| Objective To evaluate the clinical value of MRI combined with high-frequency ultrasound in evaluating rotator cuff structural changes in patients with type 2 diabetes mellitus(T2 DM).Methods 100 patients of T2 DM were enrolled and divided into two groups: 50 patients in group A(the course > 10 years),50 patients in group B(the course?10 years);Group C included 50 healthy volunteers.Age 45-65 years old,right-handed,no history of shoulder joint trauma or surgery,no special motor function exercise,no rheumatic diseases,no other endocrine diseases,no malignant tumors,no immune diseases and no systemic diseases.There were 77 males and 73 females.MRI scanning of the right shoulder joint was performed in 150 patients.The axial,oblique coronal,oblique sagittal MR images of fs-FSE T2 WI and oblique coronal SE T1 WI were obtained.The signal changes of tendon,the degree of tear and tear were observed.The effusion of joint cavity and bursa were recorded.The edema and thickening of bursa were observed.The bone changes of tendon attachment were evaluated.High frequency ultrasound was used to measure the thickness of tendon and to determine whether there was calcification in tendon.The age of patients and the comparison of tendon thickness among the three groups were analyzed by non parametric test(Kruskal-Wallis test)and multiple comparison(Tamhane test).The difference was statistically significant(P< 0.05).Single factor analysis of variance was used to compare the MRI grade of tendon,calcification of tendon,bone changes of tendon attachment point and changes of structure around rotator cuff with the course of diabetes.LSD-t test was used to compare the two groups,the difference was statistically significant(P< 0.05).Results The MRI findings of rotator cuff injury were divided into four grades: normal at grade 0,tendinitis at grade 1,partial tear at grade 2 and complete tear at grade 3.There was no complete tear in the three groups.Supraspinatus tendon: in group A,there were 13 cases of grade 2(26%),27 cases of grade 1(54%);in group B,there were 9 cases of grade 2(16),15 cases of grade 1(30%);in group C,there were 8 cases of grade 1(16%).Subscapular tendon: in group A,there were 2 cases of grade 2(4%),15 cases of grade 1(30%);in group B,there were 1 case of grade 2(2%),13 cases of grade 1(26%);in group C,there were 2 cases of grade 1(4%).Infraspinatus tendon: 1 case in group A(2%),8cases in group A(16%);7 cases in group B(14%);1 case in group C(2%).Small round tendon: 8 cases(16%)in group A,3 cases(6%)in group B,16 cases(32%)in group A,13 cases(26%)in group B and 3 cases(6%)in group C.The abnormal rate of supraspinatus tendon,subscapular tendon,infraspinatus tendon,small round tendon and long head tendon of biceps brachii in group A was significantly higher than that in groupC(P< 0.05).The abnormal rate of supraspinatus tendon in group A was significantly higher than that in group B(P< 0.05).High frequency ultrasound was used to measure the thickness of tendons.Compared with group C,the thickness of tendons in group A and B increased significantly(P< 0.05),and the thickness of supraspinatus tendons in group a increased significantly(P< 0.05).The calcification rate of supraspinatus tendon,subscapular tendon,infraspinatus tendon and long head tendon of biceps brachii in group A and B was significantly higher than that in group C(P< 0.05).On MRI,the change of bone cortex of tendon attachment point was thickened and unsmooth.Compared with group A and group B,the change of bone cortex of supraspinatus tendon attachment point in group C increased significantly(P< 0.05).Compared with group C,the proportion of joint cavity and bursa effusion in group A and B increased significantly(P< 0.05).Compared with group C,the proportion of thickened and edematous joint capsule in group A and group B increased significantly(P< 0.05).Conclusion The proportion of abnormal MRI signals in rotator cuff tendons increased significantly with the increase of the course of diabetes,especially in supraspinatus tendon and subscapularis tendon.The thickness of the rotator cuff tendon was clearly displayed by two-dimensional high-frequency ultrasound.With the increase of the course of diabetes,the thickness of the tendon and the incidence of calcification in the tendon increased significantly.On MRI,the bone cortex of tendon attachment point was thickened and unsmooth.With the increase of the course of diabetes,the proportion of bone changes of supraspinatus tendon attachment point increased.In diabetic patients,the proportion of changes in the structure around the rotator cuff,such as joint cavity effusion,synovial effusion,joint capsule edema and joint capsule thickening,increased significantly. |
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