Dual-modality ultrasound radiomics model for classifying diabetic peripheral neuropathy in type 2 diabetes: a multicenter prospective study.

OBJECTIVE: Diabetic peripheral neuropathy (DPN) is a prevalent and disabling complication of type 2 diabetes mellitus (T2DM), yet detection remains constrained by limited accessibility of nerve conduction studies. This study developed and validated a dual-modality ultrasound radiomics model for individualized DPN classification. METHODS: In total, 253 T2DM patients from three centers were prospectively enrolled between June 2025 and February 2026, allocated to training (n = 122), internal test (n = 53), and external validation (n = 78) cohorts. Radiomics features were extracted from longitudinal B-mode ultrasound and shear wave elastography images of the tibial nerve. After reproducibility filtering, batch-effect correction, and elastic-net feature selection, four machine learning algorithms were compared and the best-performing was used to construct modality-specific radiomics scores (Rad-scores). A combined model integrating Rad-scores with independently associated clinical factors was developed. Discrimination, calibration, clinical usefulness, and SHapley Additive exPlanations (SHAP) interpretability were evaluated. RESULTS: Multivariable analysis identified diabetes duration and minimum elastic modulus as independently associated factors, with both Rad-scores significantly associated with DPN status. The combined model demonstrated good discrimination across all cohorts (AUC 0.892 [95% CI 0.828-0.950], 0.824 [0.696-0.925], and 0.838 [0.735-0.926]), outperforming all other models (p < 0.05), with adequate calibration in both training and internal test cohorts (p > 0.05). Decision curve analysis confirmed clinical benefit. SHAP analysis identified diabetes duration as the most influential variable, followed by the shear wave elastography Rad-score. CONCLUSIONS: The combined model demonstrates favorable diagnostic performance for individualized DPN risk stratification and holds promise as a noninvasive complement to nerve conduction.