Diagnostic Ultrasound of the Vagus Nerve in Patients with Diabetes

Abstract

This study demonstrates a degree of vagus nerve atrophy in patients with diabetes. This finding may have relevance in the diagnosis and treatment of diabetic neuropathy if further validated.

Differential age‐, gender‐, and side‐dependency of vagus, spinal accessory, and phrenic nerve calibers detected with precise ultrasonography measures

“…In diabetes, CSA has been reported to be decreased in the vagus nerve and increased in peripheral nerves . Present data confirm the recently reported right‐left differences in vagus nerve diameters .…”

“…However, HR‐US systems are now available that provide online area measures as square millimeters with 1 or more (up to 3) digits after the decimal point, an option that can be chosen by the user in the system settings . The measures of vagus nerve CSA in the present study are lower than values reported earlier for a normal population . This can be explained by the more precise method applied here for calculating CSA.…”

“…High‐resolution ultrasound (HR‐US) is the method of choice for imaging small cervical and peripheral nerves . Such imaging is relevant for: (i) localization to avoid harm during invasive procedures, (ii) localization to target therapeutics, and (iii) measuring nerve caliber for assessing compressive, inflammatory or degenerative neuropathies . For example, mild to moderate atrophy of the vagus nerve has been detected on HR‐US in amyotrophic lateral sclerosis and in diabetic neuropathy .…”

“…Such imaging is relevant for: (i) localization to avoid harm during invasive procedures, (ii) localization to target therapeutics, and (iii) measuring nerve caliber for assessing compressive, inflammatory or degenerative neuropathies . For example, mild to moderate atrophy of the vagus nerve has been detected on HR‐US in amyotrophic lateral sclerosis and in diabetic neuropathy . Since these nerves are very small, with cross‐sectional areas (CSAs) often <2, or even <1 mm 2 , conventional methods yielding measures in full square millimeters do not allow for exact quantification of CSA.…”

“…1,[10][11][12][13][14][15] For example, mild to moderate atrophy of the vagus nerve has been detected on HR-US in amyotrophic lateral sclerosis and in diabetic neuropathy. 12,15 Since these nerves are very small, with cross-sectional areas (CSAs) often <2, or even <1 mm 2 , 16,17 conventional methods yielding measures in full square millimeters do not allow for exact quantification of CSA. With contemporary ultrasound systems, the CSA can be measured with standard tools, either by tracing the circumference of the low echogenic area, or by fitting an ellipse within the nerve's epineural rim.…”