Department of Imaging Sciences, University of Rochester Medical Center, NY 14642, USA.
AJR Am J Roentgenol. 2010 Jul;195(1):198-204. doi: 10.2214/AJR.09.2494.
This study retrospectively evaluates diabetic myopathy in a large referral hospital population. It describes the MRI findings and the distribution of muscle involvement, including comparison with clinical parameters.
MRI reports of the lower extremities from July 1999 through January 2006 were reviewed and compared with clinical parameters for patients with diabetic myopathy. Clinical parameters (e.g., type of diabetes, hemoglobin A(1C) level, creatine kinase level, and erythrocyte sedimentation rate [ESR]) and the presence of complications, including nephropathy, neuropathy, and retinopathy, were noted. The distribution of muscle involvement and imaging features were reviewed.
Over a 79-month period, 21 extremities (11 thighs and 10 calves) of 16 patients were imaged. Fourteen (88%) patients had type 2 diabetes, and two (12%) had type 1 diabetes. Four patients (25%) had disease in more than one location. In the thigh, the anterior compartment was involved in all patients. The posterior compartment was affected in nine (90%) of 10 calves. Muscle infarction and necrosis was seen in eight (38%) extremities. The creatine kinase level, ESR, and hemoglobin A(1C) level were elevated in the majority of cases. Coexisting nephropathy (50%), neuropathy (50%), and retinopathy (38%) were present in these patients.
Diabetic myopathy may occur more frequently in patients with type 2 diabetes than previously reported. In this population, T2-weighted and contrast-enhanced images have similar findings, and the increased coexistence of nephropathy makes administration of gadolinium-based contrast agents ill-advised. With a typical clinical presentation and MRI findings, a confident diagnosis can be made, and potentially harmful biopsy is avoided. Diabetic myopathy encompasses a spectrum of diseases, including muscle inflammation, ischemia, hemorrhage, infarction, necrosis, fibrosis, and fatty atrophy. It is usually seen with long-standing, poorly controlled diabetes.
本研究回顾性评估了大型转诊医院人群中的糖尿病性肌病。描述了 MRI 表现和肌肉受累的分布，包括与临床参数的比较。
回顾了 1999 年 7 月至 2006 年 1 月的下肢 MRI 报告，并将其与糖尿病性肌病患者的临床参数进行了比较。记录了临床参数（例如，糖尿病类型、血红蛋白 A（1C）水平、肌酸激酶水平和红细胞沉降率[ESR]）以及并发症的存在情况，包括肾病、神经病和视网膜病。回顾了肌肉受累的分布和影像学特征。
在 79 个月的时间里，对 16 名患者的 21 个肢体（11 个大腿和 10 个小腿）进行了成像。14 名（88%）患者患有 2 型糖尿病，2 名（12%）患有 1 型糖尿病。4 名（25%）患者在一个以上部位患病。在大腿中，所有患者的前室均受累。10 个小腿中有 9 个（90%）后室受累。8 个（38%）肢体可见肌梗死和坏死。大多数情况下，肌酸激酶水平、ESR 和血红蛋白 A（1C）水平升高。这些患者同时存在肾病（50%）、神经病（50%）和视网膜病（38%）。
与先前报道的相比，2 型糖尿病患者中糖尿病性肌病的发生率可能更高。在该人群中，T2 加权和对比增强图像具有相似的表现，并且并存肾病使得使用钆基造影剂变得不合适。具有典型的临床表现和 MRI 表现，可以做出明确的诊断，并避免潜在的有害活检。糖尿病性肌病包括一系列疾病，包括肌肉炎症、缺血、出血、梗死、坏死、纤维化和脂肪萎缩。它通常见于长期、控制不佳的糖尿病。
