Assessment of lower limb muscle morphology and mechanical properties using ultrasound combined with shear wave elastography in patients with type 2 diabetes mellitus

doi:10.3877/cma.j.issn.1674-0785.2026.04.004

Abstract

Abstract:

Objective

To evaluate morphological and mechanical changes in lower limb skeletal muscles of patients with type 2 diabetes mellitus (T2DM) and diabetic peripheral neuropathy (DPN) using conventional ultrasonography combined with shear wave elastography (SWE), to analyze the associations between muscle ultrasound parameters and clinical indicators, and to explore potential imaging indicators for assessing DPN status.

Methods

A total of 115 patients with T2DM diagnosed at the Department of Endocrinology, Hefei Second People's Hospita and 55 healthy controls (group A) were prospectively enrolled in this study. Based on clinical symptoms and signs of DPN and nerve conduction study (NCS) results, patients with T2DM were divided into a non-DPN group (group B, n=62) and a DPN group (group C, n=53). General clinical data were collected for all participants. Ultrasonography was performed to measure the muscle thickness (MT) of the bilateral rectus femoris and gastrocnemius muscles, as well as the shear wave velocity (SWV) under resting and contraction conditions. The difference between contraction and resting SWV (ΔSWV) was calculated. Spearman correlation analysis was used to evaluate associations between ultrasound parameters and clinical indicators. Logistic regression analysis was performed to determine the independent association between ΔSWV and DPN status. The reliability of ultrasound measurements was assessed using the intraclass correlation coefficient (ICC).

Results

There were statistically significant differences in rectus femoris and gastrocnemius muscle thickness and elasticity parameters among the three groups. (P＜0.05). Resting SWV of both muscles gradually decreased from group A to group B and further to group C. During muscle contraction, contraction-related parameters of the rectus femoris showed significant reduction only in group C, whereas those of the gastrocnemius decreased in group B and were further reduced in group C. In patients with T2DM, MT, resting SWV, and ΔSWV of both muscles were negatively correlated with HbA1c levels and Toronto Clinical Scoring System (TCSS) scores (P＜0.05). Logistic regression analysis showed that ΔSWV of both the rectus femoris and gastrocnemius were independent protective factors for DPN (P＜0.05). Reproducibility analysis demonstrated good reliability, with ICC values for MT and SWV ranging from 0.824 to 0.905.

Conclusion

Patients with T2DM without DPN may already exhibit alterations in skeletal muscle mechanical properties, whereas both morphological and mechanical changes become more pronounced in those with DPN. The ΔSWV of the rectus femoris and gastrocnemius are independently associated with DPN status. Conventional ultrasonography combined with SWE may serve as a useful tool for evaluating diabetes-related skeletal muscle alterations.

Key words: Diabetic peripheral neuropathy, Shear wave elastography, Type 2 diabetes mellitus, Skeletal muscle

Haiyan Tang, Xingyu Li, Chao Peng, Yan Zhu, Yu Zhang, Yue Qin, Xinyu Tang, Xiao Yang. Assessment of lower limb muscle morphology and mechanical properties using ultrasound combined with shear wave elastography in patients with type 2 diabetes mellitus[J]. Chinese Journal of Clinicians(Electronic Edition), 2026, 20(04): 275-284.

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Figures/Tables 10

临床指标	A组	B组	C组	统计值	P值
年龄（岁， $x ¯$ ±s）	57.49±9.40	59.11±9.02	60.51±6.26	1.750	0.177
性别[例（%）]				0.153	0.926
男性	26（47.27）	30（48.39）	27（50.94）
女性	29（52.73）	32（51.61）	26（49.06）
BMI（kg/m²， $x ¯$ ±s）	24.32±2.73	25.07±2.98	25.58±3.52	0.902	0.408
HbA1c（%， $x ¯$ ±s）	-	7.79±1.76	9.00±2.11	-3.372	＜0.001
LDL-C（mmol/L， $x ¯$ ±s）	-	2.67±0.82	2.76±0.87	-0.551	0.583
HDL-C（mmol/L， $x ¯$ ±s）	-	1.23±0.35	1.18±0.24	0.898	0.371
TG（mmol/L， $x ¯$ ±s）	-	1.72±0.77	1.84±0.91	-0.752	0.454
ABI（ $x ¯$ ±s）	-	1.16±0.12	1.13±0.14	1.216	0.227
病程（年）	-	8.0（3.75，14.25）	11.00（6.50，17.00）	-2.375	0.018
TCSS（分）	-	3.00（2.00，5.00）	9.00（7.00，11.50）	-8.701	＜0.001

临床指标	A组	B组	C组	统计值	P值
年龄（岁， $x ¯$ ±s）	57.49±9.40	59.11±9.02	60.51±6.26	1.750	0.177
性别[例（%）]				0.153	0.926
男性	26（47.27）	30（48.39）	27（50.94）
女性	29（52.73）	32（51.61）	26（49.06）
BMI（kg/m²， $x ¯$ ±s）	24.32±2.73	25.07±2.98	25.58±3.52	0.902	0.408
HbA1c（%， $x ¯$ ±s）	-	7.79±1.76	9.00±2.11	-3.372	＜0.001
LDL-C（mmol/L， $x ¯$ ±s）	-	2.67±0.82	2.76±0.87	-0.551	0.583
HDL-C（mmol/L， $x ¯$ ±s）	-	1.23±0.35	1.18±0.24	0.898	0.371
TG（mmol/L， $x ¯$ ±s）	-	1.72±0.77	1.84±0.91	-0.752	0.454
ABI（ $x ¯$ ±s）	-	1.16±0.12	1.13±0.14	1.216	0.227
病程（年）	-	8.0（3.75，14.25）	11.00（6.50，17.00）	-2.375	0.018
TCSS（分）	-	3.00（2.00，5.00）	9.00（7.00，11.50）	-8.701	＜0.001

指标	A组	B组	C组	F/H值	P值
股直肌
MT（cm）	1.36（1.24，1.54）	1.39（1.21，1.62）	1.22（1.10，1.47）^ab	9.205	0.010
静息态SWV（m/s， $x ¯$ ±s）	2.15±0.28	2.02±0.26^a	1.87±0.29^ab	13.924	＜0.001
收缩态SWV（m/s）	5.49（4.66，5.87）	5.22（4.49，5.75）	4.38（3.56，5.43）^ab	22.422	＜0.001
ΔSWV（m/s）	3.24（2.58，3.74）	3.07（2.49，3.80）	2.52（1.58，3.45）^ab	14.468	＜0.001
腓肠肌
MT（cm， $x ¯$ ±s）	1.86±0.30	1.75±0.23	1.55±0.27^ab	18.563	＜0.001
静息态SWV（m/s）	2.14（1.85，2.28）	1.92（1.69，2.15）^a	1.77（1.62，1.97）^ab	22.580	＜0.001
收缩态SWV（m/s）	6.79（5.95，7.24）	6.08（5.00，6.82）^a	4.56（3.74，6.14）^ab	44.411	＜0.001
ΔSWV（m/s）	4.49（3.87，5.35）	4.27（3.28，4.73）^a	2.74（2.03，4.08）^ab	36.060	＜0.001

指标	A组	B组	C组	F/H值	P值
股直肌
MT（cm）	1.36（1.24，1.54）	1.39（1.21，1.62）	1.22（1.10，1.47）^ab	9.205	0.010
静息态SWV（m/s， $x ¯$ ±s）	2.15±0.28	2.02±0.26^a	1.87±0.29^ab	13.924	＜0.001
收缩态SWV（m/s）	5.49（4.66，5.87）	5.22（4.49，5.75）	4.38（3.56，5.43）^ab	22.422	＜0.001
ΔSWV（m/s）	3.24（2.58，3.74）	3.07（2.49，3.80）	2.52（1.58，3.45）^ab	14.468	＜0.001
腓肠肌
MT（cm， $x ¯$ ±s）	1.86±0.30	1.75±0.23	1.55±0.27^ab	18.563	＜0.001
静息态SWV（m/s）	2.14（1.85，2.28）	1.92（1.69，2.15）^a	1.77（1.62，1.97）^ab	22.580	＜0.001
收缩态SWV（m/s）	6.79（5.95，7.24）	6.08（5.00，6.82）^a	4.56（3.74，6.14）^ab	44.411	＜0.001
ΔSWV（m/s）	4.49（3.87，5.35）	4.27（3.28，4.73）^a	2.74（2.03，4.08）^ab	36.060	＜0.001

临床指标	MT（cm）		静息态SWV（m/s）		ΔSWV（m/s）
临床指标	r值	P值	r值	P值	r值	P值
年龄（岁）	-0.041	0.666	-0.116	0.219	-0.223	0.017
BMI（kg/m²）	0.209	0.025	0.089	0.343	0.111	0.239
病程（年）	-0.176	0.060	-0.163	0.082	-0.262	0.005
HbA1c（%）	-0.255	0.006	-0.269	0.004	-0.337	＜0.001
LDL-C（mmol/L）	-0.016	0.863	0.013	0.887	-0.077	0.414
HDL-C（mmol/L）	-0.082	0.383	-0.058	0.540	0.073	0.438
TG（mmol/L）	0.084	0.369	0.101	0.282	-0.093	0.321
TCSS（分）	-0.339	＜0.001	-0.350	＜0.001	-0.477	＜0.001

临床指标	MT（cm）		静息态SWV（m/s）		ΔSWV（m/s）
临床指标	r值	P值	r值	P值	r值	P值
年龄（岁）	-0.160	0.087	-0.139	0.140	-0.218	0.019
BMI（kg/m²）	0.172	0.066	0.167	0.075	0.097	0.303
病程（年）	-0.189	0.043	-0.191	0.041	-0.255	0.006
HbA1c（%）	-0.324	＜0.001	-0.254	0.006	-0.355	＜0.001
LDL-C（mmol/L）	-0.072	0.446	-0.038	0.686	-0.073	0.437
HDL-C（mmol/L）	-0.058	0.535	-0.007	0.942	0.034	0.720
TG（mmol/L）	0.048	0.607	0.033	0.723	-0.098	0.295
TCSS（分）	-0.359	＜0.001	-0.382	＜0.001	-0.525	＜0.001

项目	模型1		模型2		模型3
项目	OR（95%CI）	P值	OR（95%CI）	P值	OR（95%CI）	P值
股直肌ΔSWV（m/s）	0.501（0.326~0.769）	0.002	0.460（0.288~0.733）	0.001	0.546（0.331~0.900）	0.018
腓肠肌ΔSWV（m/s）	0.503（0.358~0.708）	＜0.001	0.471（0.326~0.682）	＜0.001	0.544（0.369~0.801）	0.002

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