Vascular disease is the most frequent complication of diabetes, and also the most frequent non-traumatic cause of lower-limb amputation. In an effort to prevent these serious complications, recent years have seen an increased emphasis on routine screening of diabetic patients.
Screening of diabetics with color Doppler ultrasound (CDUS) is an effective method for identifying early-stage vascular lesions, even in asymptomatic patients, according to Italian researchers who presented a study at the March European Congress of Radiology. Greek researchers in another presentation described CDUS as "essential" in initial workups of diabetic patients.
Dr. Matteo Salcuni of the University d'Annunzio in Imbaro, Italy presented the results of a study in which 217 diabetic patients underwent vascular screening with CDUS of the carotid arteries, the abdominal aorta, and the lower limbs, in order to evaluate the presence of vascular lesions.
One hundred thirty-six of the patients were asymptomatic, but had signs of vascular disease such as laterocervical bruit or absence of a peripheral pulse, while 81 patients (37%) presented with symptoms of cerebrovascular insufficiency, and/or ischemic disease of the lower limbs, according to Salcuni.
All of the patients underwent CDUS and the results were confirmed with angiography in all patients with CDUS evidence of advanced stenosis, Salcuni said. In all, CDUS revealed 158 patients (72.8%) with steno-obstructive stenosis of 50% or greater, while 59 patients (27.2%) had no evidence of lesions. Fifteen patients underwent subsequent thromboendarterectomy of the carotid artery, eight had percutaneous transluminal angioplasty of the iliac and superficial femoral arteries, 12 had femoro-distal revascularization, and 10 received drug treatment.
"In our experience, noninvasive vascular screening with (CDUS) is a valid method for identifying vascular lesions in early stages of disease," Salcuni concluded. "Nearly 45% of patients with lesions were asymptomatic."
Another study, presented the same morning by Dr. P. Hadjilira from Athens, Greece, assessed the value of CDUS vascular screening for patients with diabetes mellitus type II who were visiting a diabetes clinic for the first time. The yearlong study screened 40 patients aged 40-70 with CDUS. The procedure revealed stenosis of 50% or greater in 12 patients, medium stenosis of the peripheral arteries in 14, and severe stenoses in 22. Because clinical findings had underestimated the severity of angiopathy in 8 patients, the authors concluded that CDUS is essential in the initial workup of diabetic patients.
By Eric Barnes
AuntMinnie.com staff writer
May 2000
Related Reading
"Impaired glucose tolerance, Type II diabetes mellitus and carotid atherosclerosis: prospective results from the Bruneck Study," Diabetologia 2000 Feb;43(2):156-64
"Atherosclerotic changes of extracoronary arteries are associated with the extent of coronary atherosclerosis," Am J Cardiol 2000 Apr 15;85(8):949-952
"Endothelial vasodilator function is related to low-density lipoprotein particle size and low-density lipoprotein vitamin E content in type 1 diabetes," J Am Coll Cardiol 2000 Feb;35(2):292-9
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![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&fit=crop&h=100&q=70&w=100)
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
