Role of shear wave elastography in evaluation of diabetic peripheral neuropathy

Abstract Background Diabetic Peripheral Neuropathy (DPN) is a common and debilitating complication of diabetes, leading to significant morbidity. Conventional diagnostic methods such as nerve conduction studies (NCS) and clinical scores are often limited by invasiveness and inability to detect early neuropathic changes. Shear Wave Elastography (SWE), a novel ultrasonographic technique that quantifies tissue stiffness, offers potential for earlier and more accurate diagnosis. Aim To evaluate the role of Shear Wave Elastography in diagnosing Diabetic Peripheral Neuropathy and compare its diagnostic efficacy with conventional methods including NCS and ultrasonographic cross-sectional area (CSA) and echogenicity measurements. Materials and methods This prospective case–control study was conducted at Indira Gandhi Medical College, Shimla (January 2024–May 2025) and included 69 participants divided equally into three groups: (I) diabetics with DPN, (II) diabetics without DPN, and (III) healthy controls. All participants underwent Modified Toronto Clinical Neuropathy Scoring (mTCNS), laboratory evaluation, NCS, ultrasonography, and SWE of the tibial nerve 5 cm above the medial malleolus. Statistical analysis was performed using SPSS v28.0, with p < 0.05 considered significant. Results SWE values were significantly higher in patients with DPN (Right = 84.04 ± 37.37 kPa; Left = 93.17 ± 41.46 kPa) compared to diabetics without DPN and controls ( p < 0.001). Echogenicity was markedly reduced in DPN (Right = 28.7 pixels) versus controls (66.5 pixels). ROC analysis yielded SWE cutoff values of 53.5 kPa (right) and 54 kPa (left), with sensitivity = 82.6% and specificity = 86.9% (AUC = 0.918 and 0.833 respectively). CSA differences were not statistically significant. Conclusion Shear Wave Elastography demonstrates high sensitivity and specificity in detecting DPN, offering a non-invasive, rapid, and reliable alternative to conventional methods. Incorporating SWE into clinical practice may facilitate earlier diagnosis and better management of diabetic neuropathy.