EFFECTIVENESS OF ULTRASOUND DIAGNOSTICS IN DIABETIC NEUROPATHY AMONG PATIENTS WITH DIABETES MELLITUS: A LITERATURE REVIEW
DOI:
https://doi.org/10.11603/1811-2471.2025.v.i2.15306Keywords:
Ultrasound, diabetes mellitus, diabetic polyneuropathy, peripheral nerves, cross-sectional area, reviewAbstract
SUMMARY. Diabetes mellitus (DM) represents one of the most pressing challenges in modern medicine. Its complications, particularly diabetic peripheral neuropathy (DPN), significantly impair patients’ quality of life and impose a substantial economic burden on healthcare systems. Early diagnosis of DPN is critical to prevent severe complications, such as foot ulcers and amputations. Traditional diagnostic methods, such as electroneuromyography (ENMG), are costly, invasive, and often inaccessible, especially in primary healthcare settings. This literature review synthesizes evidence on the effectiveness of ultrasound diagnostics for DPN based on existing studies. As a non-invasive, more accessible, and cost-effective approach, ultrasound demonstrates high efficacy in detecting structural changes in peripheral nerves, positioning it as a promising alternative for clinical practice. The integration of advanced technologies, such as shear wave elastography (SWE) and artificial intelligence (AI), holds potential to further enhance the accuracy of this method.
The aim – to systematize and analyze scientific data on the effectiveness of ultrasound diagnostics in detecting diabetic neuropathy in patients with diabetes. The review is aimed at assessing the diagnostic value of ultrasound, comparing it with other methods (ENMG, MRI), assessing the prospects of new technologies (shear wave elastography – SWE) and determining its place in clinical practice.
Material and Methods. To prepare the review, a literature search was conducted in the PubMed, Scopus and Web of Science databases for the period from 2015 to 2024. The following keywords were used: “diabetic neuropathy”, “ultrasound”, “peripheral nerves”, “cross-sectional area”. The review included original studies and systematic reviews that evaluated the effectiveness of ultrasound diagnostics of DPN in comparison with ENMG or clinical scales, had clear diagnostic criteria and at least 30 participants. Articles with insufficiently substantiated methodology (for example, without a control group or validated methods) were not included. The review is based on a synthesis of data from 25 studies, including 10 systematic reviews and meta-analyses published between 2015 and 2024.
Results. Ultrasound is an effective method for detecting DPN. Studies show that the cross-sectional area (CSA) of peripheral nerves, particularly the tibial nerve, is increased in patients with DPN. Ultrasound has a sensitivity of 80–90 % and a specificity of 75–85 %, which is comparable to that of ENMG (sensitivity 85–95 %, specificity 80–90 %). Ultrasound is superior in terms of availability and non-invasiveness, but is inferior to ENMG in detecting functional disorders. MRI has a higher accuracy (93.89%), but is more expensive. Newer techniques, such as shear wave elastography (SWE), have improved diagnostic performance, achieving a sensitivity of 75 % and a specificity of 86 %, and the integration of artificial intelligence (AI) has shown an AUC of 0.926 in the diagnosis of related conditions.
Conclusions. Ultrasound diagnostics is a valuable method for detecting diabetic neuropathy due to its high sensitivity, specificity, and accessibility. It can be an alternative to ENMG in clinical practice, especially in resource-limited settings, such as primary care. For its widespread implementation, it is recommended to standardize diagnostic criteria (e.g., CSA thresholds) and provide training for specialists. The prospects for the development of the method are associated with the integration of shear wave elastography and artificial intelligence, which may increase diagnostic accuracy, which requires further studies in large cohorts.
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