Yan Fuqiang, Cai Mingli, Li Meirong, Huang Shanshan, Guo Jingyi, Lin Jinmiao, Lyu Guorong
Department of Ultrasound Medicine, Jinjiang Municipal Hospital (Shanghai Sixth People's Hospital), Quanzhou, China.
Department of Endocrinology, Jinjiang Municipal Hospital (Shanghai Sixth People's Hospital), Quanzhou, China.
Front Endocrinol (Lausanne). 2025 Jul 23;16:1639270. doi: 10.3389/fendo.2025.1639270. eCollection 2025.
Diabetic foot complications, driven by microvascular dysfunction, remain a leading cause of morbidity and amputations. Early detection of microcirculatory and biomechanical alterations in vulnerable muscles, such as the extensor hallucis brevis (EHB), may contribute to risk stratification. However, noninvasive tools for quantifying these changes are lacking.
This cross-sectional study enrolled 90 participants stratified into healthy controls, uncomplicated type 2 diabetes (T2DM), and T2DM with microvascular complications (MC). Shear wave elastography (SWE) measured EHB stiffness (mean Young's modulus, Emean), while contrast-enhanced ultrasound (CEUS) assessed perfusion dynamics (transcapillary transit time [ΔAT], net enhancement intensity [ΔPI]). Diagnostic accuracy and reproducibility were evaluated via ROC analysis and intra-class correlation coefficients (ICC).
Emean increased progressively across groups (control: 11.88 kPa; T2DM: 15.78 kPa; T2DM+MC: 18.57 kPa; P < 0.01). T2DM+MC exhibited prolonged ΔAT (89.5 s vs. 50.5 s in controls) and reduced ΔPI (5.0 dB vs. 7.0 dB; P < 0.01). ROC analysis demonstrated high diagnostic accuracy for ΔAT (AUC = 0.970), Emean (AUC = 0.947), and ΔPI (AUC = 0.931) in detecting MC. Both SWE and CEUS showed excellent reproducibility (ICC > 0.80).
SWE and CEUS provide robust, noninvasive biomarkers for early diabetic microvascular complications. The EHB's unique susceptibility to stiffness and perfusion deficits highlights its clinical value, which may facilitate diabetic foot risk assessment and guide timely interventions to mitigate ulceration and amputations.
由微血管功能障碍引发的糖尿病足并发症仍然是发病和截肢的主要原因。早期检测诸如拇短伸肌（EHB）等易损肌肉中的微循环和生物力学改变，可能有助于风险分层。然而，目前缺乏用于量化这些变化的非侵入性工具。
这项横断面研究招募了90名参与者，分为健康对照组、无并发症的2型糖尿病（T2DM）组和伴有微血管并发症（MC）的T2DM组。剪切波弹性成像（SWE）测量EHB的硬度（平均杨氏模量，Emean），而对比增强超声（CEUS）评估灌注动力学（跨毛细血管通过时间[ΔAT]、净增强强度[ΔPI]）。通过ROC分析和组内相关系数（ICC）评估诊断准确性和可重复性。
Emean在各组中逐渐升高（对照组：11.88 kPa；T2DM组：15.78 kPa；T2DM + MC组：18.57 kPa；P < 0.01）。T2DM + MC组表现出ΔAT延长（89.5秒，而对照组为50.5秒）和ΔPI降低（5.0 dB对7.0 dB；P < 0.01）。ROC分析表明，ΔAT（AUC = 0.970）、Emean（AUC = 0.947）和ΔPI（AUC = 0.931）在检测MC方面具有较高的诊断准确性。SWE和CEUS均显示出出色的可重复性（ICC > 0.80）。
SWE和CEUS为早期糖尿病微血管并发症提供了可靠的非侵入性生物标志物。EHB对硬度和灌注不足的独特易感性突出了其临床价值，这可能有助于糖尿病足风险评估并指导及时干预以减轻溃疡和截肢。
