Association between intraneural blood flow of the sciatic nerve, peripheral neuropathies, and foot ulcers in patients with diabetes.

BACKGROUND

Intraneural blood flow (INBF) serves as a useful marker for diagnosing peripheral neuropathies. However, the specific relationship between sciatic nerve INBF (SN) and the occurrence of diabetic peripheral neuropathies (DPNs) and diabetic foot ulcers (DFUs) remains ambiguous. Thus, the purpose of this study was to investigate the association between SN, as detected by power Doppler ultrasound, and the presence of DPNs and DFUs in patients with diabetes.

METHODS

A retrospective cross-sectional study was performed on patients with diabetes between June 2018 and July 2024. The study population was categorized into two groups based on electroneurophysiological findings: a DPN and a non-DPN group. Within the DPN group, the patients were subdivided as DFU and non-DFU subgroups. Clinical characteristics and ultrasound parameters, including SN, were compared between those groups and subgroups. Logistic regression analysis was employed to investigate the relationships between SN and the presence of DPN and DFU. Additionally, the diagnostic performance of SN was assessed through the areas under the receiver operating characteristic curves (AUROCs) for identifying DPN and DFU. Meanwhile, sciatic nerves (SNs) of healthy controls (HCs) were taken as normal controls to determine whether SN can be detected in HC by power Doppler ultrasound.

RESULTS

The study included 113 patients with diabetes [mean age ± standard deviation (SD), 63.81±12.31 years; 71 males] (82 had DPN and 31 did not). The subgroup analysis of DPN patients included 61 individuals with DFU and 21 without. Adjusted logistic regression analysis revealed a significant independent association between SN and the presence of DPN in patients with diabetes [odds ratio (OR): 7.399; 95% confidence interval (CI): 1.959-27.944; P=0.004]. Further analysis within the DPN subgroup confirmed a significant association between SN and the presence of DFUs (OR: 12.255; 95% CI: 2.881-52.135; P=0.001). The AUROC for SN in diagnosing DPN and DFU was 0.755 and 0.727, respectively (all P<0.05), with corresponding sensitivities and specificities of 67.1% and 83.9% for DPN and 78.7% and 66.7% for DFU, respectively. Additionally, there were 19 HCs (38 SNs, matched gender and age with patients with diabetes). Among those HC, no SN was detected by power Doppler ultrasound.

CONCLUSIONS

SN is positively correlated with DPN in patients with diabetes and with DFU in those with DPN, suggesting that SN is a valuable indicator for diagnosing both DPN and DFU.