Data_Sheet_1_Diffusion Tensor Imaging of the Sciatic Nerve as a Surrogate Marker for Nerve Functionality of the Upper and Lower Limb in Patients With Diabetes and Prediabetes.PDF

BackgroundNerve damage in diabetic neuropathy (DN) is assumed to begin in the distal legs with a subsequent progression to hands and arms at later stages. In contrast, recent studies have found that lower limb nerve lesions in DN predominate at the proximal sciatic nerve and that, in the upper limb, nerve functions can be impaired at early stages of DN.Materials and MethodsIn this prospective, single-center cross-sectional study, participants underwent diffusion-weighted 3 Tesla magnetic resonance neurography in order to calculate the sciatic nerve’s fractional anisotropy (FA), a surrogate parameter for structural nerve integrity. Results were correlated with clinical and electrophysiological assessments of the lower limb and an examination of hand function derived from the Purdue Pegboard Test.ResultsOverall, 71 patients with diabetes, 11 patients with prediabetes and 25 age-matched control subjects took part in this study. In patients with diabetes, the sciatic nerve’s FA showed positive correlations with tibial and peroneal nerve conduction velocities (r = 0.62; p < 0.001 and r = 0.56; p < 0.001, respectively), and tibial and peroneal nerve compound motor action potentials (r = 0.62; p < 0.001 and r = 0.63; p < 0.001, respectively). Moreover, the sciatic nerve’s FA was correlated with the Pegboard Test results in patients with diabetes (r = 0.52; p < 0.001), prediabetes (r = 0.76; p < 0.001) and in controls (r = 0.79; p = 0.007).ConclusionThis study is the first to show that the sciatic nerve’s FA is a surrogate marker for functional and electrophysiological parameters of both upper and lower limbs in patients with diabetes and prediabetes, suggesting that nerve damage in these patients is not restricted to the level of the symptomatic limbs but rather affects the entire peripheral nervous system.

背景：糖尿病性神经病变（DN）中神经损伤的起始于远端下肢，随后在后期进展至手和上肢。然而，近期研究指出，在DN中，下肢神经损伤主要发生在近端坐骨神经处，而在上肢，神经功能在DN的早期阶段即可受到损害。材料与方法：在本项前瞻性、单中心横断面研究中，参与者接受了3 Tesla扩散加权磁共振神经影像学检查，以计算坐骨神经的各向异性分数（FA），该参数作为结构神经完整性的替代指标。研究结果与下肢的临床和电生理评估以及由普渡钉板测试所得的手部功能检查结果进行了相关性分析。结果：总体而言，71名糖尿病患者、11名糖尿病前期患者和25名年龄匹配的对照受试者参与了本研究。在糖尿病患者中，坐骨神经的FA与胫神经和腓神经传导速度（r = 0.62；p < 0.001和r = 0.56；p < 0.001，分别）以及胫神经和腓神经复合运动动作电位（r = 0.62；p < 0.001和r = 0.63；p < 0.001，分别）呈正相关。此外，坐骨神经的FA与糖尿病患者的钉板测试结果（r = 0.52；p < 0.001）、糖尿病前期患者的钉板测试结果（r = 0.76；p < 0.001）以及对照组的钉板测试结果（r = 0.79；p = 0.007）相关。结论：本研究首次证实，坐骨神经的FA是糖尿病和糖尿病前期患者上下肢功能及电生理参数的替代标志物，提示这些患者的神经损伤不仅限于症状性肢体水平，而是影响整个周围神经系统。