Diffusion tensor MR neurography reveals altered sciatic and tibial nerve microstructure in chronic dialysis patients.
4 affiliations
- 1Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany.
- 2Department of Nephrology, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany.
- 3Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany.
- 4Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
Abstract
Introduction
Uremic polyneuropathy is a complication of chronic kidney disease, presenting as a distal symmetric neuropathy mainly attributed to axonal damage. Electrophysiology provides limited insight into microstructural nerve alterations. Magnetic resonance neurography (MRN) may enable assessment of peripheral nerve integrity. This study aimed to quantify sciatic and tibial nerve microstructural changes in chronic dialysis patients and evaluate their clinical relevance.Methods
Thirty patients on chronic dialysis (DP)-without prediabetes or diabetes-and 30 healthy controls (HCs) underwent MRN, including diffusion tensor imaging (DTI). All MRN datasets of the distal thigh (30/30) were suitable for analysis. Four lower-leg examinations in the patient cohort (26/30) and three in the healthy group (27/30) were excluded because of motion artifacts. Fractional anisotropy (FA) was defined as the primary imaging outcome, while axial diffusivity (AD) and radial diffusivity (RD) were analyzed as secondary metrics. Electrophysiological testing was not available in four patients in the dialysis cohort (26/30). Results were compared between groups and correlated with electrophysiological, clinical, and laboratory findings.Results
FA of the sciatic (DP 0.44, HC 0.48, P < .001) and tibial nerve (DP 0.38, HC 0.43, P < .0001) and AD were significantly reduced in dialysis patients, while RD did not differ between groups. Lower FA correlated with electrophysiological measures, neuropathy scores, and was independently associated with group after adjustment for age, BMI, and sex. Subgroup analyses showed lower FA in patients fulfilling electrophysiological criteria for uremic polyneuropathy but no difference according to dialysis modality.Discussion
The reduction in FA and AD, together with electrophysiological and clinical correlations, is compatible with a predominantly axonal pattern of peripheral nerve involvement in chronic dialysis patients. DTI detected peripheral nerve microstructural alterations associated with chronic dialysis. These findings support further longitudinal and disease control studies to determine the clinical utility of DTI as an imaging biomarker in chronic dialysis patients.
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BibTeX
@article{fesselier2026diffusion,
title = {{Diffusion tensor MR neurography reveals altered sciatic and tibial nerve microstructure in chronic dialysis patients.}},
author = {Melissa Fesselier and Jonas Busecke and Katrin Klein and Clara Raudonat and Georges Sam and Markus Weiler and Sarah Khan-Blouki and Johann M E Jende and Sabine Heiland and Martin Zeier and Martin Bendszus and Christoph M Mooshage},
journal = {Clinical kidney journal},
year = {2026},
month = oct,
doi = {10.1093/ckj/sfag348},
url = {https://europepmc.org/article/MED/42899103},
note = {CC BY},
}
RIS
TY - JOUR
TI - Diffusion tensor MR neurography reveals altered sciatic and tibial nerve microstructure in chronic dialysis patients.
AU - Melissa Fesselier
AU - Jonas Busecke
AU - Katrin Klein
AU - Clara Raudonat
AU - Georges Sam
AU - Markus Weiler
AU - Sarah Khan-Blouki
AU - Johann M E Jende
AU - Sabine Heiland
AU - Martin Zeier
AU - Martin Bendszus
AU - Christoph M Mooshage
PY - 2026
DA - 2026/10/01
JO - Clinical kidney journal
DO - 10.1093/ckj/sfag348
UR - https://europepmc.org/article/MED/42899103
AB - Introduction Uremic polyneuropathy is a complication of chronic kidney disease, presenting as a distal symmetric neuropathy mainly attributed to axonal damage. Electrophysiology provides limited insight into microstructural nerve alterations. Magnetic resonance neurography (MRN) may enable assessment of peripheral nerve integrity. This study aimed to quantify sciatic and tibial nerve microstructural changes in chronic dialysis patients and evaluate their clinical relevance.Methods Thirty patients on chronic dialysis (DP)-without prediabetes or diabetes-and 30 healthy controls (HCs) underwent MRN, including diffusion tensor imaging (DTI). All MRN datasets of the distal thigh (30/30) were suitable for analysis. Four lower-leg examinations in the patient cohort (26/30) and three in the healthy group (27/30) were excluded because of motion artifacts. Fractional anisotropy (FA) was defined as the primary imaging outcome, while axial diffusivity (AD) and radial diffusivity (RD) were analyzed as secondary metrics. Electrophysiological testing was not available in four patients in the dialysis cohort (26/30). Results were compared between groups and correlated with electrophysiological, clinical, and laboratory findings.Results FA of the sciatic (DP 0.44, HC 0.48, P < .001) and tibial nerve (DP 0.38, HC 0.43, P < .0001) and AD were significantly reduced in dialysis patients, while RD did not differ between groups. Lower FA correlated with electrophysiological measures, neuropathy scores, and was independently associated with group after adjustment for age, BMI, and sex. Subgroup analyses showed lower FA in patients fulfilling electrophysiological criteria for uremic polyneuropathy but no difference according to dialysis modality.Discussion The reduction in FA and AD, together with electrophysiological and clinical correlations, is compatible with a predominantly axonal pattern of peripheral nerve involvement in chronic dialysis patients. DTI detected peripheral nerve microstructural alterations associated with chronic dialysis. These findings support further longitudinal and disease control studies to determine the clinical utility of DTI as an imaging biomarker in chronic dialysis patients.
SN - 2048-8505
SN - 2048-8513
ER -