Diffusion tensor imaging MR neurography for the detection of polyneuropathy in type 1 diabetes

作者：Vaeggemose Michael^*; Pham Mirko; Ringgaard Steffen; Tankisi Hatice; Ejskjaer Niels; Heiland Sabine; Poulsen Per L; Andersen Henning

来源：Journal of Magnetic Resonance Imaging, 2017, 45(4): 1125-1134.

DOI：10.1002/jmri.25415

• diffusion tensor imaging
• diabetes
• neuropathy
• magnetic resonance neurography
• reproducibility
• repeatability

PurposeTo evaluate if diffusion tensor imaging MR neurography (DTI-MRN) can detect lesions of peripheral nerves in patients with type 1 diabetes.
Materials and MethodsEleven type 1 diabetic patients with polyneuropathy (DPN), 10 type 1 diabetic patients without polyneuropathy (nDPN), and 10 healthy controls (HC) were investigated with a 3T MRI scanner. Clinical examinations, nerve-conduction studies, and vibratory-perception thresholds determined the presence of DPN. DTI-MRN (voxel size: 1.4 x 1.4 x 3mm(3); b-values: 0, 800 s/mm(2)) covered proximal (sciatic nerve) and distal regions of the lower extremity (tibial nerve). Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were calculated and compared to T-2-relaxometry and proton-spin density obtained from a multiecho turbo spin echo (TSE) sequence. Furthermore, we evaluated DTI reproducibility, repeatability, and diagnostic accuracy.
ResultsDTI-MRN could accurately discriminate between DPN, nDPN, and HC. The proximal FA was lowest in DPN (DPN 0.370.06; nDPN 0.470.03; HC 0.490.06; P < 0.01). In addition, distal FA was lowest in DPN (DPN 0.31 +/- 0.05; nDPN 0.41 +/- 0.07; HC 0.43 +/- 0.08; P < 0.01). Likewise, proximal ADC was highest in DPN (DPN 1.69 +/- 0.25 x 10(-3)mm(2)/s; nDPN 1.50 +/- 0.06 x 10(-3)mm(2)/s; HC 1.42 +/- 0.12 x 10(-3)mm(2)/s; P < 0.01) as was distal ADC (DPN 1.87 +/- 0.45 x 10(-3)mm(2)/s; nDPN 1.59 +/- 0.19 x 10(-3)mm(2)/s; HC 1.57 +/- 0.26 x 10(-3)mm(2)/s; P=0.09). The combined interclass-correlation (ICC) coefficient of DTI reproducibility and repeatability was high in the sciatic nerve (ICC: FA=0.86; ADC=0.85) and the tibial nerve (ICC: FA=0.78; ADC=0.66). T-2-relaxometry and proton-spin-density did not enable detection of neuropathy.
ConclusionDTI-MRN accurately detects DPN by lower nerve FA and higher ADC. These alterations are likely to reflect proximal and distal nerve fiber pathology.

• 出版日期2017-4