正相关(P<0.001)。结论:DPN患者的胫神经和腓总神经的硬度以及CSA显著高于非DPN患者。胫神经的硬度参数比常规高频超声参数诊断DPN的效能更高。总之,高频超声和SWE技术可以较好的指导DPN的临床诊断。

Objective:To investigate the application value of shear wave elastography(SWE)and conventional high-frequency ultrasound in tibial nerve and common peroneal nerve in patients with diabetes peripheral neuropathy(DPN).Methods:120 non-DPN diabetes patients,120 DPN diabetes patients and 120 healthy volunteers were prospectively selected.The crosssectional area(CSA)of tibial nerve and common peroneal nerve was measured by conventional high-frequency ultrasound,and the Young’s modulus(Emean)and shear wave velocity(SWV)of tibial nerve and common peroneal nerve were measured by SWE technology.Results:The CSA,Emean and SWV of tibial nerve and common peroneal nerve in DPN patients were significantly higher than those in the non-DPN group and control group(P<0.001),and the CSA,Emean and SWV of tibial nerve and common peroneal nerve in the non-DPN patients were also significantly higher than those in the control group(P<0.001).There was no significant difference in all parameters of left and right tibial nerve and common peroneal nerve among the three groups(P>0.05).The area under the curve of the SWV value of tibial nerve to diagnose DPN was significantly greater than that of CSA and Emean.Its diagnostic sensitivity was 76%,specificity was 94%,and the best cutoff value for diagnosing DPN was 2.95 m/s.BMI was positively correlated with nerve Emean and SWV(P<0.001).Conclusion:The hardness and CSA of tibial nerve and common peroneal nerve in the DPN patients are significantly higher than those in the non-DPN patients.The hardness parameters of tibial nerve are more effective than conventional high-frequency ultrasound parameters in diagnosing DPN.In conclusion,high-frequency ultrasound and SWE technology can better guide the clinical diagnosis of DPN.