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J Med Ultrasound
J Med Ultrasound
JMU
J Med Ultrasound
Journal of Medical Ultrasound
0929-6441
2212-1552
Wolters Kluwer - Medknow India

JMU-32-276
10.4103/jmu.jmu_42_24
Correspondence
Reply to Comments on Posterior Tibial Nerve Ultrasound Assessment of Peripheral Neuropathy in Adults with Type 2 Diabetes Mellitus
Idowu Bukunmi Michael *
Department of Radiology, Union Diagnostics and Clinical Services PLC, Lagos, Nigeria
Address for correspondence: Dr. Bukunmi Michael Idowu, Department of Radiology, Union Diagnostics and Clinical Services PLC, Lagos, Nigeria. E-mail: ibmcontacts@gmail.com
Jul-Sep 2024
10 7 2024
32 3 276276
18 4 2024
19 4 2024
Copyright: © 2024 Journal of Medical Ultrasound
2024
https://creativecommons.org/licenses/by-nc-sa/4.0/ This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
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pmcDear Editor,

We thank Dr. Mahmood Al-Mendalawi for their comments on our article titled “Posterior Tibial Nerve Ultrasound Assessment of Peripheral Neuropathy in Adults with Type 2 Diabetes Mellitus” which was published[1] in the January–March 2024 issue of the Journal of Medical Ultrasound.

In the results section of the article under reference, we stated that: “A mean posterior tibial nerve cross-sectional area (PTN CSA) of 14 mm at 5 cm above the medial malleolus was the optimal threshold for the identification of diabetic peripheral neuropathy (DPN) because it had the highest accuracy of 73.8% (62.7%–83%) to correctly classify participants as having DPN. This cut-off value’s sensitivity, specificity, positive predictive value, and negative predictive value were 77.6%, 63.6%, 84.9%, and 51.9%, respectively.”[1] The key message was that PTN CSA is a useful additional/complementary tool to the existing armamentarium of investigative methods for managing DPN. The article did not advocate for PTN CSA to supplant other methods; rather, it should supplement or complement them. Maximum benefit would be derived from using the PTN CSA alongside other methods to strengthen diagnostic confidence. It follows that PTN CSA should not be relied upon solely.

The risk of missing or failing to diagnose asymmetrical DPN can be avoided by evaluating the PTNs of both lower limbs in every patient with suspected DPN. As stated in the methods section, only the left PTNs were assessed in the study for “convenient scanning and ease of participant positioning.”

PTN terminal branching pattern anatomical variations would constitute one of the limitations of PTN CSA; however, it does not invalidate its clinical usefulness because these aberrant anatomies are visible on ultrasound,[23] allowing for measurement landmarks to be modified accordingly.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.
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REFERENCES

1 Oduola-Owoo LT Adeyomoye AA Omidiji OA Idowu BM Oduola-Owoo BB Odeniyi IA Posterior Tibial nerve ultrasound assessment of peripheral neuropathy in adults with type 2 diabetes mellitus J Med Ultrasound 2024 32 62 9 38665340
2 Nagaraj S Mistry T Sonawane K Sekar C Navigating the anomalous path of the tibial nerve at the ankle – Attention to the intricacies! Indian J Anaesth 2024 68 307 8 38476558
3 Kennedy R Nagpal A Abd-Elsayed A Posterior tibial nerve Abd-Elsayed A Pain Cham Springer International Publishing 2019 503 5 Available from: http://link.springer.com/10.1007/978-3-319-99124-5_111 [Last accessed on 2024 Apr 17]
