| ObjectiveTo investigate quantitatively common metabolites contents in lower limb skeletal muscle of patients with typeⅡdiabetes with diabetic peripheral neuropathy (DPN), typeⅡdiabetes without diabetic peripheral neuropathy (DPN) and healthy people from the level of molecular imaging using proton magnetic resonance spectroscopy techniques (1H-MRS). At the same time, discuss some changes of common metabolite contents in skeletal muscles among three groups, and to evaluate the value of magnetic resonance proton spectroscopy (1H-MRS) in diabetic peripheral neuropathy (DPN) diagnosis. Materials and Methods1. The choice of subjectsCooperation with the Department of Endocrinology, Shandong Provincial Hospital, 48 patients with typeⅡdiabetes diagnosed by the complete data (24 males, 24 females, mean age 54.5±10.5 years, range 40-84years old, course 7d-25 years) were selected in the study from March 2010 to October 2010. All patients were checked EMG examination in the calf, and were grouped into a peripheral neuropathy group (A group) 23 patients (10 males and 13 females, mean age 56.7±8.7 years, range 46-84 years) and without peripheral neuropathy group (B group), 25 cases (14 males and 11 female, mean age 54.7±9.3 years, range 40-70 years) according to EMG showed nerve damage as a diabetic peripheral neuropathy (DPN) in the diagnostic criteria.At the same time, 24 healthy adults (11 males, 13 females, mean age 52.2±13.1 years, range 20-25 years old) without T2DM were randomly selected as a control group from people who are health check. All subjects were excluded peripheral nerve lesions due to other causes. Age (F=1.092, P=0.341), gender (F=0.361, P=.550) among the three groups were not significantly different. 1.5T superconducting magnetic resonance scanner (Germany Siemens Magnetom Sonota Maestro Class) and standard knee coil was used. Scanning Sequences include the conventional sequence and MRS sequences.All subjects carried out axial and coronary T1-weighted imaging(TR 450ms, TE 13ms), coronary T2-weighted imaging(TR 3540ms, TE 85ms) and sagittal Proton density-weighted image (TR 3000ms, TE 14ms). FOV is 240mm×240mm, thickness is 10mm, with 5mm spacing.When the conventional serial scan is complete, transverse, sagittal and coronal T1-weighted image was used for positioning magnetic resonance spectroscopy. Specific parameters are as follows: single-voxel (SVS), stimulated-echo acquisition mode (STEAM),FOV 180mm,TR 1500 ms,TE 30ms,acquisition 128 times, scan time 180s, bandwidth of 1000Hz, voxel 20mm×20mm×20mm. ROI (ROI) placed on the soleus muscle in the calf, avoiding the adjacent blood vessels, fascia and the surrounding fat in order to remove their impact on data collection to ensure that collected data is more accurate. Before MRS scanning, water suppression were automatically performed by chemical shift saturation method (chemical shift selective saturation, CHESS), and the frequency of the water suppression is 35Hz.After scanning, the original spectral data was transferred to the spectrum tab of workstations, which were processed by the interactive processing software automatically. Finally, MRS curves containing all the substances to be analyzed and the peak integral areas under these materials were obtained, the most of them including creatine (Cr), choline (Cho), extra-myocellular liplids (EMCL), intra-myocellular liplids (IMCL) and relative content of Cho/Cr, EMCL/Cr, IMCL/Cr. Subsequently, if dissatisfactory, manual adjustment could be made on the MRS curves, in order to obtain more precise values of material content.3. Statistical AnalysisSPSS 17.0 statistical analysis software package was used. All measurement data are indicated with?χ±s. Single-sample Kolmogorov-Smirnov test and Levene test were used to test data normality and homogeneity of variance. One-way analysis of variance (ANOVA) was used to analyze the content and relative content differences of a material among there groups. To make the P<0.05 as a difference and P <0.01 as the significant difference.ResultsComparison results of areas under the peak Cho, Cr, EMCL, IMCL and the ratio of Cho/Cr, EMC /Cr, IMCL/Cr among there groups are as follows:2. Equiment and Methods 1. Between diabetic peripheral neuropathy group (A group) and diabetic patients without peripheral neuropathy group (B group): Content differences of Cr, Cho, EMCL, IMCL and Cho/Cr was not statistically significant (P> 0.05); Content differences of EMCL/Cr and IMCL/Cr was statistically significant (P<0.05);2. Between diabetic peripheral neuropathy group (A group) and control group (C group): Content differences of Cr, Cho, EMCL and EMCL/Cr was not statistically significant (P> 0.05); Content differences of IMCL, Cho/Cr and IMCL/Cr was statistically significant (P<0.05);3. Between diabetic patients without peripheral neuropathy group (B group) and control group (C group): Content differences of Cr, Cho, EMCL and Cho/Cr was not statistically significant (P> 0.05); Content differences of IMCL, EMCL/Cr and IMCL/Cr was statistically significant (P<0.05). ConclusionCompared with healthy people, IMCL, IMCL/Cr in soleus muscle increase in T2DM patients. IMCL, EMCL/Cr, IMCL/Cr increase in T2DM patients without peripheral neuro- pathy; IMCL, Cho/Cr, IMCL/Cr increase in T2DM patients with peripheral neuropat- hy. Therefore, 1H-MRS has some reference value in the diagnosis of peripheral neuropathy in T2DM patients by testing contents and relative contents of some common metabolites and by analyzing certain metabolic changes of the calf muscle tissue. |
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