Non-invasive stratified diagnosis of diabetic peripheral neuropathy using shear wave velocity of the extensor digitorum brevis: a pilot study

Shear wave elastography (SWE) can be used to assess neuromuscular disorders. This study aimed to evaluate the diagnostic performance of extensor digitorum brevis shear wave velocity (EDB-SWV) in distinguishing among different stages of diabetic peripheral neuropathy (DPN). In total, 127 patients with type 2 diabetes (T2DM) were divided into four groups based on clinical symptoms/signs and motor nerve conduction velocity (MCV): control (Group A) (asymptomatic, MCV ≥ 40 m/s, n = 30), symptomatic/suspected DPN (Group B) (symptomatic, MCV ≥ 40 m/s, n = 34), subclinical DPN (Group C) (asymptomatic, MCV < 40 m/s, n = 32), and confirmed DPN (Group D) (symptomatic, MCV < 40 m/s, n = 31). EDB-SWV and clinical data were collected after patients were diagnosed with T2DM. Analyze and compare the differences among the various groups. The independent factors influencing DPN were identified by univariate and multivariate logistic regression analyses. Draw the receiver operating characteristic curve, and calculate the area under the curve (AUC), sensitivity and specificity of EDB-SWV in diagnosing DPN. EDB-SWV and HbA1c levels showed a stepwise increase across the four groups (from control to confirmed DPN), while MCV showed a stepwise decrease (all P < 0.05). After adjusting for age and duration of T2DM based on their clinical relevance to DPN, both shear wave velocity (SWV) (P < 0.001) and HbA1c (P < 0.001) remained independent risk factors for DPN, with SWV showing excellent inter-observer reliability (ICC > 0.9). For DPN diagnosis, SWV achieved a sensitivity of 0.948 at a cut-off of 1.985 m/s (AUC = 0.804), and its combination with HbA1c improved diagnostic performance (AUC = 0.870). EDB-SWV was significantly increased in all diagnostic subgroups of DPN, and it had a higher sensitivity, which is expected to become an indicator for assessing DPN.