title: Contrast-enhanced ultrasonography of skeletal muscles for type 2 diabetes mellitus patients with microvascular complications.
abstract: OBJECTIVE
  To explore the applicability of contrast-enhanced ultrasound (CEUS) as a new method to detect impaired microcirculation in type 2 diabetes mellitus patients with microvascular complications (DM+MC).
  
  
  METHODS
  Ultrasound contrast agent was injected into peripheral vein of 28 patients with DM+MC, 30 uncomplicated type 2 diabetes mellitus (DM) patients, and 30 control subjects. Its appearance in the calf muscle was detected by contrast-enhanced ultrasound. Time-intensity curves were established based on mathematical modeling, particularly in small artery, muscular tissue and small vein. Times to peak intensity (TTPs), arrival times (ATs) and contrast transit times (CTTs) were analyzed. CTTs were calculated as the differences between arrival times. With patients under fasting conditions, plasma glucose and rheologic parameters of erythrocyte deformability and plasma viscosity were measured.
  
  
  RESULTS
  DM and DM+MC groups tended to have longer TTPs than the control group, but without significant differences between DM group and DM+MC group. The median artery-vein and muscle-vein CTTs were statistically significantly highest in the DM+MC group (P < 0.05). Blood viscosity in the DM+MC group was higher than two other groups (P < 0.05). Blood viscosity correlated positively with both blood glucose and C-reactive peptide (P < 0.01).
  
  
  CONCLUSIONS
  CEUS is potentially reliable to detect changes in the microvascular bed. Abnormalities in capillary recruitment may be related to abnormal hemorheology.
authors.affiliation: Department of Ultrasound Diagnosis, Tongji Hospital, Tongji University School of Medicine Shanghai 200065, China.
authors.forename: Ye
authors.initials: Y
authors.lastname: Song
authors.affiliation: Department of Ultrasound Diagnosis, Tongji Hospital, Tongji University School of Medicine Shanghai 200065, China.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Radiology, Tongji Hospital, Tongji University School of Medicine Shanghai 200065, China.
authors.forename: Pei-Jun
authors.initials: PJ
authors.lastname: Wang
authors.affiliation: Department of General Surgery, Tongji Hospital, Tongji University School of Medicine Shanghai 200065, China.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Gao
keywords: Contrast-enhanced ultrasound; microcirculation; microvascular complications; type 2 diabetes mellitus
references.citation: J Am Coll Cardiol. 2009 Jun 9;53(23):2175-83
references.pmid: 19497445
references.citation: Microcirculation. 2007 Jun-Jul;14(4-5):311-6
references.pmid: 17613804
references.citation: Eur J Radiol. 2011 Jun;78(3):419-24
references.pmid: 20005060
references.citation: Vasc Health Risk Manag. 2008;4(5):1061-8
references.pmid: 19183753
references.citation: Atherosclerosis. 2009 Feb;202(2):505-12
references.pmid: 18606414
references.citation: Microcirculation. 2005 Sep;12(6):527-37
references.pmid: 16147469
references.citation: Diabetes Res Clin Pract. 2007 Apr;76(1):82-92
references.pmid: 16950543
references.citation: Invest Radiol. 2011 Aug;46(8):504-8
references.pmid: 21487300
references.citation: Dan Med Bull. 1999 Feb;46(1):13-34
references.pmid: 10081651
references.citation: Nurs Times. 2004 Jun 1-7;100(22):52-3
references.pmid: 15195547
references.citation: Rheumatology (Oxford). 2000 Nov;39(11):1206-13
references.pmid: 11085798
references.citation: Eur Heart J. 2006 Feb;27(3):310-5
references.pmid: 16308326
references.citation: Am J Physiol Endocrinol Metab. 2007 Dec;293(6):E1804-9
references.pmid: 17911341
references.citation: Diabetes Res Clin Pract. 2008 Jul;81(1):88-92
references.pmid: 18417241
references.citation: Circ Res. 2005 Nov 25;97(11):1124-31
references.pmid: 16269657