Purpose. To evaluate the effectiveness of multimodal ultrasound of insulin-induced lipohypertrophy in diabetic patients, including B-mode, compression sonoelastography and volumetric blood flow analysis using 3D power Doppler ultrasound.

Materials and methods. We examined 124 patients receiving insulin, including 47 participants with type 1 diabetes and 77 patients with type 2 diabetes. The sites of insulin injections were assessed by palpation and ultrasound. The assessment in B-mode was following by real-time compression sonoelastography with estimation of Strain Ratio coefficient and 3D Doppler ultrasound with the calculation of Vascularization Index (VI), Flow Index (FI) and Vascularization Flow index (VFI). The areas of unchanged adipose tissue surrounding the sites of lipohypertrophy were considered as reference areas.

Results. The areas of lipohypertrophy were detected in 84 and 107 patients by palpation and ultrasonography (67.7% and 86.3% respectively). In the mode of compression sonoelastography, there was an increase in rigidity of lipohypertrophy sites (median of Strain Ratio coefficient is 1.69). Significant decrease in VI, FI, and VFI values was revealed by 3D power Doppler ultrasound in the areas of lipohypertrophy (p=0.0002, p=0.001, p=0.0003 respectively).

The obtained results demonstrate the frequent formation of lipohypertrophy areas at the sites of insulin injections in patients with diabetes. The areas of lipohypertrophy differ from the surrounding adipose tissue by density and demonstrate greater rigidity and depleted vascularization.

Conclusion. Multiparameter ultrasound, including B-mode, compression sonoelastography and volumetric examination of blood flow by 3D power Doppler ultrasound, provides objective quantitative characterization of insulin-induced lipohypertrophy in patients with diabetes.