Evaluation Of Abnormal Changes In Muscle Of Lower Limb In Patients With Type 2 Diabetes Mellitus With Diabetic Peripheral Neuropathy Using Conventional Ultrasound And Two-Dimensional Shear Wave Elastography

Objective: To evaluate the abnormal changes in the quadriceps femoris in patients with type 2 diabetes mellitus(T2DM)with or without diabetic peripheral neuropathy(DPN)using conventional ultrasound and two-dimensional shear wave elastography(2D-SWE).Methods: From December 2021 to July 2022,a total of 66 patients with T2 DM,including 31 males and 35 females,with a mean age of 54.90 years and a range of 35-71 years,were enrolled from the Department of Endocrinology,Second Hospital of Dalian Medical University.All of them met the diagnostic guidelines of diabetes set by the World Health Organization in 1999.T2 DM patients were divided into two groups according to whether they were combined with DPN: the group A(T2DM with DPN,30cases: 14 males,16 females,mean age of 56.04±8.12 years,range of 40-71 years)and the group B(T2DM without DPN,36 cases: 17 males,19 females,mean age of53.78±10.42 years,range of 35-70 years)and healthy subjects were enrolled as control into the group C(30 cases: 15 males,15 females,mean age of 54.80±9.31 years,range of 39-70 years).Exclusion criteria: lower limb deformity and surgical history,acute or chronic musculoskeletal diseases such as myofibrositis and myasthenia gravis,history of nervous system diseases and metabolic diseases,such as stroke,malignant tumor and anemia.Using the Mindray Resona 8 ultrasound machine with 2D-SWE software and a linear array probe(L11-3U,3-10 MHz),a single operator performed all ultrasound examinations.Two-dimensional ultrasound was used to measure the cross-sectional area and the thickness of the rectus femoris,as well as the lateral and medial femoral muscle.The shear wave velocity(SWV,m/s)in the relaxed and tensive positions of the rectus femoris,as well as the lateral and medial femoral muscle,were obtained through2D-SWE.In addition,fasting blood glucose(FBG),glycosylated hemoglobin(Hb A1c),triglyceride(TG),total cholesterol(TC),low density lipoprotein cholesterol(LDL-c),and high density lipoprotein cholesterol(HDL-C)were also obtained.Results: The comparisons of two-dimensional ultrasonography of the quadriceps femoris among the three groups: there was no significant difference in the cross-sectional area of the rectus femoris,the thickness of the rectus femoris,the lateral and medial femoral muscle between the left and right quadriceps femoris in each group(all P>0.05).The cross-sectional area of the rectus femoris,the thickness of the rectus femoris,the lateral and medial femoral muscle in the group A and the group B were significantly smaller than those in the group C(all P<0.05).The cross-sectional area of the rectus femoris,the thickness of the rectus femoris,the lateral and medial femoral muscle in the group A were significantly smaller than those in the group B(all P<0.05).The comparisons of elastic measurements between different positions of the quadriceps femoris in each group: the SWV of the rectus femoris,the lateral femoris and medial femoris in the relaxed position were significantly smaller than those in the tensive position in each group(all P<0.05).The comparisons of SWV of the quadriceps femoris under two positions among groups: there was no significant difference in SWV between the right and left rectus femoris,medial femoris and lateral femoris in each group(all P>0.05).In the relaxed position,the SWV of the rectus femoris,the lateral femoris and medial femoris in the group A and the group B were significantly smaller than those in the group C(all P<0.05).The SWV of the rectus femoris,the lateral femoris and medial femoris in the group A was significantly smaller than those in the group B(all P<0.05).In the tensive position the SWV of the rectus femoris,the lateral femoris and medial femoris in the group A and the group B were significantly smaller than those in the group C(all P<0.05).The SWV of the rectus femoris,the lateral femoris and medial femoris in the group A was significantly smaller than those in the group B(all P<0.05).Conclusion: Conventional ultrasound and 2D-SWE can accurately and objectively detect abnormal changes in the quadriceps femoris of T2 DM patients with or without DPN.This has important significance for early prevention,diagnosis,and treatment of diabetic myopathy,as well as evaluating the efficacy of intervention measures.