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Neto T, Johannsson J, Andrade RJ. Using ultrasound shear wave elastography to characterize peripheral nerve mechanics: a systematic review on the normative reference values in healthy individuals. Ultrasonography 2024; 43:169-178. [PMID: 38544459 PMCID: PMC11079506 DOI: 10.14366/usg.23211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 02/09/2024] [Accepted: 02/14/2024] [Indexed: 05/09/2024] Open
Abstract
Ultrasound shear wave elastography (SWE) is an emerging non-invasive imaging technique for peripheral nerve evaluation. Shear wave velocity (SWV), a surrogate measure of stiffness, holds promise as a biomarker for various peripheral nerve disorders. However, to maximize its clinical and biomechanical value, it is important to fully understand the factors that influence nerve SWV measurements. This systematic review aimed to identify the normal range of SWV for healthy sciatic and tibial nerves and to reveal the factors potentially affecting nerve SWV. An electronic search yielded 17 studies eligible for inclusion, involving 548 healthy individuals (age range, 17 to 72 years). Despite very good reliability metrics, the reported SWV values differed considerably across studies for the sciatic (1.9-9.9 m/s) and tibial (2.3-9.1 m/s) nerves. Factors such as measurement proximity to joint regions, limb postures inducing nerve axial stretching, and transducer alignment with nerve fiber orientation were associated with increased SWV. These findings suggest regional-specific nerve mechanical properties, non-linear elastic behaviour, and marked mechanical anisotropy. The impact of age and sex remains unclear and warrants further investigation. These results emphasize the importance of considering these factors when assessing and interpreting nerve SWE. While increased SWV has been linked to pathological changes affecting nerve tissue mechanics, the significant variability observed in healthy nerves highlights the need for standardized SWE assessment protocols. Developing guidelines for enhanced clinical utility and achieving a comprehensive understanding of the factors that influence nerve SWE assessments are critical in advancing the field.
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Affiliation(s)
- Tiago Neto
- Luxembourg Institute of Research in Orthopedics, Sports Medicine and Science, Luxembourg, Luxembourg
| | - Johanna Johannsson
- Department of Physiotherapy, LUNEX International University of Health, Exercise and Sports, Differdange, Luxembourg
| | - Ricardo J. Andrade
- Nantes University, Movement - Interactions - Performance, MIP, UR 4334, 44000, Nantes, France
- Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, Australia
- School of Health Sciences and Social Work, Griffith University, Brisbane and Gold Coast, Australia
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Rossetto G, Lopomo NF, Shaikh SZ. Longitudinal Movements and Stiffness of Lower Extremity Nerves Measured by Ultrasonography and Ultrasound Elastography in Symptomatic and Asymptomatic Populations: A Systematic Review With Meta-analysis. ULTRASOUND IN MEDICINE & BIOLOGY 2023:S0301-5629(23)00140-0. [PMID: 37331920 DOI: 10.1016/j.ultrasmedbio.2023.04.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 04/07/2023] [Accepted: 04/24/2023] [Indexed: 06/20/2023]
Abstract
This study was aimed at analyzing the effectiveness of ultrasonography (US) and ultrasound elastography (UE) in evaluating longitudinal sliding and stiffness of nerves. In line with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement, we analyzed 1112 publications (range: 2010-2021) extracted from MEDLINE, Scopus and Web of Science focusing on specific outcomes, including shear wave velocity (m/s), shear modulus (kPa), strain ratio (SR) and excursion (mm). Thirty-three papers were included and evaluated for overall quality and risk of bias. From the analysis of data concerning 1435 participants, mean shear wave velocity (SWV) in the sciatic nerve was 6.70 ± 1.26 m/s in controls and 7.51 ± 1.73 m/s in participants presenting with leg pain; in the tibial nerve, mean SWV was 3.83 ± 0.33 m/s in controls and 3.42 ± 3.53 m/s in participants presenting with diabetic peripheral neuropathy (DPN). The mean shear modulus (SM) was 20.9 ± 9.33 kPa for sciatic nerve, whereas it was an average of 23.3 ± 7.20 kPa for the tibial nerve. Considering 146 subjects (78 experimental, 68 controls) no significant difference was observed in SWV when comparing participants with DPN with controls (standard mean difference [SMD]: 1.26, 95% confidence interval [CI]: 0.54, 1.97), whereas a significant difference was observed in the SM (SMD: 1.78, 95% CI: 1.32, 2.25); furthermore, we found significant differences between left and right extremity nerves (SMD:1.14. 95% CI: 0.45, 1.83) among 458 participants (270 with DPN and 188 controls). No descriptive statistics are available for excursion because of the variability in participants and limb positions, whereas SR is considered only a semiquantitative outcome and therefore not comparable among different studies. Despite the presence of some limitations in study designs and methodological biases, on the basis of our findings, we can conclude that US and UE are effective methods in assessing longitudinal sliding and stiffness of lower extremity nerves in both symptomatic and asymptomatic subjects.
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Affiliation(s)
- Gianluca Rossetto
- Department of Information Engineering, University of Brescia, Brescia, Italy
| | | | - Summaiva Zareen Shaikh
- Department of Neuro-physiotherapy, SIA College of Health Sciences, College of Physiotherapy, Thane, India.
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Jerban S, Barrère V, Andre M, Chang EY, Shah SB. Quantitative Ultrasound Techniques Used for Peripheral Nerve Assessment. Diagnostics (Basel) 2023; 13:956. [PMID: 36900101 PMCID: PMC10000911 DOI: 10.3390/diagnostics13050956] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/14/2023] [Accepted: 02/17/2023] [Indexed: 03/06/2023] Open
Abstract
AIM This review article describes quantitative ultrasound (QUS) techniques and summarizes their strengths and limitations when applied to peripheral nerves. METHODS A systematic review was conducted on publications after 1990 in Google Scholar, Scopus, and PubMed databases. The search terms "peripheral nerve", "quantitative ultrasound", and "elastography ultrasound" were used to identify studies related to this investigation. RESULTS Based on this literature review, QUS investigations performed on peripheral nerves can be categorized into three main groups: (1) B-mode echogenicity measurements, which are affected by a variety of post-processing algorithms applied during image formation and in subsequent B-mode images; (2) ultrasound (US) elastography, which examines tissue stiffness or elasticity through modalities such as strain ultrasonography or shear wave elastography (SWE). With strain ultrasonography, induced tissue strain, caused by internal or external compression stimuli that distort the tissue, is measured by tracking detectable speckles in the B-mode images. In SWE, the propagation speed of shear waves, generated by externally applied mechanical vibrations or internal US "push pulse" stimuli, is measured to estimate tissue elasticity; (3) the characterization of raw backscattered ultrasound radiofrequency (RF) signals, which provide fundamental ultrasonic tissue parameters, such as the acoustic attenuation and backscattered coefficients, that reflect tissue composition and microstructural properties. CONCLUSIONS QUS techniques allow the objective evaluation of peripheral nerves and reduce operator- or system-associated biases that can influence qualitative B-mode imaging. The application of QUS techniques to peripheral nerves, including their strengths and limitations, were described and discussed in this review to enhance clinical translation.
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Affiliation(s)
- Saeed Jerban
- Department of Radiology, University of California, San Diego, CA 92093, USA
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, CA 92161, USA
- Department of Orthopaedic Surgery, University of California, San Diego, CA 92093, USA
| | - Victor Barrère
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, CA 92161, USA
- Department of Orthopaedic Surgery, University of California, San Diego, CA 92093, USA
| | - Michael Andre
- Department of Radiology, University of California, San Diego, CA 92093, USA
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, CA 92161, USA
| | - Eric Y. Chang
- Department of Radiology, University of California, San Diego, CA 92093, USA
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, CA 92161, USA
| | - Sameer B. Shah
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, CA 92161, USA
- Department of Orthopaedic Surgery, University of California, San Diego, CA 92093, USA
- Department of Bioengineering, University of California, San Diego, CA 92093, USA
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Daeschler SC, Pennekamp A, Tsilingiris D, Bursacovschi C, Aman M, Eisa A, Boecker A, Klimitz F, Stolle A, Kopf S, Schwarz D, Bendszus M, Kneser U, Kender Z, Szendroedi J, Harhaus L. Effect of Surgical Release of Entrapped Peripheral Nerves in Sensorimotor Diabetic Neuropathy on Pain and Sensory Dysfunction-Study Protocol of a Prospective, Controlled Clinical Trial. J Pers Med 2023; 13:jpm13020348. [PMID: 36836582 PMCID: PMC9962788 DOI: 10.3390/jpm13020348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/07/2023] [Accepted: 02/16/2023] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND Nerve entrapment has been hypothesized to contribute to the multicausal etiology of axonopathy in sensorimotor diabetic neuropathy. Targeted surgical decompression reduces external strain on the affected nerve and, therefore, may alleviate symptoms, including pain and sensory dysfunction. However, its therapeutic value in this cohort remains unclear. AIM Quantifying the treatment effect of targeted lower extremity nerve decompression in patients with preexisting painful sensorimotor diabetic neuropathy and nerve entrapment on pain intensity, sensory function, motor function, and neural signal conduction. STUDY DESIGN This prospective, controlled trial studies 40 patients suffering from bilateral therapy-refractory, painful (n = 20, visual analogue scale, VAS ≥ 5) or painless (n = 20, VAS = 0) sensorimotor diabetic neuropathy with clinical and/or radiologic signs of focal lower extremity nerve compression who underwent unilateral surgical nerve decompression of the common peroneal and the tibial nerve. Tissue biopsies will be analyzed to explore perineural tissue remodeling in correlation with intraoperatively measured nerve compression pressure. Effect size on symptoms including pain intensity, light touch threshold, static and moving two-point discrimination, target muscle force, and nerve conduction velocity will be quantified 3, 6, and 12 months postoperatively, and compared (1) to the preoperative values and (2) to the contralateral lower extremity that continues non-operative management. CLINICAL SIGNIFICANCE Targeted surgical release may alleviate mechanical strain on entrapped lower extremity nerves and thereby potentially improve pain and sensory dysfunction in a subset of patients suffering from diabetic neuropathy. This trial aims to shed light on these patients that potentially benefit from screening for lower extremity nerve entrapment, as typical symptoms of entrapment might be erroneously attributed to neuropathy only, thereby preventing adequate treatment.
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Affiliation(s)
- Simeon C Daeschler
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG-Trauma Center Ludwigshafen/Rhine, Department of Hand and Plastic Surgery, University of Heidelberg, 67071 Ludwigshafen, Germany
| | - Anna Pennekamp
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG-Trauma Center Ludwigshafen/Rhine, Department of Hand and Plastic Surgery, University of Heidelberg, 67071 Ludwigshafen, Germany
| | - Dimitrios Tsilingiris
- Department of Internal Medicine 1 and Clinical Chemistry, University Hospital of Heidelberg, 69120 Heidelberg, Germany
| | - Catalina Bursacovschi
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG-Trauma Center Ludwigshafen/Rhine, Department of Hand and Plastic Surgery, University of Heidelberg, 67071 Ludwigshafen, Germany
| | - Martin Aman
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG-Trauma Center Ludwigshafen/Rhine, Department of Hand and Plastic Surgery, University of Heidelberg, 67071 Ludwigshafen, Germany
| | - Amr Eisa
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG-Trauma Center Ludwigshafen/Rhine, Department of Hand and Plastic Surgery, University of Heidelberg, 67071 Ludwigshafen, Germany
| | - Arne Boecker
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG-Trauma Center Ludwigshafen/Rhine, Department of Hand and Plastic Surgery, University of Heidelberg, 67071 Ludwigshafen, Germany
| | - Felix Klimitz
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG-Trauma Center Ludwigshafen/Rhine, Department of Hand and Plastic Surgery, University of Heidelberg, 67071 Ludwigshafen, Germany
| | - Annette Stolle
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG-Trauma Center Ludwigshafen/Rhine, Department of Hand and Plastic Surgery, University of Heidelberg, 67071 Ludwigshafen, Germany
| | - Stefan Kopf
- Department of Internal Medicine 1 and Clinical Chemistry, University Hospital of Heidelberg, 69120 Heidelberg, Germany
- German Center for Diabetes Research, 85764 Neuherberg, Germany
| | - Daniel Schwarz
- Department of Neuroradiology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Ulrich Kneser
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG-Trauma Center Ludwigshafen/Rhine, Department of Hand and Plastic Surgery, University of Heidelberg, 67071 Ludwigshafen, Germany
| | - Zoltan Kender
- Department of Internal Medicine 1 and Clinical Chemistry, University Hospital of Heidelberg, 69120 Heidelberg, Germany
- German Center for Diabetes Research, 85764 Neuherberg, Germany
| | - Julia Szendroedi
- Department of Internal Medicine 1 and Clinical Chemistry, University Hospital of Heidelberg, 69120 Heidelberg, Germany
- German Center for Diabetes Research, 85764 Neuherberg, Germany
- Joint Heidelberg-ICD Translational Diabetes Program, Helmholtz-Zentrum, 85764 Neuherberg, Germany
| | - Leila Harhaus
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG-Trauma Center Ludwigshafen/Rhine, Department of Hand and Plastic Surgery, University of Heidelberg, 67071 Ludwigshafen, Germany
- Department of Handsurgery, Peripheral Nerve Surgery and Rehabilitation, BG Trauma Hospital, 67071 Ludwigshafen, Germany
- Department of Orthopedic Surgery, Section Upper Extremity, University Hospital Heidelberg, 69120 Heidelberg, Germany
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Chen SP, Ye TT, Hong J, Zhu H. Evaluation of Sciatic Nerve Stiffness Using Shear Wave Elastography in Patients with Unilateral Diabetic Foot Ulcers. Diagnostics (Basel) 2023; 13:diagnostics13030547. [PMID: 36766650 PMCID: PMC9914609 DOI: 10.3390/diagnostics13030547] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 01/28/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To evaluate the stiffness of the sciatic nerve by shear wave elastography (SWE) and to determine whether SWE can be used to predict diabetic foot ulcer (DFU) in a patient with diabetic peripheral neuropathy (DPN). METHODS Sixteen patients (thirty-two lower limbs) with unilateral DFU were studied retrospectively. The ultrasonographic parameters including cross-sectional area (CSA) of sciatic nerve, intraneural blood flow, peak systolic velocity (Vmax) and resistive index (RI) in the intraneural artery of the sciatic nerve, and the SWE stiffness value of the sciatic nerve were measured. The examinations of arteries of the lower limbs were also performed by ultrasound. According to the presence or absence of DFU, the 32 lower limbs were divided into two groups: the DFU group and the non-DFU group. The ultrasonographic parameters were compared between these two groups. RESULTS There was no significant difference (p > 0.05) between the two groups for CSA, intraneural blood flow, Vmax and RI in the intraneural artery of the sciatic nerve, and numbers of severe artery stenosis or full occlusion of the artery in the lower limbs. However, SWE stiffness values in the sciatic nerve in the DFU group are higher than the non-DFU group (p < 0.05). When the SWE stiffness values were used for prediction of DFU in patients with DPN, the area under the ROC curve (AUC) was 0.727 (95% CI: 0.541-0.868). When the best SWE stiffness value of 24.48 kPa was taken as a cutoff for prediction of DFU, the sensitivity was 62.50% (95% CI: 35.4-84.8%), and the specificity was 75% (95% CI: 47.6-92.7%). CONCLUSIONS Sciatic nerve stiffness is significantly higher in lower limbs with DFU. SWE is a noninvasive imaging method that may be used to evaluate sciatic nerve stiffness, then potentially predict DFU in patients with DPN.
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Affiliation(s)
- Shun-Ping Chen
- Department of Ultrasonography, First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
- Correspondence: (S.-P.C.); (H.Z.)
| | - Ting-Ting Ye
- Department of Endocrinology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Jing Hong
- Department of Endocrinology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Hong Zhu
- Department of Endocrinology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
- Correspondence: (S.-P.C.); (H.Z.)
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Wang C, Wang H, Zhou Y, Zhang S, Huang M. Evaluation of the clinical value of shear wave elastography for early detection and diagnosis of diabetic peripheral neuropathy: a controlled preliminary prospective clinical study. BMC Musculoskelet Disord 2022; 23:1120. [PMID: 36550450 PMCID: PMC9773497 DOI: 10.1186/s12891-022-06085-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
PURPOSE This study aims to analyze the clinical application value of shear wave elastography (SWE) technique for early diagnosis of diabetic peripheral neuropathy (DPN). METHODS Diabetic patients hospitalized in the Department of Endocrinology of the First Affiliated Hospital of Anhui Medical University from August 2021 to February 2022 were enrolled as DPN group (n=38) and non-DPN group (n=35) based on the neurophysiological examination results. 30 healthy subjects were recruited as the control group during the same period. Ultrasound examination of the tibial nerve and related laboratory tests were examined and collected for the total 103 study subjects. Statistical analysis of the collected data, and the receiver operating characteristic(ROC) curve for determination of the optimal cut-off values of mean stiffness of tibial nerve to detect DPN, with determination of area under curve (AUC), specificity, sensitivity, and Youden index.P value < 0.05 is considered statistically significant. RESULTS Gender, age and BMI differences among three groups were insignificant (P>0.05). The difference of serological indicators between DPN and non-DPN groups was also not found (P>0.05), whereas longer duration of diabetes was observed in DPN group as compared to non-DPN group. As to the ultra-sound relevant parameters, the cross-sectional area and elastic modulus of the tibial nerve in both lower extremities among these three groups were not significantly different (Oneway ANOVA analysis) although the differences were indeed observed if we compared DPN group exclusively with non-DPN group, or compared non-DPN group with healthy group, or compared DPN group with healthy group (t test). Additionally, the mean elasticity (Emean) cut-off value for the diagnosis of DPN was preferably taken as 67.55 kPa. CONCLUSION SWE has unique advantages in early detection and diagnosis of DPN, which deserve further research.
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Affiliation(s)
- Can Wang
- grid.412679.f0000 0004 1771 3402Department of Ultrasound Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022 China
| | - Huiqin Wang
- grid.412679.f0000 0004 1771 3402Department of Ultrasound Medicine, Dongcheng branch of The First Affiliated Hospital of Anhui Medical University(Feidong Peoples Hospital), Hefei, 231699 China
| | - Yi Zhou
- grid.412679.f0000 0004 1771 3402Department of Ultrasound Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022 China
| | - Shiqi Zhang
- grid.412679.f0000 0004 1771 3402Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022 China
| | - Meng Huang
- grid.412679.f0000 0004 1771 3402Department of Ultrasound Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022 China ,grid.412679.f0000 0004 1771 3402Department of Ultrasound Medicine, Dongcheng branch of The First Affiliated Hospital of Anhui Medical University(Feidong Peoples Hospital), Hefei, 231699 China
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Wu H, Zhao HJ, Xue WL, Wang YC, Zhang WY, Wang XL. Ultrasound and elastography role in pre- and post-operative evaluation of median neuropathy in patients with carpal tunnel syndrome. Front Neurol 2022; 13:1079737. [PMID: 36588903 PMCID: PMC9800593 DOI: 10.3389/fneur.2022.1079737] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 11/23/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction Carpal tunnel syndrome (CTS) is a common compression neuropathy of the median nerve in the wrist. Early diagnosis of CTS is essential for selecting treatment options and assessing prognosis. The current diagnosis of CTS is based on the patient's clinical symptoms, signs, and an electromyography (EMG) test. However, they have some limitations. Recently, ultrasound has been adopted as an adjunct diagnostic tool for electromyography (EMG). Ultrasound is a non-invasive and cost-effective technique. It provides a dynamic display of morphological changes in the median nerve and an assessment of CTS etiology such as tenosynovitis, mass compression, and tendon disease. This study aimed to investigate the value of conventional ultrasound and real-time shear wave elastography (SWE) in evaluation of median neuropathy in patients with carpal tunnel syndrome (CTS) before and after surgery. Methods First, the Boston Carpal Tunnel Questionnaire (BCTQ) was administered to patients with CTS. All subjects were measured at three levels: the distal 1/3 of the forearm, the carpal tunnel inlet, and the distal carpal tunnel using conventional ultrasound and SWE. Median nerve parameters were examined in patients with CTS 1 week after surgery. Results The cross-sectional area (CSA) and stiffness of the median nerve at the carpal tunnel inlet and distal carpal tunnel were significantly higher in patients with CTS than in healthy controls (p < 0.001). The CSA and stiffness of the median nerve at the carpal tunnel inlet were statistically significantly significantly between pre- and postoperative patients with CTS (p < 0.001). The CSA and stiffness of the nerve in patients with CTS had a positive correlation with electrophysiology severity. Conclusions and discussion Conventional ultrasound and elastography are valuable in the diagnosis of CTS and are useful in the clinical assessment of patient's nerve recovery after operation.
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Elfattah Hassan Gadalla AA, Nada HR, Kaddah RO, Khalil AS, Saleh MM. Quantitative shear wave elastography assessment of tibial nerve in diagnosis of diabetic peripheral neuropathy. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00803-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Diabetic peripheral neuropathy (DPN) is one of the most common complications of diabetes mellitus. Diagnosis of DPN is very important in the prognosis of disease and treatment as early treatment of DPN decreases both short-term and long-term morbidities. SWE elastography is a noninvasive and reproducible method for the precise evaluation of nerve stiffness.
Results
Tibial nerve stiffness is notably high at SWE in diabetic patients with DPN (mean shear wave elastography value of RT tibial SWE 75.3 ± 15.1 kPa) compared to patients without DPN (mean shear wave elastography value of RT tibial SWE 37.8 ± 11.6 kPa) and nerve stiffness in healthy control subjects (mean shear wave elastography value of RT tibial SWE 24.9 ± 6.3 kPa). There is a significant increase in the cross-sectional area (CSA) among diabetic patients with DPN (mean cross-sectional area of the right tibial nerve of 17 ± 1.9 mm2) and without DPN (mean cross-sectional area of the right tibial nerve of 14.5 ± 3.8 mm2) in comparison with control subjects (mean cross-sectional area of the right tibial nerve of 13.2 ± 3.1 mm2) in the right side. Borderline significance of the CSA parameters of the tibial nerve study on the left side in different groups. The cutoff point to determine DPN among diabetic patients in the right lower limb is more than 63.8 kPa. With 89% sensitivity and 100% specificity in the detection of DPN on the right side, the SWE has 100% PPV and 95.5% NPV in the detection of DPN on the right side.
Conclusion
SWE is an effective assistant method in the diagnosis of DPN and is useful when a suspected neuropathy is not detectable by electrophysiology.
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Thomas E, Ficarra S, Nakamura M, Paoli A, Bellafiore M, Palma A, Bianco A. Effects of Different Long-Term Exercise Modalities on Tissue Stiffness. SPORTS MEDICINE - OPEN 2022; 8:71. [PMID: 35657537 PMCID: PMC9166919 DOI: 10.1186/s40798-022-00462-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 05/13/2022] [Indexed: 11/10/2022]
Abstract
AbstractStiffness is a fundamental property of living tissues, which may be modified by pathologies or traumatic events but also by nutritional, pharmacological and exercise interventions. This review aimed to understand if specific forms of exercise are able to determine specific forms of tissue stiffness adaptations. A literature search was performed on PubMed, Scopus and Web of Science databases to identify manuscripts addressing adaptations of tissue stiffness as a consequence of long-term exercise. Muscular, connective, peripheral nerve and arterial stiffness were considered for the purpose of this review. Resistance training, aerobic training, plyometric training and stretching were retrieved as exercise modalities responsible for tissue stiffness adaptations. Differences were observed related to each specific modality. When exercise was applied to pathological cohorts (i.e. tendinopathy or hypertension), stiffness changed towards a physiological condition. Exercise interventions are able to determine tissue stiffness adaptations. These should be considered for specific exercise prescriptions. Future studies should concentrate on identifying the effects of exercise on the stiffness of specific tissues in a broader spectrum of pathological populations, in which a tendency for increased stiffness is observed.
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Zhao P, Ding C, Fu X, Zhang Y, Gu J, Hu J, Wang C, Yang M, Sheng Y, Zhang Y, Chen X, Mao P, Liu CF. Ultrasound exploration of muscle characteristic changes and diabetic peripheral neuropathy in diabetic patients. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:1403-1411. [PMID: 36218110 DOI: 10.1002/jcu.23365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/13/2022] [Accepted: 09/18/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE Using brightness mode ultrasound combined with shear wave elastography, this study aims to detect structural and functional changes of the medial head of gastrocnemius (MG) in type 2 diabetes mellitus (T2DM) patients with or without diabetic peripheral neuropathy (DPN). METHODS 149 T2DM patients (DPN group and non-DPN group) and 60 healthy volunteers (control group) were enrolled. We measured the absolute difference of fascicle length (FL), pennation angle (PA), and shear wave velocity (SWV) of both MG in neutral position and maximal ankle joint's plantar flexion and calculated ΔFL, ΔPA, and ΔSWV. These three parameters, along with muscle thickness (MT), were compared among the three groups. RESULTS In the DPN group, the MG's MT, ΔPA, and ΔSWV were significantly lower than in the non-DPN group (p < 0.01); these parameters achieved the highest scores in the control group (p < 0.01). The area under the receiver operating characteristic curve of the combination of ΔSWV and ΔFL was the largest for predicting inpatients with or without DPN. CONCLUSIONS Decreased muscle mass (MT) and muscle contractibility (ΔFL and ΔSWV) were detected in patients with T2DM, with or without DPN. ΔSWV and ΔFL of the MG showed high-diagnostic accuracy for DPN warning signs.
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Affiliation(s)
- Ping Zhao
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Changwei Ding
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Xinxu Fu
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yingchun Zhang
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Jiarui Gu
- Department of Endocrinology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Ji Hu
- Department of Endocrinology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Caishan Wang
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Min Yang
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yujing Sheng
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Ying Zhang
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiaofang Chen
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Pan Mao
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Chun-Feng Liu
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, China
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11
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Song Y, Zhang Y, Zhang Y, Hu B. Two-dimensional ultrasound and two-dimensional shear wave elastography on femoral and saphenous neuropathy in patients with type 2 diabetes mellitus. Front Neurol 2022; 13:996199. [PMID: 36341093 PMCID: PMC9634548 DOI: 10.3389/fneur.2022.996199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 10/03/2022] [Indexed: 11/21/2022] Open
Abstract
Objective This study aims to examine the value of two-dimensional (2D) ultrasound and two-dimensional shear wave elastography (2D-SWE) in evaluating femoral nerve (FN) and saphenous nerve (SN) neuropathy in patients with type 2 diabetes mellitus (T2DM). Materials and methods According to the diabetic peripheral neuropathy (DPN) diagnostic criteria, 60 patients with T2DM were enrolled and divided into 35 T2DM patients without DPN (non-DPN group) and 25 T2DM patients with DPN (DPN group). The control group consisted of another 15 healthy volunteers. The width, thickness, cross-sectional area (CSA), and perimeter of the FN and SN in the lower extremities were measured with 2D ultrasound. The average shear wave velocity (SWV) of the FN and SN was measured by 2D-SWE. Parameters of the left and right lower extremities were compared in each group, and the above parameters were compared among groups. The correlations between ultrasonographic and laboratory parameters were evaluated, and the independent influencing factors of SWV of the FN and SN were analyzed. Results The width, thickness, CSA, perimeter, and SWV of FN and SN in the DPN group were greater than those in the non-DPN groups and control group (P < 0.05). The width, thickness, CSA, perimeter, and SWV of the FN and SN in the non-DPN group were greater than those in the control group (P < 0.05). The CSA of FN was positively correlated with FPG, HbA1c, and TG (r = 0.34–0.69, P < 0.01). The perimeter of FN was positively correlated with FPG, HbA1c, and TG (r = 0.37–0.68, P < 0.01). The perimeter of the FN was negatively correlated with IgF-1 (r = −0.31, P < 0.05). The CSA of the SN was positively correlated with FPG and TG (r = 0.26–0.42, P < 0.05). The perimeter of the SN was positively correlated with FPG and TG (r = 0.37–0.39, P < 0.01). The SWV of FN and SN were positively correlated with FPG and TG (r = 0.35–0.57, P < 0.01; r = 0.43–0.49, P < 0.01). FPG and TG were independent influencing factors of the SWV of the FN and SN (P < 0.05). Conclusion 2D ultrasound and 2D-SWE could be used to non-invasively, objectively, and accurately evaluate the abnormal changes of the FN and SN in patients with T2DM. It has important clinical significance for the early diagnosis of DPN and the curative effect evaluation.
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Affiliation(s)
- Yang Song
- Department of Diagnostic Ultrasound, The Second Hospital of Dalian Medical University, Dalian, China
| | - Ying Zhang
- Department of Diagnostic Ultrasound, Xinhua Affiliated Hospital of Dalian University, Dalian, China
| | - Yuhong Zhang
- Department of Diagnostic Ultrasound, The Second Hospital of Dalian Medical University, Dalian, China
- *Correspondence: Yuhong Zhang
| | - Bin Hu
- Department of Diagnostic Ultrasound, The Second Hospital of Dalian Medical University, Dalian, China
- Bin Hu
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12
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Zhang J, Zhang L, Guo F, Zhang T. Shear Wave Elastography of the Coracohumeral Ligament With Frozen Shoulder in Different Stages. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:2527-2534. [PMID: 35005780 DOI: 10.1002/jum.15942] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/17/2021] [Accepted: 12/20/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To study the shear wave elastography (SWE) of the coracohumeral ligament (CHL) in different stages of frozen shoulder and to analyze its correlation with the visual analogue scale (VAS) score and shoulder range of motion (ROM). METHODS Sixty-four patients with frozen shoulder were divided into three stages: stage I (freezing phase), stage II (frozen phase), and stage III (thawing phase). The SWE of the CHL of the affected and healthy sides was measured and compared in the different stages. The VAS score and ROM of the affected side were evaluated, and their correlation with the SWE of the CHL was analyzed in the different stages. RESULTS In stage I frozen shoulder, the SWE of the CHL on the affected side was lower than that on the healthy side, while in stages II and III, the SWE on the affected side was higher (P = .001 for all). The SWE of the CHL of the affected side was different across the three stages; the SWE in stages II and III higher than that in stage I (P < .01), while the difference between stages II and III was not significant (P > .05). The SWE of the CHL of the affected side was negatively correlated with the VAS score but not with forward flexion (Ff), external rotation (Er) or internal rotation (Ir) in stage I; in stages II and III, it was positively correlated with the VAS score and negatively correlated with Ff, Er, and Ir. CONCLUSIONS The CHL stiffness of the affected side and its correlation with the shoulder VAS score and ROM are different for different stages of frozen shoulder.
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Affiliation(s)
- Jingfeng Zhang
- Department of Ultrasound, Baoji High-Tech Hospital, Baoji, China
| | - Lei Zhang
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
- Department of Radiology, Baoji High-Tech Hospital, Baoji, China
| | - Fanglan Guo
- Department of Ultrasound, Baoji High-Tech Hospital, Baoji, China
| | - Tian Zhang
- Department of Ultrasound, Baoji High-Tech Hospital, Baoji, China
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13
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Dong B, Lyu G, Yang X, Wang H, Chen Y. Shear wave elastography as a quantitative biomarker of diabetic peripheral neuropathy: A systematic review and meta-analysis. Front Public Health 2022; 10:915883. [PMID: 35937233 PMCID: PMC9354049 DOI: 10.3389/fpubh.2022.915883] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 07/01/2022] [Indexed: 11/23/2022] Open
Abstract
Background Diabetic peripheral neuropathy (DPN) is one of the most common chronic complications of diabetes and the strongest initiating risk factor for diabetic foot ulceration. Early diagnosis of DPN through screening measures is, therefore, of great importance for diabetic patients. Recently, shear wave elastography (SWE) has been used as a method that is complementary to neuroelectrophysiological examination in the diagnosis of DPN. We aimed to conduct a meta-analysis based on currently available data to evaluate the performance of tibial nerve stiffness on SWE for diagnosing DPN. Methods Both PubMed, EMBASE, the Cochrane Library, and Web of Science were searched for studies that investigated the diagnostic performance of SWE for DPN up to March 1th, 2022. Three measures of diagnostic test performance, including the summary area under receiver operating characteristics curve (AUROC), the summary sensitivity and specificity, and the summary diagnostic odds ratios were used to assess the diagnostic accuracy of SWE. All included studies were published between 2017 and 2021. Results Six eligible studies (with 170 DPN patients, 28 clinically defined DPN patients, 168 non-DPN patients, and 154 control participants) that evaluated tibial nerve stiffness were included for meta-analysis. The summary sensitivity and specificity of SWE for tibial nerve stiffness were 75% (95% confidence interval [CI]: 68–80%) and 86% (95% CI: 80–90%), respectively, and the summary AUROC was 0.84 (95% CI: 0.81–0.87), for diagnosing DPN. A subgroup analysis of five two-dimensional SWE studies revealed similar diagnostic performance, showing the summary sensitivity and specificity of 77% (95% CI: 69–83%) and 86% (95% CI: 79–91%), respectively, and a summary AUROC value of 0.86 (95% CI: 0.83–0.89). Conclusions SWE is found to have good diagnostic accuracy for detecting DPN and has considerable potential as an important and noninvasive adjunctive tool in the management of patients with DPN.
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Affiliation(s)
- Bingtian Dong
- Department of Ultrasound, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Guorong Lyu
- Department of Ultrasound, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
- Department of Clinical Medicine, Quanzhou Medical College, Quanzhou, China
- *Correspondence: Guorong Lyu
| | - Xiaocen Yang
- Department of Ultrasound, Chenggong Hospital, Xiamen University, Xiamen, China
| | - Huaming Wang
- Department of Ultrasound, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Yongjian Chen
- Department of Ultrasound, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
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14
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Chiba E, Hamamoto K, Kanai E, Oyama-Manabe N, Omoto K. A preliminary animal study on the prediction of nerve block success using ultrasonographic parameters. Sci Rep 2022; 12:3119. [PMID: 35210487 PMCID: PMC8873395 DOI: 10.1038/s41598-022-06986-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
This study aimed to evaluate the diagnostic value of ultrasonographic parameters as an indicator for predicting regional nerve block success. Ultrasound-guided sciatic nerve block was performed in seven dogs using either 2% mepivacaine (nerve-block group) or saline (sham-block group). The cross-sectional area (CSA), nerve blood flow (NBF), and shear wave velocity (SWV) of the sciatic nerve (SWVN), SWV of the biceps femoris muscle (SWVM), and their ratio (SWVNMR) were measured at 0, 30, 60, and 90 min after the nerve block as well as the change rate of each parameter from the baseline. A receiver operating characteristic (ROC) curve analysis was performed to determine the diagnostic value of each parameter in the prediction of nerve block success. No significant changes were observed in the CSA or NBF in association with the nerve block. The SWVN and SWVNMR in the nerve-block group were significantly higher than those in the sham-block group at 90 min and at 30, 60, and 90 min, respectively (p < 0.05). The change rates of SWVN and SWVNMR in the nerve-block group were significantly higher than those in the sham-block group at all time points (p < 0.05). The ROC curve analysis showed that SWVN had a moderate diagnostic accuracy (area under the curve [AUC], 0.779), whereas SWVNMR and change rates of SWVN and SWVNMR had a high diagnostic accuracy (AUC, 0.947, 0.998, and 1.000, respectively). Ultrasonographic evaluation of the SWVN and SWVNMR could be used as indicators for predicting nerve block success.
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Affiliation(s)
- Emiko Chiba
- Department of Radiology, Jichi Medical University Saitama Medical Center, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Kohei Hamamoto
- Department of Radiology, Jichi Medical University Saitama Medical Center, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan.
| | - Eiichi Kanai
- Laboratory of Small Animal Surgery, Department of Veterinary Medicine, Azabu University, 1-17-71, Fuchinobe, Chuo-ku, Sagamihara, Kanagawa, 252-5201, Japan
| | - Noriko Oyama-Manabe
- Department of Radiology, Jichi Medical University Saitama Medical Center, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Kiyoka Omoto
- Department of Laboratory Medicine, Jichi Medical University Saitama Medical Center, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
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15
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Liu F, Li D, Xin Y, Liu F, Li W, Zhu J. Quantification of Nerve Viscosity Using Shear Wave Dispersion Imaging in Diabetic Rats: A Novel Technique for Evaluating Diabetic Neuropathy. Korean J Radiol 2022; 23:237-245. [PMID: 35029080 PMCID: PMC8814712 DOI: 10.3348/kjr.2021.0603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 10/08/2021] [Accepted: 10/23/2021] [Indexed: 11/15/2022] Open
Abstract
Objective Viscoelasticity is an essential feature of nerves, although little is known about their viscous properties. The discovery of shear wave dispersion (SWD) imaging has presented a new approach for the non-invasive evaluation of tissue viscosity. The present study investigated the feasibility of using SWD imaging to evaluate diabetic neuropathy using the sciatic nerve in a diabetic rat model. Materials and Methods This study included 11 diabetic rats in the diabetic group and 12 healthy rats in the control group. Bilateral sciatic nerves were evaluated 3 months after treatment with streptozotocin. We measured the nerve cross-sectional area (CSA), nerve stiffness using shear wave elastography (SWE), and nerve viscosity using SWD imaging. The motor nerve conduction velocity (MNCV) was also measured. These four indicators and the histology of the sciatic nerves were then compared between the two groups. The performance of CSA, SWE, and SWD imaging in distinguishing the two groups was assessed using receiver operating characteristic (ROC) analysis. Results Nerve CSA, stiffness, and viscosity in the diabetic group was significantly higher than those in the control group (all p < 0.05). The results also revealed a significantly lower MNCV in the diabetic group (p = 0.005). Additionally, the density of myelinated fibers was significantly lower in the diabetic group (p = 0.004). The average thickness of the myelin sheath was also lower in the diabetic group (p = 0.012). The area under the ROC curve for distinguishing the diabetic neuropathy group from the control group was 0.876 for SWD imaging, which was significantly greater than 0.677 for CSA (p = 0.030) and 0.705 for SWE (p = 0.035). Conclusion Sciatic nerve viscosity measured using SWD imaging was significantly higher in diabetic rats. The viscosity measured using SWD imaging performed well in distinguishing the diabetic neuropathy group from the control group. Therefore, SWD imaging may be a promising method for the evaluation of diabetic neuropathy.
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Affiliation(s)
- Feifei Liu
- Department of Ultrasound, Peking University People's Hospital, Beijing, China
| | - Diancheng Li
- Department of Ultrasound, Peking University People's Hospital, Beijing, China
| | - Yuwei Xin
- Department of Ultrasound, Peking University People's Hospital, Beijing, China
| | - Fang Liu
- Department of Ultrasound, Peking University People's Hospital, Beijing, China
| | - Wenxue Li
- Department of Ultrasound, Peking University People's Hospital, Beijing, China
| | - Jiaan Zhu
- Department of Ultrasound, Peking University People's Hospital, Beijing, China.
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16
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Chen Y, Duan H, Huang L, Jiang Z, Huang H. Supersonic shear wave imaging of the tibial nerve for diagnosis of diabetic peripheral neuropathy: A meta-analysis. Front Endocrinol (Lausanne) 2022; 13:934749. [PMID: 36120458 PMCID: PMC9478111 DOI: 10.3389/fendo.2022.934749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 08/01/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Diabetic peripheral neuropathy (DPN) is the most common diabetes-associated complication and imposes a significant burden to healthcare systems. Thus, early diagnosis of DPN is extremely critical for management and outcome of diabetic patients. Supersonic Shear Wave Imaging (SSI) enables the noninvasive measurement of nerve stiffness. However, previous studies on SSI in the diagnosis of DPN were limited in sample sizes and reported various results. In this meta-analysis, we aimed to obtain comprehensive evidence on the value of tibial nerve stiffness measurement by SSI in the diagnosis of DPN. METHODS A comprehensive literature search in English and Chinese electronic database was conducted for studies (published until January 25, 2022) that investigated the diagnostic performance of tibial nerve stiffness measurement by SSI for detecting DPN. Summary receiver operating characteristics (SROC) modelling was constructed to conduct the meta-analysis of diagnostic accuracy of SSI for detecting DPN. RESULTS Finally, a total of 12 eligible studies with 1325 subjects were included for evaluation, and a meta-analysis was conducted to evaluate the diagnostic performance of tibial nerve stiffness measurement by SSI for detecting DPN. For tibial nerve stiffness measurement by SSI, the summary sensitivity and specificity for the diagnosis of DPN were 80% (95% confidence interval [CI]: 73%-86%) and 86% (95% CI: 82%-89%), respectively. The summary area under the ROC curve (AUROC) value of the SROC was 0.90 (95% CI: 0.87-0.92), for diagnosing DPN. A subgroup analysis of 11 SSI studies from China revealed similar diagnostic performance, with a summary sensitivity of 79% (95% CI: 72%-85%), specificity of 86% (95% CI: 82%-89%) and summary AUROC value of the SROC of 0.90 (95% CI: 0.87-0.92) for diagnosing DPN. CONCLUSIONS Our meta-analysis suggests that a tibial nerve stiffness measurement by SSI shows good performance in diagnosing DPN and has considerable potential as a noninvasive tool for detecting DPN.
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Affiliation(s)
- Yuping Chen
- Department of Endocrinology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Honghong Duan
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Lichun Huang
- Department of Endocrinology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Zhengrong Jiang
- Department of Endocrinology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Huibin Huang
- Department of Endocrinology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
- *Correspondence: Huibin Huang,
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17
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Li X, Sun H, Zhang Z, Liu J, Xu H, Ma L, Zhang H, Li J, Luo Q, Wang X, Guo M, Guo Z, Chen X. Shear Wave Elastography in the Diagnosis of Peripheral Neuropathy in Patients With Chronic Kidney Disease Stage 5. Front Endocrinol (Lausanne) 2022; 13:899822. [PMID: 35813645 PMCID: PMC9259929 DOI: 10.3389/fendo.2022.899822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 05/19/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To observe the feasibility of shear wave elastography (SWE) in the diagnosis of peripheral neuropathy in patients undergoing hemodialysis [chronic kidney disease stage 5 dialysis (CKD5D)]. METHODS Forty patients with CKD5D were divided into a uremic peripheral neuropathy (UPN) group (n = 25) and a non-UPN group (n = 15) according to the results of a neuro-electrophysiological examination. Sixteen healthy control subjects were also enrolled in this study. Two-dimensional ultrasound examination was conducted, and SWE was then performed to measure Young's modulus of the tibial nerve. The left and right diameters (D1), anterior and posterior diameters (D2), perimeter (C), cross-sectional area (CSA), and Young's modulus (E) were measured three times at the same non-entrapment site. The average values were recorded and calculated. The following evaluation indices were also analyzed: sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the receiver operating characteristic curve (AUC). RESULTS D1, D2, C, and CSA were not significantly different among the three groups (P > 0.05). However, the difference in the E value among the three groups was statistically significant (P < 0.05). The AUC was 0.889 based on the E value. Using a tibial nerve E value of 48.35 kPa as the cutoff value, the sensitivity, specificity, PPV, and NPV were 86.0%, 84.0%, 81.1%, and 88.1%, respectively. CONCLUSIONS SWE is useful for the diagnosis of peripheral neuropathy in patients with CKD5D. Young's modulus of 48.35 kPa for the tibial nerve is the optimal cutoff value and has the best diagnostic efficiency for peripheral neuropathy in CKD5D patients.
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Affiliation(s)
- Xuan Li
- Department of Nephrology, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Haoqi Sun
- Department of Nephrology, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Zhaoguang Zhang
- Department of Ultrasound, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Jing Liu
- Department of Electrophysiology, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Huiying Xu
- Department of Nephrology, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Lin Ma
- Department of Nephrology, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Haibo Zhang
- Department of Nephrology, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Jialin Li
- Department of Nephrology, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Qian Luo
- Department of Ultrasound, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Xiangming Wang
- Department of Nephrology, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Min Guo
- Department of Nephrology, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Zhentao Guo
- Department of Nephrology, Affiliated Hospital of Weifang Medical University, Weifang, China
- *Correspondence: Xuexun Chen, ; Zhentao Guo,
| | - Xuexun Chen
- Department of Nephrology, Affiliated Hospital of Weifang Medical University, Weifang, China
- *Correspondence: Xuexun Chen, ; Zhentao Guo,
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18
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Wang F, Zheng M, Hu J, Fang C, Chen T, Wang M, Zhang H, Zhu Y, Song X, Ma Q. Value of shear wave elastography combined with the Toronto clinical scoring system in diagnosis of diabetic peripheral neuropathy. Medicine (Baltimore) 2021; 100:e27104. [PMID: 34477149 PMCID: PMC8415960 DOI: 10.1097/md.0000000000027104] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 08/12/2021] [Indexed: 01/05/2023] Open
Abstract
To evaluate the diagnostic values of shear wave elastography (SWE) alone and in combination with the Toronto clinical scoring system (TCSS) on diabetic peripheral neuropathy (DPN) in patients with type 2 diabetes mellitus (T2DM).The study included 41 DPN patients, 42 non-DPN patients, and 21 healthy volunteers. Conventional ultrasonography and SWE were performed on the 2 sides of the tibial nerves, and cross-sectional area (CSA) and nerve stiffness were measured. TCSS was applied to all patients. A receiver operating characteristic curve analysis was performed.The stiffness of the tibial nerve, as measured as mean, minimum or maximum elasticity, was significantly higher in patients in the DPN group than the other groups (P < .05). The tibial nerve of subjects in the non-DPN group was significantly stiffer compared to the control group (P < .05). There was no significant difference of the tibial nerve CSA among the 3 groups (P > .05). Mean elasticity of the tibial nerve with a cutoff of 71.3 kPa was the most sensitive (68.3%) and had a higher area under the curve (0.712; 0.602-0.806) among the 3 shear elasticity indices for diagnosing DPN when used alone. When combining SWE with TCSS in diagnosing DPN, the most effective parameter was the EMax, which yielded a sensitivity of 100.00% and a specificity of 95.24%.SWE is a better diagnostic tool for DPN than the conventional ultrasonic parameter CSA, and a higher diagnostic value is attained when combining SWE with TCSS.
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Affiliation(s)
- Fei Wang
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Suzhou, Jiangsu, China
| | - Miao Zheng
- Department of Endocrinology, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Suzhou, Jiangsu, China
| | - Ji Hu
- Department of Endocrinology, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Suzhou, Jiangsu, China
| | - Chen Fang
- Department of Endocrinology, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Suzhou, Jiangsu, China
| | - Tong Chen
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Suzhou, Jiangsu, China
| | - Meng Wang
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Suzhou, Jiangsu, China
| | - Honghong Zhang
- Department of Endocrinology, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Suzhou, Jiangsu, China
| | - Yunyan Zhu
- Department of Endocrinology, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Suzhou, Jiangsu, China
| | - Xin Song
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Suzhou, Jiangsu, China
| | - Qi Ma
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Suzhou, Jiangsu, China
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Bedewi MA, Elsifey AA, Alfaifi T, Kotb MA, Abdelgawad MS, Bediwy AM, Swify SM, Awad EM. Shear wave elastography of the tibial nerve in healthy subjects. Medicine (Baltimore) 2021; 100:e23999. [PMID: 33545992 PMCID: PMC7837829 DOI: 10.1097/md.0000000000023999] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 11/25/2020] [Indexed: 11/26/2022] Open
Abstract
The purpose of this study is to investigate sonoelastographic features of the tibial nerve.The study included 72 tibial nerves in 36 healthy subjects. High resolution ultrasound and Shear wave elastography were used to evaluate the tibial nerve. Cross sectional area and stiffness were measured.The mean cross sectional area of the tibial nerve was 13.4 mm2. The mean shear elastic modulus of the tibial nerve in the short axis was 23.3 kPa. The mean shear elastic modulus of the tibial nerve in long axis was 26.1 kPa. The tibial nerve elastic modulus also showed no correlation with cross sectional area neither in the long axis nor short axis. Age, height, weight, and body mass index showed no correlation with tibial nerve elastic modulus in short or long axes.The elastic modulus of the tibial nerve has been determined in healthy subjects and can serve as a reference for future assessment of polyneuropathy.
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Affiliation(s)
| | | | | | - Mamdouh A. Kotb
- Neurology Department, College of Medicine, Prince Sattam Bin Abdulaziz university, Al-Kharj, Kingdom of Saudi Arabia
- Neurology Department, Faculty of Medicine, Minia University, Minia
| | | | | | | | - Ezzat M. Awad
- Department of Vascular Biology and Thrombosis Research, Center for Physiology and Pharmacology, Institute for Specific Prophylaxis and Tropical Medicine [ISPTM], Center for Pathophysiology, Infectiology
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20
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Bedewi MA, Kotb MA, Aldossary NM, Abodonya AM, Alhariqi BA, Swify SM. Shear wave elastography of the ulnar nerve at the forearm. Medicine (Baltimore) 2021; 100:e24071. [PMID: 33466166 PMCID: PMC7808468 DOI: 10.1097/md.0000000000024071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 12/03/2020] [Indexed: 01/05/2023] Open
Abstract
The study included 38 ulnar nerves in 20 healthy subjects. High-resolution ultrasound and Shear wave elastography were used to evaluate the ulnar nerve at the mid forearm. The mean cross-sectional area of the ulnar nerve was 7.1 mm2. The mean shear elastic modulus of the nerve in the short axis was 27.4 kPa. The mean shear elastic modulus of the nerve in long axis was 24.7 kPa. No statistical relation could be noted between elasticity measurements in long and short axes. The ulnar nerve elastic modulus also showed no correlation with CSA neither in the long axis nor short axis. Age, height, weight, and body mass index showed no correlation with the ulnar elastic modulus in short or long axes. The elastic modulus of the ulnar nerve has been determined in healthy subjects and can serve as a reference for future assessment of compressive neuropathies of the ulnar nerve.
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Affiliation(s)
- Mohamed Abdelmohsen Bedewi
- Department of Internal Medicine, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj, Kingdom of Saudi Arabia
| | - Mamdouh A. Kotb
- Neurology Department, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj, Kingdom of Saudi Arabia
- Neurology Department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Nasser M. Aldossary
- Department of Internal Medicine, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj, Kingdom of Saudi Arabia
| | - Ahmed M. Abodonya
- Anesthesia and Intensive Care Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
- Surgery Department, College of Medicine, Prince Sattam bin Abdulaziz University, Al-Kharj, Kingdom of Saudi Arabia
| | - Bader A. Alhariqi
- Department of Internal Medicine, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj, Kingdom of Saudi Arabia
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21
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Huang H, Wu S. Application of High-Resolution Ultrasound on Diagnosing Diabetic Peripheral Neuropathy. Diabetes Metab Syndr Obes 2021; 14:139-152. [PMID: 33469331 PMCID: PMC7813464 DOI: 10.2147/dmso.s292991] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 12/24/2020] [Indexed: 12/20/2022] Open
Abstract
Diabetic peripheral neuropathy (DPN) is a common complication of diabetes mellitus (DM). The typical manifestation is a length-dependent "glove and sock" sensation. At present, diagnosis is mainly dependent on clinical manifestations. Since the pathogenesis is not clear, there are no effective treatment measures. Management consists mainly of glucose control, peripheral nerve nutrition, and other measures to delay the progress of the disease; early diagnosis is therefore crucial to improving prognosis and quality of life for patients with DPN. Due to the lack of obvious symptoms in 50% of patients and the low sensitivity of neuro-electrophysiology to small fibers, the missed diagnosis rate is high. High-resolution ultrasound (HRU), as a convenient noninvasive tool, has been proven by many studies to have excellent clinical value in diagnosing DPN. With the development of related new technology, HRU shows promise for the screening, diagnosing, and follow-up of DPN, which could serve as a biomarker and provide new diagnostic insights. In this paper, we review the ability of HRU to detect nerve cross-sectional area and blood flow, and echo and other image changes, and in showing the characteristics of peripheral nerve morphological changes in patients with DPN. We also explore the application of two other recent technological developments-shear wave elastography (SWE) and ultrasound scoring systems-in improving the diagnostic efficiency of HRU in peripheral neuropathy.
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Affiliation(s)
- Hailun Huang
- Department of Neurology, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou550001, People’s Republic of China
| | - Shan Wu
- Department of Neurology, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou550001, People’s Republic of China
- Correspondence: Shan Wu Department of Neurology, Affiliated Hospital of Guizhou Medical University, Guizhou550001, People’s Republic of ChinaTel +86 13312231575 Email
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22
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Abstract
Diabetic peripheral neuropathy (DPN) is a common complication of diabetes mellitus. It often causes symmetrical paresthesia, loss of sensation, and hyperalgesia. Without early intervention, it might lead to diabetic foot ulceration, gangrene, and subsequent amputation in people with diabetes. DPN is an insidious disease and often underdiagnosed. This paper reviews the current national and international prevalence of DPN, screening methods for early DPN, including quantitative sensory measurement, neurological function scoring system, confocal microscopy, and high-frequency ultrasound, and summarizes the related research progress, clinical application, and development prospects of these methods in recent years.
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23
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Gitto S, Messina C, Vitale N, Albano D, Sconfienza LM. Quantitative Musculoskeletal Ultrasound. Semin Musculoskelet Radiol 2020; 24:367-374. [PMID: 32992365 DOI: 10.1055/s-0040-1709720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Ultrasound (US) imaging plays a crucial role in the assessment of musculoskeletal (MSK) disorders. Several quantitative tools are offered by US systems and add information to conventional US imaging. This article reviews the quantitative US imaging tools currently available in MSK radiology, specifically focusing on the evaluation of elasticity with shear-wave elastography, perfusion with contrast-enhanced US and noncontrast superb microvascular imaging, and bone and muscle mass with quantitative US methods. Some of them are well established and already of clinical value, such as elasticity and contrast-enhanced perfusion assessment in muscles and tendons. MSK radiologists should be aware of the potential of quantitative US tools and take advantage of their use in everyday practice, both for clinical and research purposes.
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Affiliation(s)
- Salvatore Gitto
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy
| | - Carmelo Messina
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy.,IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
| | - Nicoló Vitale
- Scuola di Specializzazione in Medicina Fisica e Riabilitativa, Dipartimento di Scienze Biomediche e Biotecnologiche, Università Degli Studi di Catania, Catania, Italy
| | - Domenico Albano
- IRCCS Istituto Ortopedico Galeazzi, Milano, Italy.,Sezione di Scienze Radiologiche, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli Studi di Palermo, Palermo, Italy
| | - Luca Maria Sconfienza
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy.,IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
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24
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Bedewi MA, Elsifey AA, Kotb MA, Bediwy AM, Ahmed YM, Swify SM, Abodonya AM. Shear wave elastography of the saphenous nerve. Medicine (Baltimore) 2020; 99:e22120. [PMID: 32925760 PMCID: PMC7489694 DOI: 10.1097/md.0000000000022120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The purpose of this study is to study sonoelastographic features of the saphenous nerve.The study included 72 saphenous nerves in 36 healthy subjects. High resolution ultrasound and Shearwave elastography were used to evaluate the saphenous nerve. Cross sectional area (CSA) and stiffness were measured.The mean CSA of the saphenous nerve was 5.7 mm. The mean shear elastic modulus of the saphenous nerve in the short axis was 29.5 kPa. The mean shear elastic modulus of the saphenous nerve in long axis was 29.9 kPa. The saphenous nerve elastic modulus also showed no correlation with CSA in neither the long axis nor short axis. Positive correlation between elasticity measurements in the long and short axes. Age, height, weight, and BMI showed no correlation with saphenous nerve elastic modulus in short or long axes.The elastic modulus of the saphenous nerve has been determined in healthy subjects and can serve as a reference for future assessment of the saphenous nerve before different procedures.
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Affiliation(s)
| | - Ayman A. Elsifey
- Department of Internal Medicine, Prince Sattam Bin Abdulaziz university, College of Medicine
| | - Mamdouh A. Kotb
- Neurology Department, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj, Kingdom of Saudi Arabia
- Neurology Department, Faculty of Medicine, Minia University, Minia
| | | | | | | | - Ahmed M. Abodonya
- Anesthesia and Intensive Care Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
- Surgery Department, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj, Kingdom of Saudi Arabia
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25
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Andrade RJ, Freitas SR, Hug F, Le Sant G, Lacourpaille L, Gross R, Quillard JB, McNair PJ, Nordez A. Chronic effects of muscle and nerve-directed stretching on tissue mechanics. J Appl Physiol (1985) 2020; 129:1011-1023. [PMID: 32853116 DOI: 10.1152/japplphysiol.00239.2019] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Tissue-directed stretching interventions can preferentially load muscular or nonmuscular structures such as peripheral nerves. How these tissues adapt mechanically to long-term stretching is poorly understood. This randomized, single-blind, controlled study used ultrasonography and dynamometry to compare the effects of 12-wk nerve-directed and muscle-directed stretching programs versus control on maximal ankle dorsiflexion range of motion (ROM) and passive torque, shear wave velocity (SWV; an index of stiffness), and architecture of triceps surae and sciatic nerve. Sixty healthy adults were randomized to receive nerve-directed stretching, muscle-directed stretching, or no intervention (control). The muscle-directed protocol was designed to primarily stretch the plantar flexor muscle group, whereas the nerve-directed intervention targeted the sciatic nerve tract. Compared with the control group [mean; 95% confidence interval (CI)], muscle-directed intervention showed increased ROM (+7.3°; 95% CI: 4.1-10.5), decreased SWV of triceps surae (varied from -0.8 to -2.3 m/s across muscles), decreased passive torque (-6.8 N·m; 95% CI: -11.9 to -1.7), and greater gastrocnemius medialis fascicle length (+0.4 cm; 95% CI: 0.1-0.8). Muscle-directed intervention did not affect the SWV and size of sciatic nerve. Participants in the nerve-directed group showed a significant increase in ROM (+9.9°; 95% CI: 6.2-13.6) and a significant decrease in sciatic nerve SWV (> -1.8 m/s across nerve regions) compared with the control group. Nerve-directed intervention had no effect on the main outcomes at muscle and joint levels. These findings provide new insights into the long-term mechanical effects of stretching interventions and have relevance to clinical conditions where change in mechanical properties has occurred.NEW & NOTEWORTHY This study demonstrates that the mechanical properties of plantar flexor muscles and sciatic nerve can adapt mechanically to long-term stretching programs. Although interventions targeting muscular or nonmuscular structures are both effective at increasing maximal range of motion, the changes in tissue mechanical properties (stiffness) are specific to the structure being preferentially stretched by each program. We provide the first in vivo evidence that stiffness of peripheral nerves adapts to long-term loading stimuli using appropriate nerve-directed stretching.
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Affiliation(s)
- Ricardo J Andrade
- Laboratory of Movement, Interactions, Performance (EA 4334), Faculty of Sport Sciences, Nantes, University of Nantes, France.,School of Allied Health Sciences, Griffith University, Brisbane and Gold Coast, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Sandro R Freitas
- Universidade de Lisboa, Faculdade de Motricidade Humana, Centro Interdisciplinar de Estudo da Performance Humana (CIPER), Lisbon, Portugal
| | - François Hug
- Laboratory of Movement, Interactions, Performance (EA 4334), Faculty of Sport Sciences, Nantes, University of Nantes, France.,Institut Universitaire de France (IUF), Paris, France.,The University of Queensland, National Health and Medical Research Council (NHMRC) Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, Brisbane, Australia
| | - Guillaume Le Sant
- Laboratory of Movement, Interactions, Performance (EA 4334), Faculty of Sport Sciences, Nantes, University of Nantes, France.,School of Physiotherapy (IFM3R), Nantes, France
| | - Lilian Lacourpaille
- Laboratory of Movement, Interactions, Performance (EA 4334), Faculty of Sport Sciences, Nantes, University of Nantes, France
| | - Raphaël Gross
- Laboratory of Movement, Interactions, Performance (EA 4334), Faculty of Sport Sciences, Nantes, University of Nantes, France.,Gait Analysis Laboratory, Physical and Rehabilitation Medicine Department, University Hospital of Nantes, Nantes, France
| | - Jean-Baptiste Quillard
- Laboratory of Movement, Interactions, Performance (EA 4334), Faculty of Sport Sciences, Nantes, University of Nantes, France
| | - Peter J McNair
- Health and Rehabilitation Research Institute, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Antoine Nordez
- Laboratory of Movement, Interactions, Performance (EA 4334), Faculty of Sport Sciences, Nantes, University of Nantes, France.,Institut Universitaire de France (IUF), Paris, France.,Health and Rehabilitation Research Institute, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
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26
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Chen R, Wang XL, Xue WL, Sun JW, Dong XY, Jiang ZP, Wu H, Ma R, Zhou XL. Application value of conventional ultrasound and real-time shear wave elastography in patients with type 2 diabetic polyneuropathy. Eur J Radiol 2020; 126:108965. [PMID: 32268245 DOI: 10.1016/j.ejrad.2020.108965] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 02/29/2020] [Accepted: 03/10/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE To explore the application value of conventional ultrasound and real-time shear wave elastography (SWE) to the tibial nerve (TN) and the common peroneal nerve (CPN) in diabetic peripheral neuropathy (DPN). MATERIALS AND METHODS Thirty-three healthy volunteers, 33 diabetic patients without DPN, and 30 diabetic patients with DPN were enrolled in this study. The anteroposterior diameter (APD), the cross-sectional area (CSA), and the perimeter of the TN and the CPN were measured by conventional ultrasound, and the stiffness of the nerves was measured by SWE. RESULTS The conventional ultrasound parameters and stiffness of the TN in patients with DPN were significantly larger than those of the other two groups (P < 0.01). The conventional ultrasound parameters of the CPN were significantly higher in patients with DPN than in the other two groups (P < 0.01).The patients with DPN demonstrated a greater stiffness of the CPN compared to the control group (P < 0.05). The comparison of all parameters for the left and right TNs and CPNs among the three groups showed no significant difference. The area under the curve (AUC) of TN stiffness for the diagnosis of DPN was significantly greater than that of conventional ultrasound parameters. CONCLUSION The conventional ultrasound parameters and the stiffness of the TN and the CPN were significantly higher in patients with DPN. The stiffness of the TN could better diagnose DPN than conventional ultrasound parameters. In short, conventional ultrasound and SWE of nerves are of good application value in the diagnosis of DPN.
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Affiliation(s)
- Rui Chen
- In-Patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Harbin, China.
| | - Xiao-Lei Wang
- In-Patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Harbin, China.
| | - Wei-Li Xue
- In-Patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Harbin, China.
| | - Jia-Wei Sun
- In-Patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Harbin, China.
| | - Xue-Ying Dong
- In-Patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Harbin, China.
| | - Zhao-Peng Jiang
- In-Patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Harbin, China.
| | - Han Wu
- In-Patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Harbin, China.
| | - Rao Ma
- In-Patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Harbin, China.
| | - Xian-Li Zhou
- In-Patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Harbin, China.
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27
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Rugel CL, Franz CK, Lee SSM. Influence of limb position on assessment of nerve mechanical properties by using shear wave ultrasound elastography. Muscle Nerve 2020; 61:616-622. [PMID: 32086830 DOI: 10.1002/mus.26842] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 02/17/2020] [Accepted: 02/18/2020] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Evaluation of nerve mechanical properties has the potential to improve assessment of nerve impairment. Shear wave velocity, as measured by using shear wave (SW) ultrasound elastography, is a promising indicator of nerve mechanical properties such as stiffness. However, elucidation of external factors that influence SW velocity, particularly nerve tension, is required for accurate interpretations. METHODS Median and ulnar nerve SW velocities were measured at proximal and distal locations with limb positions that indirectly altered nerve tension. RESULTS Shear wave velocity was greater at proximal and distal locations for limb positions that induced greater tension in the median (mean increase proximal 89.3%, distal 64%) and ulnar (mean increase proximal 91.1%, distal 37.4%) nerves. DISCUSSION Due to the influence of nerve tension when SW ultrasound elastography is used, careful consideration must be given to limb positioning.
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Affiliation(s)
- Chelsea L Rugel
- Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Colin K Franz
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,The Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Shirley Ryan AbilityLab, Chicago, Illinois
| | - Sabrina S M Lee
- Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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28
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Wee TC, Simon NG. Ultrasound elastography for the evaluation of peripheral nerves: A systematic review. Muscle Nerve 2019; 60:501-512. [PMID: 31269240 DOI: 10.1002/mus.26624] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 06/24/2019] [Accepted: 06/29/2019] [Indexed: 02/06/2023]
Abstract
Peripheral nerve disorders are commonly encountered in clinical practice. Electrodiagnostic studies remain the cornerstone of the evaluation of nerve disorders. More recently, ultrasound has played an increasing complementary role in the neuromuscular clinic. Ultrasound elastography is a technique that measures the elastic properties of tissues. Given the histological changes that occur in diseased peripheral nerves, nerve ultrasound elastography has been explored as a noninvasive way to evaluate changes in nerve tissue composition. Studies to date suggest that nerve stiffness tends to increase in the setting of peripheral neuropathy, regardless of etiology, consistent with loss of more compliant myelin, and replacement with connective tissue. The aim of this systematic review is to summarize the current literature on the use of ultrasound elastography in the evaluation of peripheral neuropathy. Limitations of ultrasound elastography and gaps in current literature are discussed, and prospects for future clinical and research applications are raised.
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Affiliation(s)
- Tze Chao Wee
- Department of Rehabilitation Medicine, Changi General Hospital, Singapore
| | - Neil G Simon
- St Vincent's Clinical School, University of New South Wales, Darlinghurst, New South Wales, Australia
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