Tomohiro Sato1, Katsuyoshi Ito1, Tsutomu Tamada 1, Akira Yamamoto1, and Akihiko Kanki1
1Radiology, Kawasaki Medical School, Kurashiki city, Japan
Synopsis
The liver plays a pivotal role in glucose
metabolism, so 60-80% of patients with cirrhosis experience impaired glucose
tolerance and hyperinsulinemia, and 10-50% develop diabetes. This study was
intended to clarify the extent to which pancreatic MRI findings are affected by
the presence of diabetes mellitus in patients with liver cirrhosis. On 3-T MRI,
size of the pancreas was significantly increased, the grade of pancreatic
lobulation was significantly reduced, and pancreatic SIRs on T2WI with fat suppression
were significantly increased in cirrhotic patients complicated with diabetes as
compared to cirrhotic patients without diabetes.
Purpose
Liver cirrhosis represents the terminal phase of chronic liver disease, histologically characterized by the destruction of normal liver structure
by fibrosis and the presence of regenerative nodules. The
clinical condition of the liver is
colorful, because the liver has various functions. The liver
plays a pivotal role in glucose metabolism, so 60-80% of patients with cirrhosis experience
impaired glucose tolerance and hyperinsulinemia,
and 10-50% develop diabetes 1-9. Magnetic resonance
imaging (MRI) non-invasively provides a wide variety of information, such as
focal form, tissue perfusion, diffusion of water molecules, and metabolic characteristics.
MRI plays a central role in the diagnosis of pancreatic cancer and other pancreatic
diseases. Changes
in MR imaging
findings may reflect damage to the pancreatic parenchyma due
to glucose
intolerance and diabetes in patients
with liver cirrhosis. Improved understanding of such changes is expected to contribute to better diagnostic accuracy for acute pancreatitis,
chronic pancreatitis, and early small pancreatic cancer (≤2 cm) and thus to improved prognosis. In addition, the pathologies associated with changes in the various MR imaging findings for pancreatic parenchyma encountered frequently in
daily clinical practice will be clarified. However,
no reports have evaluated characteristic imaging findings on pancreatic MRI
findings in liver cirrhosis patients with complications of impaired glucose
tolerance and diabetes. The
purpose of this study was to
investigate pancreatic changes on MRI in patients with cirrhosis and diabetes, using findings
from gadolinium ethoxybenzyl diethylenetriamine pentaacetic
acid (Gd-EOB-DTPA) MRI and blood testing. This
study was intended to clarify the extent to which pancreatic MRI findings are affected
by the presence of diabetes mellitus in patients with liver cirrhosis.Methods and Materials
This retrospective study
was approved by the institutional review board, and the requirement for
informed consent was waived. Subjects
were 61 patients with cirrhosis who underwent abdominal dynamic contrast 3-T MRI using Gd-EOB-DTPA between March 2012 and March 2015 and showed clear depiction of the
pancreas. We excluded those cases with a history or signs of
pancreatic disease. Of the 61 cirrhotic patients,
21 were complicated
with type 2 diabetes
(alcoholic cirrhosis, n=6; hepatitis
B virus (HBV)-induced cirrhosis, n=3; hepatitis C virus (HCV)-induced
cirrhosis, n=9; other causes, n=3),
and 40 showed no diabetes (alcoholic cirrhosis, n=12; HBV-induced cirrhosis, n=6; HCV-induced cirrhosis, n=14; alcoholic with HCV-induced
cirrhosis, n=2; other causes,
n=6). All images were reviewed
to investigate pancreatic changes in patients with cirrhosis
and diabetes
as compared to cirrhotic patients without diabetes. The MR parameters examined
were: pancreatic anteroposterior (AP) diameter (head, body, tail); grade of
pancreatic lobulation; pancreatic signal intensity ratio (SIR); apparent
diffusion coefficient
(ADC) values;
depiction of the main pancreatic duct (MPD); grade of pancreatic parenchymal
fatty change; and enhancement effect of the pancreas in the arterial and late
phases of contrast-enhanced dynamic imaging.Results
Pancreatic AP
diameters in the diabetes +
cirrhosis group were: pancreas head, 26.61 ±
5.96 mm; pancreas body, 16.95 ± 4.12 mm; pancreas tail, 18.59 ± 4.03 mm; and
overall average, 20.72 ± 4.07 mm. On the other hand, pancreatic AP diameters in
the diabetes alone group were: pancreas head, 23.84 ± 3.42 mm; pancreas body,
14.61 ± 4.35 mm; pancreas tail, 17.58 ± 4.07 mm; and overall average, 18.68 ±
3.13 mm. AP diameter of the pancreatic head, pancreatic body, and
overall average were significantly increased in the presence of diabetes (head,
p = 0.024; body, p = 0.04; average, p = 0.026).
Average
grade of pancreatic lobulation in the
diabetes + cirrhosis group (1.00
± 0.71) was significantly reduced compared to without cirrhosis (1.48 ± 0.88; p = 0.035). A significant
difference was observed in pancreatic SIR on T2-weighted imaging (T2WI) with
fat suppression. Pancreatic SIRs on T2WI with
fat suppression in the diabetes + cirrhosis group were: pancreas head, 0.1324 ± 0.0354; pancreas body,
0.1339 ± 0.0318; pancreas tail, 0.1465 ± 0.0234; and overall average, 0.1376 ±
0.0274. On the other hand, pancreatic SIRs on T2WI with
fat suppression in the diabetes without cirrhosis group were: pancreas head,
0.1373 ± 0.0418; pancreas body, 0.1179 ± 0.0268; pancreas tail, 0.1343 ± 0.0254;
and overall average, 0.1298 ± 0.0275. SIRs of the
T2WI with fat suppression
of the pancreatic body and tail were significantly increased in the presence of
diabetes (body, p = 0.047; tail, p = 0.038).Conclusion
On 3-T MRI, size of the
pancreas was significantly increased, the grade of pancreatic lobulation was
significantly reduced, and pancreatic SIRs on T2WI with fat suppression were
significantly increased in cirrhotic patients complicated with diabetes as compared
to cirrhotic patients without diabetes.Acknowledgements
No acknowledgement found.References
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