Association of Small Fiber Function with Microvascular Perfusion of Peripheral Nerves in Patients with Type 2 Diabetes : Study using Quantitative Sensory Testing and Magnetic Resonance Neurography.

Christoph M Mooshage, Lukas Schimpfle, Zoltan Kender, Dimitrios Tsilingiris, Taraneh Aziz-Safaie, Anja Hohmann, Julia Szendroedi, Peter Nawroth, Volker Sturm, Sabine Heiland, Martin Bendszus, Stefan Kopf, Felix T Kurz, Johann M E Jende

Journal: Clinical neuroradiology 2024;34(1):55-66

PMID: 37548682

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Abstract

INTRODUCTION/AIMS

Diabetic small fiber neuropathy (SFN) is caused by damage to thinly myelinated A‑fibers (δ) and unmyelinated C‑fibers. This study aimed to assess associations between quantitative sensory testing (QST) and parameters of peripheral nerve perfusion obtained from dynamic contrast enhanced (DCE) magnetic resonance neurography (MRN) in type 2 diabetes patients with and without SFN.

METHODS

A total of 18 patients with type 2 diabetes (T2D, 8 with SFN, 10 without SFN) and 10 healthy controls (HC) took part in this cross-sectional single-center study and underwent QST of the right leg and DCE-MRN of the right thigh with subsequent calculation of the sciatic nerve constant of capillary permeability (K), extravascular extracellular volume fraction (V), and plasma volume fraction (V).

RESULTS

The K (HC 0.031 min ± 0.009, T2D 0.043 min ± 0.015; p = 0.033) and V (HC 1.2% ± 1.5, T2D: 4.1% ± 5.1; p = 0.027) were lower in T2D patients compared to controls. In T2D patients, compound z‑scores of thermal and mechanical detection correlated with K (r = 0.73; p = 0.001, and r = 0.57; p = 0.018, respectively) and V (r = 0.67; p = 0.002, and r = 0.69; p = 0.003, respectively). Compound z‑scores of thermal pain and V (r = -0.57; p = 0.015) correlated negatively.

DISCUSSION

The findings suggest that parameters of peripheral nerve microcirculation are related to different symptoms in SFN: A reduced capillary permeability may result in a loss of function related to insufficient nutritional supply, whereas increased capillary permeability may be accompanied by painful symptoms related to a gain of function.

Address: Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.; Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.; German Center of Diabetes Research, associated partner in the DZD, Munich-Neuherberg, Germany.; Institute for Diabetes and Cancer (IDC), Helmholtz Diabetes Center, Helmholtz Center, Munich, Neuherberg, Munich, Germany.; German Center of Diabetes Research, associated partner in the DZD, Munich-Neuherberg, Germany.; Institute for Diabetes and Cancer (IDC), Helmholtz Diabetes Center, Helmholtz Center, Munich, Neuherberg, Munich, Germany.; Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.; Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany.; Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.; German Center of Diabetes Research, associated partner in the DZD, Munich-Neuherberg, Germany.; Joint Heidelberg-IDC Translational Diabetes Program, Inner Medicine 1, Heidelberg University Hospital, Heidelberg, Germany.; Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.; Department of Neuroradiology, Division of Experimental Radiology, Heidelberg, Germany.; Department of Neuroradiology, Division of Experimental Radiology, Heidelberg, Germany.; Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.; German Cancer Research Center, Heidelberg, Germany.; Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany. [email protected].

DOI: 10.1007/s00062-023-01328-5

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https://dx.doi.org/10.1007/s00062-023-01328-5

MeSH Terms: Humans, Diabetes Mellitus, Type 2, Cross-Sectional Studies, Pain, Sciatic Nerve, Perfusion, Magnetic Resonance Spectroscopy, Magnetic Resonance Imaging