MR T₂ Mapping Evaluation Of Primary Frozen Shoulder Ligaments Of Female Diabetic Patients

Objective Noninvasive assessment of imaging signs of primary frozen shoulder（PFS）in female diabetic patients by using magnetic resonance T₂ mapping sequence and conventional T₂WI sequence,in order to explore the effect of diabetes on female PFS ligaments.Materials and Methods Seventy-five female patients with primary PFS and 10 female healthy volunteers,with the age of 40-65 years,received MRI T₂ mapping and routine sequence examination.The 75 patients were divided into two groups,39 cases of diabetic PFS group（group A）,36 cases of non-diabetic primary frozen PFS（group B）,and healthy volunteer group（group C）.Diabetic PFS in stageⅠis defined as group A1,stageⅡis in group A2,and stageⅢis in group A3.In the non-diabetic group,PFS in stageⅠas group B1,stageⅡas group B2,and stageⅢas group B3.Diabetes group Patients were divided into 2 groups according to the length of diabetes history,the disease duration≤10 years was defined as group A4,and duration>10 years as group A5.T₂ mapping of 75 patients and 10 healthy volunteers were measured.For the measurement of the anterior bundle of the inferior glenohumeral ligaments,select the thickest layer of the anterior bundle of the inferior glenohumeral ligaments in the coronal image,and measure the area of the anterior bundle of the inferior glenohumeral ligaments.For the measurement of the coracohumeral ligaments,select the thickest layer of the coracohumeral ligaments in the oblique sagittal image,and measure the area of the coracohumeral ligaments.Each region of interests（ROI）was measured twice and the average value was taken.The independent sample t test was used to compare the T₂values of the ligaments at different stages in the diabetic group and the non-diabetic group,and to explore the changes in the T₂values of the ligaments at different stages of PFS.The independent sample t test was used to compare the T₂values of the ligaments in the diabetic group and the non-diabetic group at the same stage of PFS,and the independent sample t test was used to compare the T₂value of the lagments in the non-diabetic group at different stages of the PFS and the healthy volunteers were compared with the ligaments T₂value to explore the influence of diabetes on the change of lagments T₂value.The Mann-Whitney U test was used to compare the T₂values of the ligaments in the two groups with the disease time≤10 years and>10 years,and to explore the influence of the duration of diabetes on the PFS.Spearman correlation analysis was used to explore the relationship between the American shoulder and elbow surgery score and the ligaments T₂value of all enrolled cases（including primary frozen shoulder patients and healthy volunteers）.Results（1）Diabetes group:Comparison of the T₂value of the inferior coracoid-humeral ligaments at different stages of PFS.There was no statistical difference between phase III and phase III（P=0.413）.Compared with the T₂value of the anterior bundle of the glenohumeral ligaments,there were statistical differences in stage I/II,II/III,and I/III（P<0.001）.（2）Non-diabetic group:T₂values of the anterior bundle of the inferior glenohumeral ligaments and the coracoid humeral ligaments were compared at different stages of PFS,and there were statistical differences in stage I/II,II/III,and I/III（P<0.001）.（3）There was no significant difference in the T₂value of coracoid humeral ligaments between diabetic PFS stage I and non-diabetic PFS stage I（P=0.901）,and there was no statistical difference in T₂value of anterior bundle of glenohumeral ligaments（P=0.397）.（4）The T₂values of the coracoid humeral ligaments and the anterior bundle of the glenohumeral ligaments were significantly different between diabetic PFS stage II and non-diabetic PFS stage II（P<0.05）.（5）The T₂values of the anterior bundle of the glenohumeral ligaments and the coracohumeral ligaments of diabetic _PFSstage III and non-diabetic PFS stage III were statistically different（P<0.001）.（6）The T₂values of non-diabetic PFS stageⅠ,Ⅱ,Ⅲand healthy volunteers were significantly different（P<0.001）.（7）The T₂value of coracohumeral ligaments with diabetes duration≤10 years and>10 years was not statistically different（P=0.243）,while the T₂value of diabetes duration≤10 years and>10 years was statistically significant difference（P<0.05）.（8）Bivariate Pearson correlation analysis,coracohumeral ligaments T₂value was negatively correlated with ASES score（r=-0.833,P<0.001）,The T₂value of the anterior bundle of the glenohumeral ligaments is negatively correlated with the ASES score（r=-0.942,P<0.001）.Conclusion Diabetes has a certain influence on the change of T₂value of female PFS ligaments,and T₂ mapping has certain auxiliary diagnostic value for diabetic PFS.