Comparison of sural and distal sural nerve responses: Diagnostic role of the amplitude ratio in diabetic polyneuropathy

IF 3 4区医学 Q2 CLINICAL NEUROLOGY

Neurophysiologie Clinique/Clinical Neurophysiology Pub Date : 2025-11-01 Epub Date: 2025-10-08 DOI:10.1016/j.neucli.2025.103114

Canan Duman İlki , Ege Çadırcı , Zerin Özaydın Aksun , Esra Eraslan Aydemir , Asena Gökçay Canpolat , Hüseyin Özden Şener

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引用次数: 0

Abstract

Objective

To assess the diagnostic utility of distal sural (DSUR) sensory responses and amplitude ratios compared with conventional proximal sural (PSUR) studies in diabetic polyneuropathy (DPN).

Methods

Fifty-eight patients with diabetes and clinical evidence of polyneuropathy (neuropathic symptoms and/or signs, median Neuropathy Impairment Score of the Lower Limbs (NIS-LL) score 6 [IQR 2–8]) and 44 healthy controls underwent bilateral nerve conduction studies of the PSUR and DSUR, and the right radial nerve. Amplitudes, conduction velocities (CV), and amplitude ratios [sural-to-radial amplitude ratio (SRAR), distal sural-to-radial amplitude ratio (DSRAR), and proximal-to-distal sural amplitude ratio (PDSR)] were analysed.

Results

PSUR and DSUR amplitudes were significantly lower and conduction velocities slower in patients compared with controls (p < 0.001). DSUR amplitude achieved diagnostic accuracy comparable to PSUR amplitude (AUC 0.762 vs. 0.775), with higher sensitivity (58.5% vs. 41.5 %) and preserved specificity (91 % vs. 93%). SRAR and DSRAR were reduced in patients, but their diagnostic performance was modest (AUC < 0.65). PDSR did not differ significantly between groups (p > 0.05) and was therefore not included in ROC analysis. Amplitude ratios showed weak correlations with diabetes duration, vibration threshold, and NIS-LL.

Conclusion

DSUR amplitude is a feasible and reliable parameter that increases sensitivity in the electrophysiological detection of DPN while maintaining high specificity. In contrast, PDSR did not provide significant diagnostic value, suggesting that absolute amplitude measures are more informative than ratio-based indices in routine clinical practice.

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腓肠和远端腓肠神经反应的比较：振幅比在糖尿病多发神经病中的诊断作用。

目的：评估腓肠远端（DSUR）感觉反应和振幅比与传统腓肠近端（PSUR）研究在糖尿病多发性神经病变（DPN）中的诊断价值。方法：58例有多神经病变临床证据（神经病变症状和/或体征，下肢正中神经病变损害评分（NIS-LL）评分6分[IQR 2-8]）的糖尿病患者和44名健康对照者进行双侧PSUR、DSUR和右侧桡神经的神经传导研究。分析振幅、传导速度（CV）和振幅比[桡动脉幅值比（SRAR）、远端桡动脉幅值比（DSRAR）和近端远端桡动脉幅值比（PDSR）]。结果：与对照组相比，患者PSUR和DSUR振幅明显降低，传导速度明显减慢（p < 0.001）。DSUR振幅的诊断准确性与PSUR振幅相当（AUC为0.762比0.775），具有更高的灵敏度（58.5%比41.5%）和保留的特异性（91%比93%）。患者的SRAR和DSRAR降低，但其诊断性能一般（AUC < 0.65）。各组间PDSR无显著差异（p < 0.05），因此未纳入ROC分析。振幅比与糖尿病病程、振动阈值和NIS-LL呈弱相关。结论：DSUR振幅是一个可行、可靠的参数，在保持高特异性的同时增加了DPN电生理检测的敏感性。相比之下，PDSR没有提供显著的诊断价值，这表明在常规临床实践中，绝对振幅测量比基于比率的指标更能提供信息。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Neurophysiologie Clinique/Clinical Neurophysiology 医学-临床神经学

CiteScore

5.20

自引率

3.30%

发文量

审稿时长

60 days

期刊介绍： Neurophysiologie Clinique / Clinical Neurophysiology (NCCN) is the official organ of the French Society of Clinical Neurophysiology (SNCLF). This journal is published 6 times a year, and is aimed at an international readership, with articles written in English. These can take the form of original research papers, comprehensive review articles, viewpoints, short communications, technical notes, editorials or letters to the Editor. The theme is the neurophysiological investigation of central or peripheral nervous system or muscle in healthy humans or patients. The journal focuses on key areas of clinical neurophysiology: electro- or magneto-encephalography, evoked potentials of all modalities, electroneuromyography, sleep, pain, posture, balance, motor control, autonomic nervous system, cognition, invasive and non-invasive neuromodulation, signal processing, bio-engineering, functional imaging.