Role of nerve ultrasound and shear wave elastography in stratified diagnosis of diabetic peripheral neuropathy

The aim of this study is to ascertain the role of high-resolution nerve ultrasound (NUS) and shear wave elastography (SWE) in assessing the stratified diagnosis of diabetic peripheral neuropathy (DPN). To assess the potential diagnostic worth of NUS and SWE, across different levels of DPN. To determine whether the integration of NUS with SWE can enhance diagnostic accuracy. This retrospective study enrolled a total of 121 patients diagnosed with type 2 diabetes mellitus from September 2022 to May 2024, including 91 patients with DPN. All participants were categorized into 4 groups: group A (subclinical-DPN), group B (suspected-DPN), group C (clinically diagnosed-DPN), group D (confirmed-DPN), with a control group of type 2 diabetes mellitus patients without DPN. NUS and SWE examinations were performed to generate the receiver operating characteristics (ROC) curves of different diagnostic methods, determine the diagnostic threshold and compare the difference in diagnostic efficacy. Significant differences were observed in tibial nerve characteristics between DPN patients and controls. The DPN group had a larger cross-sectional area (CSA; 24.78 ± 4.75 mm² vs 22.40 ± 3.19 mm², P < .05) and higher mean elasticity modulus (Emean; 54.46 ± 16.76 kPa vs 34.37 ± 9.37 kPa, P < .05). ROC curve analysis was performed to evaluate the diagnostic performance of CSA, Emean, and combined model (Emean + CSA) in detecting DPN. The area under the ROC curve of Emean was significantly higher than NUS (z = -4.032, P < .001). The combined model showed no significant improvement over SWE alone (z = -1.486, P = .137). Stratified analysis revealed that CSA measurements are more reliable in advanced disease stages; Emean demonstrated significantly superior diagnostic efficacy compared to CSA for all disease stages. The combination of Emean and CSA showed more pronounced improvements in all disease stages compared to CSA alone, while only showing marginal improvement trends in subclinical and confirmed-DPN, without reaching statistical significance compared to Emean. This study establishes an evidence-based, stage-specific framework for the diagnosis of DPN. The combined NUS + SWE approach offers unparalleled advantages for early detection, whereas SWE alone may suffice in advanced stages.