Department of Radiology, Division of Musculoskeletal Radiology, Henry Ford Hospital, Detroit, Michigan, USA.
Department of Radiology, Division of Musculoskeletal Radiology, University of Kentucky Healthcare, University of Kentucky College of Medicine, Lexington, Kentucky, USA.
J Ultrasound Med. 2020 Feb;39(2):323-329. doi: 10.1002/jum.15110. Epub 2019 Aug 18.
To evaluate whether the ultrasound appearance of the deltoid muscle in diabetic patients differs from that in obese nondiabetic patients.
Ultrasound images of the deltoid muscle from 137 type 2 diabetic patients (including 13 prediabetic patients) and 49 obese nondiabetic patients were blindly reviewed by 2 musculoskeletal radiologists, and by a third when arbitration was needed, to determine whether the appearance was "normal," "suspected diabetes," or "definite diabetes." Age, sex, race, body mass index (BMI), insulin use, and hemoglobin A were analyzed. This retrospective study included patients presenting between October 2005 and November 2017. Statistical analyses included a 2-sided sample t test or Wilcoxon rank sum test and a χ or Fisher exact test. Statistical significance was defined as P < .05.
The type 2 diabetic patients included 98 women and 39 men aged 29 to 92 years, and the nondiabetic patients included 19 women and 30 men aged 18 to 75 years. A consensus diagnosis of definite diabetes by the musculoskeletal radiologists based on a hyperechoic deltoid was a powerful predictor of diabetes, with a positive predictive value of 89%. A hyperechoic deltoid was also a powerful predictor of prediabetes. Of the 13 prediabetic patients, all had the same hyperechoic appearance of the diabetic deltoid, regardless of BMI. Although obese diabetic patients more often had a diagnosis of definite diabetes, the BMI alone could not explain the increased echogenicity, as obese nondiabetic patients' deltoid muscles did not appear as hyperechoic and were correctly categorized as not having definite diabetes with 82% specificity.
The characteristic hyperechoic deltoid appearance is a strong predictor of both diabetes and prediabetes and differs from that of obese nondiabetic patients.
评估糖尿病患者三角肌的超声表现是否与肥胖非糖尿病患者不同。
由 2 名肌肉骨骼放射科医生对 137 例 2 型糖尿病患者（包括 13 例糖尿病前期患者）和 49 例肥胖非糖尿病患者的三角肌超声图像进行盲法回顾，并在需要仲裁时由第 3 名医生进行评估，以确定外观是“正常”、“疑似糖尿病”还是“明确糖尿病”。分析年龄、性别、种族、体重指数（BMI）、胰岛素使用情况和血红蛋白 A。本回顾性研究纳入了 2005 年 10 月至 2017 年 11 月就诊的患者。统计分析包括双侧样本 t 检验或 Wilcoxon 秩和检验和 χ 或 Fisher 确切检验。统计显著性定义为 P <.05。
2 型糖尿病患者包括 98 名女性和 39 名男性，年龄 29 至 92 岁，非糖尿病患者包括 19 名女性和 30 名男性，年龄 18 至 75 岁。肌肉骨骼放射科医生根据三角肌高回声诊断为明确糖尿病的共识，是糖尿病的有力预测指标，阳性预测值为 89%。高回声三角肌也是糖尿病前期的有力预测指标。在 13 例糖尿病前期患者中，所有患者的三角肌均呈现相同的糖尿病高回声表现，无论 BMI 如何。虽然肥胖的糖尿病患者更常被诊断为明确的糖尿病，但 BMI 本身并不能解释回声增强，因为肥胖的非糖尿病患者的三角肌并不表现出高回声，并且以 82%的特异性正确归类为没有明确的糖尿病。
特征性的高回声三角肌外观是糖尿病和糖尿病前期的强烈预测指标，与肥胖非糖尿病患者不同。
