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Meta-Analysis
. 2022 Jul 22:10:915883.
doi: 10.3389/fpubh.2022.915883. eCollection 2022.

Shear wave elastography as a quantitative biomarker of diabetic peripheral neuropathy: A systematic review and meta-analysis

Bingtian Dong  1 , Guorong Lyu  1   2 , Xiaocen Yang  3 , Huaming Wang  1 , Yongjian Chen  1
Affiliations
Meta-Analysis

Shear wave elastography as a quantitative biomarker of diabetic peripheral neuropathy: A systematic review and meta-analysis

Bingtian Dong et al. Front Public Health. .

Abstract

Background: Diabetic peripheral neuropathy (DPN) is one of the most common chronic complications of diabetes and the strongest initiating risk factor for diabetic foot ulceration. Early diagnosis of DPN through screening measures is, therefore, of great importance for diabetic patients. Recently, shear wave elastography (SWE) has been used as a method that is complementary to neuroelectrophysiological examination in the diagnosis of DPN. We aimed to conduct a meta-analysis based on currently available data to evaluate the performance of tibial nerve stiffness on SWE for diagnosing DPN.

Methods: Both PubMed, EMBASE, the Cochrane Library, and Web of Science were searched for studies that investigated the diagnostic performance of SWE for DPN up to March 1th, 2022. Three measures of diagnostic test performance, including the summary area under receiver operating characteristics curve (AUROC), the summary sensitivity and specificity, and the summary diagnostic odds ratios were used to assess the diagnostic accuracy of SWE. All included studies were published between 2017 and 2021.

Results: Six eligible studies (with 170 DPN patients, 28 clinically defined DPN patients, 168 non-DPN patients, and 154 control participants) that evaluated tibial nerve stiffness were included for meta-analysis. The summary sensitivity and specificity of SWE for tibial nerve stiffness were 75% (95% confidence interval [CI]: 68-80%) and 86% (95% CI: 80-90%), respectively, and the summary AUROC was 0.84 (95% CI: 0.81-0.87), for diagnosing DPN. A subgroup analysis of five two-dimensional SWE studies revealed similar diagnostic performance, showing the summary sensitivity and specificity of 77% (95% CI: 69-83%) and 86% (95% CI: 79-91%), respectively, and a summary AUROC value of 0.86 (95% CI: 0.83-0.89).

Conclusions: SWE is found to have good diagnostic accuracy for detecting DPN and has considerable potential as an important and noninvasive adjunctive tool in the management of patients with DPN.

Keywords: biomarker; diabetic peripheral neuropathy; diagnosis; shear wave elastography; stiffness measurement.

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Figures

Figure 1
Figure 1
Flow diagram of study identification.
Figure 2
Figure 2
Distribution of research population of the included studies.
Figure 3
Figure 3
Illustration of the shear wave elastography (SWE) technique used in examination of nerves. SWE generates shear waves via acoustic radiation force (ARF). This technique provides more quantitative information in relation to the elasticity of the tissue.
Figure 4
Figure 4
Coupled forest plots of the summary sensitivity and specificity of tibial nerve stiffness using shear wave elastography (SWE) (A) and two-dimensional SWE (B) for the diagnosis of diabetic peripheral neuropathy (DPN).
Figure 5
Figure 5
Summary receiver operating characteristic (SROC) curve of tibial nerve stiffness using shear wave elastography (SWE) (A) and two-dimensional SWE (B) for the diagnosis of diabetic peripheral neuropathy (DPN).
Figure 6
Figure 6
Deeks' funnel plot used to assess publication bias.
See this image and copyright information in PMC

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