Division of Musculoskeletal Radiology, Department of Radiology, Henry Ford Hospital/Wayne State University, 2799 West Grand Blvd, Detroit, MI, 48202, USA.
Department of Public Health Sciences, Henry Ford Health System, 1 Ford Place, Detroit, MI, 48202, USA.
BMC Endocr Disord. 2022 Jul 27;22(1):193. doi: 10.1186/s12902-022-01107-2.
In our previous published study, we demonstrated that a qualitatively assessed elevation in deltoid muscle echogenicity on ultrasound was both sensitive for and a strong predictor of a type 2 diabetes (T2DM) diagnosis. This study aims to evaluate if a sonographic quantitative assessment of the deltoid muscle can be used to detect T2DM.
Deltoid muscle ultrasound images from 124 patients were stored: 31 obese T2DM, 31 non-obese T2DM, 31 obese non-T2DM and 31 non-obese non-T2DM. Images were independently reviewed by 3 musculoskeletal radiologists, blinded to the patient's category. Each measured the grayscale pixel intensity of the deltoid muscle and humeral cortex to calculate a muscle/bone ratio for each patient. Following a 3-week delay, the 3 radiologists independently repeated measurements on a randomly selected 40 subjects. Ratios, age, gender, race, body mass index, insulin usage and hemoglobin A were analyzed. The difference among the 4 groups was compared using analysis of variance or chi-square tests. Both univariate and multivariate linear mixed models were performed. Multivariate mixed-effects regression models were used, adjusting for demographic and clinical variables. Post hoc comparisons were done with Bonferroni adjustments to identify any differences between groups. The sample size achieved 90% power. Sensitivity and specificity were calculated based on set threshold ratios. Both intra- and inter-radiologist variability or agreement were assessed.
A statistically significant difference in muscle/bone ratios between the groups was identified with the average ratios as follows: obese T2DM, 0.54 (P < 0.001); non-obese T2DM, 0.48 (P < 0.001); obese non-T2DM, 0.42 (P = 0.03); and non-obese non-T2DM, 0.35. There was excellent inter-observer agreement (intraclass correlation coefficient 0.87) and excellent intra-observer agreements (intraclass correlation coefficient 0.92, 0.95 and 0.94). Using threshold ratios, the sensitivity for detecting T2DM was 80% (95% CI 67% to 88%) with a specificity of 63% (95% CI 50% to 75%).
The sonographic quantitative assessment of the deltoid muscle by ultrasound is sensitive and accurate for the detection of T2DM. Following further studies, this process could translate into a dedicated, simple and noninvasive screening method to detect T2DM with the prospects of identifying even a fraction of the undiagnosed persons worldwide. This could prove especially beneficial in screening of underserved and underrepresented communities.
在我们之前发表的研究中，我们证明了超声检查中三角肌回声强度的定性升高既是 2 型糖尿病（T2DM）诊断的敏感指标，也是其强有力的预测指标。本研究旨在评估超声对三角肌的定量评估是否可用于检测 T2DM。
共储存了 124 例患者的三角肌超声图像：31 例肥胖的 T2DM 患者、31 例非肥胖的 T2DM 患者、31 例肥胖的非 T2DM 患者和 31 例非肥胖的非 T2DM 患者。3 名肌肉骨骼放射科医生对图像进行了独立评估，对患者的类别不知情。每位医生均测量了三角肌和肱骨皮质的灰度像素强度，以计算每位患者的肌肉/骨比值。在 3 周的延迟后，3 名放射科医生独立地对随机选择的 40 名患者重复了测量。分析了比值、年龄、性别、种族、体重指数、胰岛素使用情况和血红蛋白 A。使用方差分析或卡方检验比较 4 组之间的差异。使用单变量和多变量线性混合模型进行分析。使用多变量混合效应回归模型，调整了人口统计学和临床变量。采用 Bonferroni 调整进行事后比较，以确定组间的任何差异。该样本量达到了 90%的功效。根据设定的阈值比值计算了敏感性和特异性。评估了内部和内部放射科医生的变异性或一致性。
组间肌肉/骨比值存在统计学显著差异，平均比值如下：肥胖的 T2DM 为 0.54（P<0.001）；非肥胖的 T2DM 为 0.48（P<0.001）；肥胖的非 T2DM 为 0.42（P=0.03）；非肥胖的非 T2DM 为 0.35。观察者间的一致性极好（组内相关系数 0.87），观察者内的一致性极好（组内相关系数 0.92、0.95 和 0.94）。使用阈值比值，检测 T2DM 的敏感性为 80%（95%CI 67%至 88%），特异性为 63%（95%CI 50%至 75%）。
超声对三角肌的定量评估对 T2DM 的检测具有敏感性和准确性。经过进一步研究，这一过程可能会转化为一种专门的、简单的、非侵入性的筛查方法，用于检测 T2DM，甚至可能发现全球未确诊人群中的一部分。这对于筛查服务不足和代表性不足的人群可能特别有益。
