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Tastemur M, Ozdemir C, Olcucuoğlu E, Besler MS, Tekdemir H, Arik G, Silay K. An Investigation of the Relationship Between Pancreas Volume, Nutritional Status, and HbA1c in Geriatric Patients. MEDICINA (KAUNAS, LITHUANIA) 2025; 61:711. [PMID: 40283002 PMCID: PMC12028710 DOI: 10.3390/medicina61040711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2025] [Revised: 04/02/2025] [Accepted: 04/10/2025] [Indexed: 04/29/2025]
Abstract
Background and Objectives: With physiological aging, the pancreas is expected to decrease in size as in every organ. The objective of this study was to examine the correlation between pancreas volume (PV), nutritional status, and glycolyzed hemoglobin A1c (HbA1c) in elderly patients with and without type 2 diabetes mellitus (DM). Materials and Methods: Between July 2020 and April 2022, 109 patients aged ≥ 65 years who applied to geriatrics clinics and outpatient clinics were included in the study. PV was measured from available abdominal contrast-enhanced computed tomography (CT) scans. Patients were divided into two groups according to the presence of DM. The relationship between PV; biochemical parameters, especially HbA1c; and Mini Nutritional Assessment Short Form (MNAsf) score was analyzed between groups. p < 0.05 was considered statistically significant. Results: The mean age of all participants was M: 77.40, with SD: 7.32. A total of 54.1% of the participants were female, and 55 had DM. There were no significant differences in age and gender between those with and without DM. Glucose (p < 0.001), HbA1C (p < 0.001), and triglycerides (p < 0.001) were significantly higher, and HDL (p < 0.001) was significantly lower in patients with DM. PV was also significantly lower in those with DM (p = 0.028). A correlation analysis revealed significant positive correlations between PV, the MNAsf score (rho (109)) = 0.413, p = 0.003), and lipase (rho (109)) = 0.297, p = 0.002). Conclusions: PV, which is expected to decrease with age, was found to be lower in patients with DM in our study in which we evaluated elderly patients with and without DM. We also found that PV was associated with malnutrition. Our study highlights the importance of determining the clinical effects of pancreatic volume in the geriatric population where organ atrophy is expected. Therefore, we believe that more comprehensive studies are needed to clarify the clinical implications of pancreatic volume on our diagnostic and therapeutic decisions.
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Affiliation(s)
- Mercan Tastemur
- Department of Geriatrics Medicine, Ankara Bilkent City Hospital, Ministry of Health, Ankara 06800, Turkey; (G.A.); (K.S.)
| | - Cagla Ozdemir
- Evliya Çelebi Training and Research Hospital, Kütahya Health Sciences University, Kütahya 43020, Turkey;
| | - Esin Olcucuoğlu
- Department of Radiology, Ankara Bilkent City Hospital, Ministry of Health, Ankara 06800, Turkey; (E.O.); (M.S.B.); (H.T.)
| | - Muhammed Said Besler
- Department of Radiology, Ankara Bilkent City Hospital, Ministry of Health, Ankara 06800, Turkey; (E.O.); (M.S.B.); (H.T.)
| | - Halil Tekdemir
- Department of Radiology, Ankara Bilkent City Hospital, Ministry of Health, Ankara 06800, Turkey; (E.O.); (M.S.B.); (H.T.)
| | - Gunes Arik
- Department of Geriatrics Medicine, Ankara Bilkent City Hospital, Ministry of Health, Ankara 06800, Turkey; (G.A.); (K.S.)
| | - Kamile Silay
- Department of Geriatrics Medicine, Ankara Bilkent City Hospital, Ministry of Health, Ankara 06800, Turkey; (G.A.); (K.S.)
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Meloni A, Restaino G, Positano V, Pistoia L, Keilberg P, Santodirocco M, Spasiano A, Casini T, Serra M, De Marco E, Roberti MG, Bagnato S, Pepe A, Clemente A, Missere M. Pancreatic Volume in Thalassemia: Determinants and Association with Alterations of Glucose Metabolism. Diagnostics (Basel) 2025; 15:568. [PMID: 40075815 PMCID: PMC11899254 DOI: 10.3390/diagnostics15050568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2024] [Revised: 02/14/2025] [Accepted: 02/25/2025] [Indexed: 03/14/2025] Open
Abstract
Objectives: This study aimed to compare the pancreatic volume between beta-thalassemia major (β-TM) and beta-thalassemia intermedia (β-TI) patients and between thalassemia patients and healthy subjects and to determine the predictors of pancreatic volume and its association with glucose metabolism in β-TM and β-TI patients. Methods: We considered 145 β-TM patients and 19 β-TI patients enrolled in the E-MIOT project and 20 healthy subjects. The pancreatic volume and pancreatic and hepatic iron levels were quantified by magnetic resonance imaging. Results: The pancreatic volume indexed by body surface area (PVI) was significantly lower in both β-TI and β-TM patients compared to healthy subjects and in β-TM patients compared to β-TI patients. The only independent determinants of PVI were pancreatic iron in β-TM and hepatic iron in β-TI. In β-TM, there was an association between alterations of glucose metabolism and PVI, and PVI was a comparable predictor of altered glucose metabolism compared to pancreatic iron. Only one β-TI patient had an altered glucose metabolism and showed a reduced PVI and pancreatic iron overload. Conclusions: Thalassemia syndromes are characterized by a reduced pancreatic volume, associated with iron levels. In β-TM, the pancreatic volume and iron deposition are associated with the development and progression of alterations of glucose metabolism.
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Affiliation(s)
- Antonella Meloni
- Bioengineering Unit, Fondazione G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy;
| | - Gennaro Restaino
- Radiology Department, Responsible Research Hospital, 86100 Campobasso, Italy; (G.R.); (M.M.)
| | - Vincenzo Positano
- Bioengineering Unit, Fondazione G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy;
| | - Laura Pistoia
- Unità Operativa Complessa Ricerca Clinica, Fondazione G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy;
| | - Petra Keilberg
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy;
| | - Michele Santodirocco
- Centro Microcitemia—Day Hospital Thalassemia Poliambulatorio “Giovanni Paolo II”, Ospedale Casa Sollievo della Sofferenza IRCCS, 71013 San Giovanni Rotondo, Italy;
| | - Anna Spasiano
- Unità Operativa Semplice Dipartimentale Malattie Rare del Globulo Rosso, Azienda Ospedaliera di Rilievo Nazionale “A. Cardarelli”, 80131 Napoli, Italy;
| | - Tommaso Casini
- SOC Oncologia, Ematologia e Trapianto di Cellule Staminali Emopoietiche, Meyer Children’s Hospital IRCCS, 50139 Firenze, Italy;
| | - Marilena Serra
- Day Hospital di Talassemia, Ospedale “V. Fazzi”, 73100 Lecce, Italy;
| | - Emanuela De Marco
- Unità Operativa Oncoematologia Pediatrica, Azienda Ospedaliero Universitaria Pisana—Stabilimento S. Chiara, 56126 Pisa, Italy;
| | - Maria Grazia Roberti
- Servizio Trasfusionale, Azienda Ospedaliero-Universitaria OO.RR. Foggia, 71100 Foggia, Italy;
| | - Sergio Bagnato
- Ematologia Microcitemia, Ospedale San Giovanni di Dio—ASP Crotone, 88900 Crotone, Italy;
| | - Alessia Pepe
- Institute of Radiology, Department of Medicine, University of Padua, 35128 Padua, Italy;
| | - Alberto Clemente
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy;
| | - Massimiliano Missere
- Radiology Department, Responsible Research Hospital, 86100 Campobasso, Italy; (G.R.); (M.M.)
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Kiyoyama H, Tanabe M, Higashi M, Kamamura N, Kawano Y, Ihara K, Hideura K, Ito K. Association of visceral fat obesity with structural change in abdominal organs: fully automated three-dimensional volumetric computed tomography measurement using deep learning. Abdom Radiol (NY) 2025:10.1007/s00261-025-04834-x. [PMID: 39937214 DOI: 10.1007/s00261-025-04834-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2024] [Revised: 01/13/2025] [Accepted: 02/02/2025] [Indexed: 02/13/2025]
Abstract
The purpose of this study was to explore the association between structural changes in abdominal organs and visceral fat obesity (VFO) using a fully automated three-dimensional (3D) volumetric computed tomography (CT) measurement method based on deep learning algorithm. A total of 610 patients (295 men and 315 women; mean age, 68.4 years old) were included. Fully automated 3D volumetric CT measurements of the abdominal organs were performed to determine the volume and average CT attenuation values of each organ. All patients were divided into 2 groups based on the measured visceral fat area: the VFO group (≥ 100 cm2) and non-VFO group (< 100 cm2), and the structural changes in abdominal organs were compared between these groups. The volumes of all organs were significantly higher in the VFO group than in the non-VFO group (all of p < 0.001). Conversely, the CT attenuation values of all organs in the VFO group were significantly lower than those in the non-VFO group (all of p < 0.001). Pancreatic CT values (r = - 0.701, p < 0.001) were most strongly associated with the visceral fat, followed by renal CT values (r = - 0.525, p < 0.001) and hepatic CT values (r = - 0.510, p < 0.001). Fully automated 3D volumetric CT measurement using a deep learning algorithm has the potential to detect the structural changes in the abdominal organs, especially the pancreas, such as an increase in the volumes and a decrease in CT attenuation values, probably due to increased ectopic fat accumulation in patients with VFO. This technique may provide valuable imaging support for the early detection and intervention of metabolic-related diseases.
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Affiliation(s)
- Haruka Kiyoyama
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Masahiro Tanabe
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan.
| | - Mayumi Higashi
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Naohiko Kamamura
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Yosuke Kawano
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Kenichiro Ihara
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Keiko Hideura
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Katsuyoshi Ito
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
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Shimada R, Yamada Y, Okamoto K, Murakami K, Motomura M, Takaki H, Fukuzawa K, Asayama Y. Pancreatic volume change using three dimensional-computed tomography volumetry and its relationships with diabetes on long-term follow-up in autoimmune pancreatitis. World J Radiol 2024; 16:644-656. [PMID: 39635311 PMCID: PMC11612800 DOI: 10.4329/wjr.v16.i11.644] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Revised: 09/07/2024] [Accepted: 09/23/2024] [Indexed: 11/27/2024] Open
Abstract
BACKGROUND Several studies found that early pancreatic atrophy detected by computed tomography (CT) within 6 months was associated with a high incidence of diabetes in patients with type-1 autoimmune pancreatitis (AIP) receiving steroid therapy; however, no long-term follow-up studies have been performed. AIM To investigate pancreatic volume (PV) changes using three dimensional (3D)-CT volumetry and their relationship with IgG4 and diabetes in patients with AIP. METHODS This retrospective study included 33 patients with type-1 AIP receiving steroid therapy. Patients were divided into diffuse (D-type) and mass-forming type (M-type) AIP. PV was determined by semi-automated 3D-CT volumetry, and changes between initial and follow-up values were calculated. The relationship between PV and serum IgG4 levels was analyzed by Spearman's rank correlation. The PV atrophy ratio compared with the presumed normal PV at the time of last follow-up CT and its relationship with diabetes were investigated. RESULTS There were 16 D-type and 17 M-type patients with long-term follow-up (mean, 95.8 months). The regression curve of mean relative PV change reduced exponentially and rapidly during the first 25 months and then more slowly in both groups. The overall cumulative pancreas re-enlargement rates at 1, 3, 5, 7 and 10 years were 6.1%, 12.2%, 29.2%, 47.5% and 55.0%, respectively. There was a moderate-to-very strong positive correlation (ρ ≥ 0.4) between PV and serum IgG4 levels in nine (9/13, 69.2%) patients. All 33 patients showed pancreatic atrophy (mean 59.3%) after long-term follow-up. Patients with D-type AIP had a significantly higher atrophy rate and higher incidence of diabetes than M-type patients (P < 0.05). CONCLUSION PV change initially reduced exponentially and then more slowly and is considered an important factor associated with diabetes. Serum IgG4 levels were positively correlated with PV during follow-up.
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Affiliation(s)
- Ryuichi Shimada
- Department of Radiology, Oita University Faculty of Medicine, Yufu 879-5593, Oita, Japan
| | - Yasunari Yamada
- Department of Radiology, Oita Red Cross Hospital, Oita 870-0033, Oita, Japan
| | - Kazuhisa Okamoto
- Department of Gastroenterology, Oita University Faculty of Medicine, Yufu 879-5593, Oita, Japan
| | - Kazunari Murakami
- Department of Gastroenterology, Oita University Faculty of Medicine, Yufu 879-5593, Oita, Japan
| | - Mitsuteru Motomura
- Department of Hepato-Biliary-Pancreatic Internal Medicine, Oita Red Cross Hospital, Oita 870-0033, Oita, Japan
| | - Hajime Takaki
- Department of Radiology, Oita Red Cross Hospital, Oita 870-0033, Oita, Japan
| | - Kengo Fukuzawa
- Department of Surgery, Oita Red Cross Hospital, Oita 870-0033, Oita, Japan
| | - Yoshiki Asayama
- Department of Radiology, Oita University Faculty of Medicine, Yufu 879-5593, Oita, Japan
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Akazawa Y, Ohtani M, Nosaka T, Takahashi K, Naito T, Matsuda H, Nakamoto Y. Usefulness of pancreatic volume quantitative analysis as a predictor of development and severity of post-endoscopic retrograde cholangiopancreatography pancreatitis. Pancreatology 2024; 24:698-705. [PMID: 38879434 DOI: 10.1016/j.pan.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 04/01/2024] [Accepted: 06/03/2024] [Indexed: 07/15/2024]
Abstract
BACKGROUND Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is one of the most common and serious adverse events associated with ERCP. Thus, we aimed to investigate the usefulness of pre-ERCP pancreatic volume, which is deeply involved in exocrine pancreatic function, as a predictor of PEP development and severity. METHODS In total, 1107 patients who underwent their first ERCP were recruited from January 2012 to December 2022 for this retrospective study. Pancreatic volume was measured by cross-sectional analysis using pre-ERCP computed tomography images. The potential risk factors for PEP were analyzed using multivariate logistic regression. RESULTS Of the 745 patients included in the study, 34 (4.6 %) developed PEP: severe, moderate, or mild PEP in 1, 7, and 26 cases, respectively. Multivariate analysis revealed that only a large pancreatic volume (>70 cm3) was an independent risk factor for the development of PEP (odds ratio, 7.98; 95 % confidence interval, 11.80-67.50; P < 0.001). Additionally, the incidence of PEP was significantly higher in patients with a pancreatic volume >70 cm3 than in those with a pancreatic volume ≤70 cm3 (18.5 % [31/168] vs. 0.5 % [3/577]; P < 0.001). Also, the association between the pre-ERCP pancreatic volume and PEP severity was positively correlated (r = 0.625, P < 0.005), with a larger pancreatic volume corresponding to increased PEP severity. CONCLUSIONS A large pancreatic volume before ERCP may be a novel risk factor for PEP incidence and severity. This finding suggests that quantitative analysis of the pre-ERCP pancreatic volume could be a useful predictor of PEP.
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Affiliation(s)
- Yu Akazawa
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Japan
| | - Masahiro Ohtani
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Japan
| | - Takuto Nosaka
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Japan
| | - Kazuto Takahashi
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Japan
| | - Tatsushi Naito
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Japan
| | - Hidetaka Matsuda
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Japan
| | - Yasunari Nakamoto
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Japan.
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D'Cruz V, De Zutter A, Van den Broecke M, Ribeiro S, Abreu de Carvalho L, Smeets P, Lecluyse C, Pape E, Callebout E, Berrevoet F, Geboes K. Prevalence of metabolic dysfunction-associated fatty liver disease after pancreatic surgery in a historical Belgian cohort and review of the literature. Acta Gastroenterol Belg 2024; 87:373-380. [PMID: 39411790 DOI: 10.51821/87.3.10078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2024]
Abstract
Background and objectives Metabolic dysfunction-associated fatty liver disease (MAFLD) has been reported as a complication after pancreatic surgery. The aim of this study is to assess this phenomenon in a Belgian population, specifically in a period in time when less perioperative chemotherapy was given. Methods We performed a retrospective monocentric cohort study with 124 selected patients who underwent pancreatic surgery - pancreaticoduodenectomy (PD), distal pancreatectomy (DP) or total pancreatectomy - between 2005 and 2014. Steatosis was assessed radiologically, using Hounsfield units on liver and spleen. Data on imaging, liver function, weight and other relevant parameters were gathered preoperatively as well as 2 and 6 months, 1 and 2 years after surgery. Results Thirty-eight (31%) out of 124 patients developed liver steatosis at least at one point in time in the two years following surgery, with a prevalence of 21.0% at 2 months, 28.6% at 6 months, 16.4% at 1 year and 20.8 % at 2 years. A statistically significant association with preoperative AST and ALT values, administration of pancreatic enzyme supplementation as a surrogate for pancreatic exocrine insufficiency (PEI) and weight loss at 2 years was detected. Conclusion MAFLD is seen in 31% of patients with PD or DP pancreatic resection in this retrospective analysis of a monocentric Belgian cohort. Both early and late onset of MAFLD was observed, implying that long-term follow-up is necessary. Clinical impact as well as a direct correlation with patients' weight and oral enzyme supplements needs to be further investigated.
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Affiliation(s)
- V D'Cruz
- Ghent University Hospital, department of Gastroenterology, Ghent, Belgium
| | - A De Zutter
- Ghent University Hospital, department of Gastroenterology, Ghent, Belgium
- Sint-Andriesziekenhuis, department of Gastroenterology, Tielt, Belgium
| | - M Van den Broecke
- Ghent University Hospital, department of Radiology, Ghent, Belgium
- Sint Vincentiusziekenhuis, department of Radiology, Deinze, Belgium
| | - S Ribeiro
- Ghent University Hospital, department of Gastroenterology, Ghent, Belgium
| | - L Abreu de Carvalho
- Ghent University Hospital, General and HPB Surgery and Liver Transplantation, Ghent, Belgium
| | - P Smeets
- Ghent University Hospital, department of Radiology, Ghent, Belgium
| | - C Lecluyse
- Ghent University Hospital, department of Radiology, Ghent, Belgium
| | - E Pape
- Ghent University Hospital, General and HPB Surgery and Liver Transplantation, Ghent, Belgium
| | - E Callebout
- Ghent University Hospital, department of Gastroenterology, Ghent, Belgium
| | - F Berrevoet
- Ghent University Hospital, General and HPB Surgery and Liver Transplantation, Ghent, Belgium
| | - K Geboes
- Ghent University Hospital, department of Gastroenterology, Ghent, Belgium
- Ghent University Hospital, Cancer Centre, Ghent, Belgium
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Wu L, Carlino MS, Brown DA, Long GV, Clifton-Bligh R, Mellor R, Moore K, Sasson SC, Menzies AM, Tsang V, Gunton JE. Checkpoint Inhibitor-Associated Autoimmune Diabetes Mellitus Is Characterized by C-peptide Loss and Pancreatic Atrophy. J Clin Endocrinol Metab 2024; 109:1301-1307. [PMID: 37997380 PMCID: PMC11031227 DOI: 10.1210/clinem/dgad685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/05/2023] [Accepted: 11/20/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVE To conduct a multicenter case series characterizing the clinical characteristics at presentation and pancreatic volume changes of patients with checkpoint inhibitor-associated autoimmune diabetes (CIADM). RESEARCH DESIGN AND METHODS Electronic medical records were reviewed with 36 consecutive patients identified with CIADM, as defined by (1) previous immune checkpoint inhibitor (ICI) therapy, (2) new-onset hyperglycemia (blood glucose level ≥ 11.1 mmol/L and/or glycosylated hemoglobin ≥ 6.5%), and (3) insulin deficiency [C-peptide <0.4 nmol/L or diabetic ketoacidosis (DKA)] within 1 month of presentation. Pancreatic volume was available and measured using computed tomography volumetry for 17 patients with CIADM and 3 sets of control patients: 7 with ICI-related pancreatitis, 13 with asymptomatic ICI-related lipase elevation, and 11 ICI-treated controls for comparison. RESULTS All patients had either anti-programmed cell death protein 1 or anti-programmed cell death ligand 1 therapy. Median time from ICI commencement to CIADM diagnosis was 15 weeks. At presentation, 25 (69%) had DKA, 27 (84%) had low C-peptide, and, by 1 month, 100% had low C-peptide. Traditional type 1 diabetes autoantibodies were positive in 15/35 (43%). Lipase was elevated in 13/27 (48%) at presentation. In 4 patients with longitudinal lipase testing, elevated levels peaked 1 month prior to CIADM diagnosis. Pancreatic volume was lower pre-ICI in CIADM patients compared with controls and demonstrated a mean decline of 41% from pretreatment to 6 months post-CIADM diagnosis. CONCLUSION Pronounced biochemical and radiologic changes occur during CIADM pathogenesis. Rapid loss of C-peptide is a distinct characteristic that can be used to aid diagnosis as autoantibodies are often negative.
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Affiliation(s)
- Linda Wu
- Westmead Institute for Medical Research, Centre for Diabetes and Endocrinology, Westmead 2145, NSW, Australia
- Department of Endocrinology, Westmead Hospital, Westmead 2145, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Camperdown 2050, NSW, Australia
- Melanoma Institute Australia, The University of Sydney, Wollstonecraft 2065, NSW, Australia
| | - Matteo Salvatore Carlino
- Faculty of Medicine and Health, The University of Sydney, Camperdown 2050, NSW, Australia
- Melanoma Institute Australia, The University of Sydney, Wollstonecraft 2065, NSW, Australia
- Department of Oncology, Westmead Hospital, Westmead 2145, NSW Australia
| | - David Alexander Brown
- Westmead Institute for Medical Research, Centre for Diabetes and Endocrinology, Westmead 2145, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Camperdown 2050, NSW, Australia
- Institute of Clinical Pathology and Medical Research, Department of Immunology, NSW Health Pathology, Westmead 2145, NSW, Australia
- Department of of Immunology, Westmead Hospital, Westmead 2145, NSW Australia
| | - Georgina Venetia Long
- Faculty of Medicine and Health, The University of Sydney, Camperdown 2050, NSW, Australia
- Department of Medical Oncology, Royal North Shore Hospital, St Leonards 2065, NSW, Australia
| | - Roderick Clifton-Bligh
- Faculty of Medicine and Health, The University of Sydney, Camperdown 2050, NSW, Australia
- Department of Endocrinology, Royal North Shore Hospital, St Leonards 2065, NSW, Australia
| | - Rhiannon Mellor
- Department of Oncology, Westmead Hospital, Westmead 2145, NSW Australia
| | - Krystal Moore
- Department of Radiology, Westmead Hospital, Westmead 2145, NSW Australia
| | - Sarah Christina Sasson
- Faculty of Medicine and Health, The University of Sydney, Camperdown 2050, NSW, Australia
- Department of of Immunology, Westmead Hospital, Westmead 2145, NSW Australia
| | - Alexander Maxwell Menzies
- Faculty of Medicine and Health, The University of Sydney, Camperdown 2050, NSW, Australia
- Department of Medical Oncology, Royal North Shore Hospital, St Leonards 2065, NSW, Australia
| | - Venessa Tsang
- Faculty of Medicine and Health, The University of Sydney, Camperdown 2050, NSW, Australia
- Department of Endocrinology, Royal North Shore Hospital, St Leonards 2065, NSW, Australia
| | - Jenny Elizabeth Gunton
- Westmead Institute for Medical Research, Centre for Diabetes and Endocrinology, Westmead 2145, NSW, Australia
- Department of Endocrinology, Westmead Hospital, Westmead 2145, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Camperdown 2050, NSW, Australia
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Patil NS, Larocque N, van der Pol CB, Torres C, Raptis DA, Patlas MN. Chemotherapy-Induced Toxicities: An Imaging Primer. Can Assoc Radiol J 2023; 74:432-445. [PMID: 35968850 DOI: 10.1177/08465371221120263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The Coronavirus Disease of 2019 (COVID-19) pandemic has caused significant delays in the delivery of cancer treatments in Canada. As cancer treatment and imaging volumes return to normal, radiologists will encounter more cases of chemotherapy-induced toxicities. These toxicities have varied appearances on imaging, and can affect multiple organ systems. The purpose of this review is to offer a unified resource for general radiologists regarding the imaging appearances of chemotherapy-induced toxicities.
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Affiliation(s)
- Nikhil S Patil
- Michael DeGroote School of Medicine, 62703McMaster University, Hamilton, ON, Canada
| | - Natasha Larocque
- Department of Radiology, 3710McMaster University, Hamilton, ON, Canada
| | - Christian B van der Pol
- Department of Diagnostic Imaging, Juravinski Hospital and Cancer Centre, Hamilton Health Sciences, Canada
| | - Carlos Torres
- Department of Radiology, Radiation Oncology and Medical Physics, 6363University of Ottawa, Ottawa, ON, Canada
| | - Demetrios A Raptis
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, USA
| | - Michael N Patlas
- Department of Radiology, 3710McMaster University, Hamilton, ON, Canada
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9
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Steinkohl E, Olesen SS, Hansen TM, Drewes AM, Frøkjær JB. Quantification of parenchymal fibrosis in chronic pancreatitis: relation to atrophy and pancreatic function. Acta Radiol 2023; 64:936-944. [PMID: 35915988 DOI: 10.1177/02841851221114772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Non-invasive modalities for assessing chronic pancreatitis (CP) are needed in clinical practice. PURPOSE To investigate the correlation between magnetic resonance elastography (MRE)-derived stiffness and T1 relaxation times (as proxies of fibrosis) and explore their relationships to gland volume and pancreatic functions in patients with CP and healthy controls (HCs). MATERIAL AND METHODS In 49 patients with CP and 35 HCs, pancreatic stiffness, T1 relaxation times, and gland volume were assessed. Fecal elastase and the presence of diabetes were used to evaluate pancreatic exocrine and endocrine functions. Uni- and multivariable linear regression models were used to analyze correlations between imaging parameters. RESULTS There was a positive correlation between MRE-derived stiffness and T1 relaxation times in patients with CP (R2 = 0.42; P < 0.001) and HCs (R2 = 0.14; P = 0.028). There was no correlation between MRE-derived stiffness and gland volume in patients (R2 = 0.007; P = 0.065) or HCs (R2 = 0.010; P = 0.57). T1 relaxation time was correlated to gland volume (R2 = 0.19; P = 0.002) in patients with CP but not in the HCs (P = 0.056). Severity of pancreatic functional impairment was reflected by increased fibrosis-related parameters in patients without functional impairment, followed by a further increase in fibrosis-related parameters and reduction in gland volume in patients with pancreatic functional impairments. CONCLUSION Pancreatic MRE-derived stiffness and T1 relaxation times might reflect early pathophysiological changes in CP. The dynamic correlation with pancreatic function suggests that these parameters may be useful for the non-invasive and early identification of CP.
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Affiliation(s)
- Emily Steinkohl
- Mech-Sense, Department of Radiology, 53141Aalborg University Hospital, Aalborg, Denmark
- Centre for Pancreatic Diseases, Department of Gastroenterology and Hepatology, 53141Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, 1004Aalborg University, Aalborg, Denmark
| | - Søren Schou Olesen
- Centre for Pancreatic Diseases, Department of Gastroenterology and Hepatology, 53141Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, 1004Aalborg University, Aalborg, Denmark
| | - Tine Maria Hansen
- Mech-Sense, Department of Radiology, 53141Aalborg University Hospital, Aalborg, Denmark
- Centre for Pancreatic Diseases, Department of Gastroenterology and Hepatology, 53141Aalborg University Hospital, Aalborg, Denmark
| | - Asbjørn Mohr Drewes
- Centre for Pancreatic Diseases, Department of Gastroenterology and Hepatology, 53141Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, 1004Aalborg University, Aalborg, Denmark
| | - Jens Brøndum Frøkjær
- Mech-Sense, Department of Radiology, 53141Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, 1004Aalborg University, Aalborg, Denmark
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10
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Ragimov MR, Nikonova TV, Marchenko EV, Malysheva NM, Derevyanko OS. A clinical case of exocrine pancreatic insufficiency in a patient with type 1 diabetes mellitus. DIABETES MELLITUS 2023. [DOI: 10.14341/dm12884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
The pancreas belongs to the glands of mixed secretion and simultaneously performs both endo- and exocrine functions. Exocrine pancreatic insufficiency (EPI) is the general name for the malabsorption process caused by inadequate production and decreased activation of the enzymes of the pancreas acinar cells, such as amylase, lipase and protease, which are necessary for digestion. The prevalence of EPI in patients with type 1 diabetes, according to many authors, varies from 25 to 59%, which is determine by the data of pancreatic elastase-1. In this work, we present a clinical case of confirmed exocrine pancreatic insufficiency in a patient with a 6-year history of type 1 diabetes, which became the main cause of the development of episodes of hypoglycemia after meals. In the course of further studies, antibodies to lactoferrin and a reduced prostate volume, determined by MRI data, high levels of antibodies to glutamate decarboxylase and zinc co-transporter 8, as well as residual insulin secretion based on the level of C-peptide on an empty stomach detected.
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11
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Single- and multiparameter magnetic resonance imaging for diagnosing and severity grading of chronic pancreatitis. Abdom Radiol (NY) 2023; 48:630-641. [PMID: 36477631 DOI: 10.1007/s00261-022-03760-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 11/29/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE The study aimed to determine the performance of advanced magnetic resonance imaging (MRI), including a multiparametric MRI-index, for diagnosing and severity grading of chronic pancreatitis (CP) at various functional stages with focus on detection of CP with preserved pancreatic function. METHODS Fifty-four CP patients and 35 healthy controls underwent MRI including assessment of pancreatic volume, main pancreatic duct (MPD) diameter, T1 relaxation time, magnetic resonance elastography (MRE) derived stiffness, and intravoxel incoherent motion (IVIM) diffusion-weighted imaging. Patients were categorized into three subgroups: Preserved pancreatic function (n = 14), partial pancreatic insufficiency (exocrine insufficiency or diabetes, n = 25), and complete pancreatic insufficiency (exocrine insufficiency and diabetes, n = 15). A multiparametric MRI-index was based on ordinal logistic regression analysis. Diagnostic performances of MRI parameters for diagnosing CP at different functional stages were determined using receiver operating characteristic (ROC) analysis. RESULTS All MRI parameters differed across CP subgroups and healthy controls (all P < 0.001), except for IVIM. T1 relaxation time (ROC area under the curve (ROC-AUC) 0.82), MRE (ROC-AUC 0.88), and MRI-index (ROC-AUC 0.86) showed the highest performance for detecting patients with preserved pancreatic function (early CP) vs. healthy controls. For detecting preserved pancreatic function vs. partial insufficiency, pancreatic volume, MRI-index, and T1 relaxation time performed best (all ROC-AUC > 0.75), with the MRI-index tending to outperform MRE (ROC-AUC 0.77 vs. 0.63; P = 0.10). CONCLUSION Quantitative assessments of T1 relaxation time and MRE-derived stiffness seem promising for diagnosing CP at different functional stages and may together with multiparametric MRI-index be used for early identification, staging and monitoring of CP.
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12
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Hökenek UD, Aydıner Ö, Kart JS, Arslan G, Saracoglu KT. Evaluation of the effect of pancreatic volume on mortality in patients with acute pancreatitis. Am J Emerg Med 2023; 63:38-43. [PMID: 36327747 DOI: 10.1016/j.ajem.2022.10.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 10/10/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Pancreatic volume is enlarged in acute pancreatitis. OBJECTIVE This study aimed to evaluate whether there was a difference in pancreatic volume between survivors and non-survivors with acute pancreatitis using computer-generated 3D imaging. METHOD This single-center retrospective observational cohort study was conducted between January 2015 and December 2020. The hospital automation system was used to get the patients diagnosed with acute pancreatitis by using International Classification of Diseases (ICD) (ninth edition, code 577.0 or 10th version, code K 85.0) codes. The patients' pancreatic volumes, computed tomography severity index (CTSI), and modified computed tomography severity index (mCTSI) scores were calculated using the data obtained from the hospital automation system. The pancreatic volumes of the patients were measured using the computer-generated 3D imaging method. Pancreatic volume, CTSI, and mCTSI were then statistically compared in terms of mortality prediction by using the receiver operating characteristic (ROC) analysis. RESULTS Of the 143 patients, 57.34% were female and 42.66% were male. The cut-off value of pancreatic volume in determining mortality was>81.5 cm3 OR:17.43 (%95 CI: 2.2-138.1) Cohen's d:1.126, at which it had 92.3% sensitivity, 60.0% specificity, 18.8% positive predictive value, and 98.7% negative predictive value. As a result of the ROC analysis of pancreatic volume in mortality prediction, the area under curve (AUC) value was determined as 0.787 [95% confidence interval (CI): 0.711-0.851]. The ROC analysis of the CTSI and mCTSI scores in mortality prediction revealed AUC values of 0.822 (95%CI: 0.750-0.881) and 0.955 (95%CI: 0.907-0.983) respectively. CONCLUSION Although CTSI scores pancreatic enlargement and mCTSI scores pancreatic necrosis and inflammation, the pancreatic volume value is not clearly scored in both. In this study population, pancreatic volume above 81.5 cm was associated with increased mortality. Both CTSI and mCTSI scores outperformed pancreatic volume in predicting mortality.
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Affiliation(s)
- Ummahan Dalkılınç Hökenek
- Department of Anaesthesiology and Reanimation, University of Health Sciences, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey.
| | - Ömer Aydıner
- Department of Interventional Radiology, University of Health Sciences, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - Julide Sayın Kart
- Department of Anaesthesiology and Reanimation, University of Health Sciences, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - Gülten Arslan
- Department of Anaesthesiology and Reanimation, University of Health Sciences, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - Kemal Tolga Saracoglu
- Department of Anaesthesiology and Reanimation, University of Health Sciences, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
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13
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Impact of the transection plan on postoperative pancreatic fistulas occurring after robot-assisted distal pancreatectomy for nonmalignant pancreatic neoplasms. Surg Endosc 2023; 37:309-318. [PMID: 35941312 DOI: 10.1007/s00464-022-09489-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 07/16/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Postoperative pancreatic fistula (POPF) is the main complication of distal pancreatectomy (DP) and affects the prognosis of patients. The impact of several clinical factors mentioned in recent studies on POPF remains controversial. This study aimed to investigate the impact of a remnant pancreas and other perioperative factors on POPFs occurring after robot-assisted distal pancreatectomy (RDP) for nonmalignant pancreatic neoplasms. METHODS A total of 197 patients who received robot-assisted distal pancreatectomy (RDP) for nonmalignant pancreatic neoplasms at the Pancreatic Disease Center, Ruijin Hospital Shanghai Jiaotong University School of Medicine from January 2018 to December 2020 were included in this retrospective study. According to the intraoperative transection plan, patients were divided into an RDP body group and an RDP tail group. Clinical and pathological features and perioperative factors affecting POPF were analyzed and compared between the two groups. RESULTS The results showed that a transection plan involving the tail of the pancreas (OR = 2.133, 95% CI 1.109-4.103, p = 0.023) and spleen preservation (OR = 2.588, 95% CI 1.435-4.665, p = 0.001) independently increased the incidence of POPF in patients with nonmalignant pancreatic neoplasms treated by RDP. A transection plan involving the tail of the pancreas was also an independent risk factor (OR = 3.464, 95% CI 1.270-9.450, p = 0.015) for grade B/C POPF. Length of remnant pancreas > 6.23 cm was an independent risk factor for POPF (OR = 3.116, 95% CI 1.364-7.121, p = 0.007). Length of remnant pancreas > 9.82 cm was an independent risk factor for grade B/C POPF (OR = 3.340, 95% CI 1.386-8.051, p = 0.007). CONCLUSION This retrospective study suggests that a transection plan involving the tail of the pancreas is an independent risk factor for POPF in patients with nonmalignant neoplasms treated by RDP. We also propose that the postoperative length of the remnant pancreas evaluated by computed tomography scans can be used to identify patients with a high risk of POPF in order to optimize the individualized strategy.
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14
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Huang C, Simeone DM, Luk L, Hecht EM, Khatri G, Kambadakone A, Chandarana H, Ream JM, Everett JN, Guimaraes A, Liau J, Dasyam AK, Harmath C, Megibow AJ. Standardization of MRI Screening and Reporting in Individuals With Elevated Risk of Pancreatic Ductal Adenocarcinoma: Consensus Statement of the PRECEDE Consortium. AJR Am J Roentgenol 2022; 219:903-914. [PMID: 35856454 DOI: 10.2214/ajr.22.27859] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is one of the most aggressive malignancies, with a dismal survival rate. Screening the general population for early detection of PDAC is not recommended, but because early detection improves survival, high-risk individuals, defined as those meeting criteria based on a family history of PDAC and/or the presence of known pathogenic germline variant genes with PDAC risk, are recommended to undergo screening with MRI and/or endoscopic ultrasound at regular intervals. The Pancreatic Cancer Early Detection (PRECEDE) Consortium was formed in 2018 and is composed of gastroenterologists, geneticists, pancreatic surgeons, radiologists, statisticians, and researchers from 40 sites in North America, Europe, and Asia. The overarching goal of the PRECEDE Consortium is to facilitate earlier diagnosis of PDAC for high-risk individuals to increase survival of the disease. A standardized MRI protocol and reporting template are needed to enhance the quality of screening examinations, improve consistency of clinical management, and facilitate multiinstitutional research. We present a consensus statement to standardize MRI screening and reporting for individuals with elevated risk of pancreatic cancer.
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Affiliation(s)
| | | | | | | | - Gaurav Khatri
- University of Texas Southwestern Medical Center, Dallas, TX
| | | | | | | | | | | | - Joy Liau
- University of California at San Diego, La Jolla, CA
| | - Anil K Dasyam
- University of Pittsburgh Medical Center, Pittsburgh, PA
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15
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Leiu KH, Poppitt SD, Miles-Chan JL, Sequeira IR. Fatty Pancreas and Cardiometabolic Risk: Response of Ectopic Fat to Lifestyle and Surgical Interventions. Nutrients 2022; 14:nu14224873. [PMID: 36432559 PMCID: PMC9693202 DOI: 10.3390/nu14224873] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/11/2022] [Accepted: 11/14/2022] [Indexed: 11/19/2022] Open
Abstract
Ectopic fat accumulation in non-adipose organs, such as the pancreas and liver, is associated with an increased risk of cardiometabolic disease. While clinical trials have focused on interventions to decrease body weight and liver fat, ameliorating pancreatic fat can be crucial but successful intervention strategies are not yet defined. We identified twenty-two published studies which quantified pancreatic fat during dietary, physical activity, and/or bariatric surgery interventions targeted at body weight and adipose mass loss alongside their subsequent effect on metabolic outcomes. Thirteen studies reported a significant decrease in body weight, utilising weight-loss diets (n = 2), very low-energy diets (VLED) (n = 2), isocaloric diets (n = 1), a combination of diet and physical activity (n = 2), and bariatric surgery (n = 5) including a comparison with VLED (n = 1). Surgical intervention achieved the largest decrease in pancreatic fat (range: -18.2% to -67.2%) vs. a combination of weight-loss diets, isocaloric diets, and/or VLED (range: -10.2% to -42.3%) vs. diet and physical activity combined (range: -0.6% to -3.9%), with a concurrent decrease in metabolic outcomes. While surgical intervention purportedly is the most effective strategy to decrease pancreas fat content and improve cardiometabolic health, the procedure is invasive and may not be accessible to most individuals. Given that dietary intervention is the cornerstone for the prevention of adverse metabolic health, the alternative approaches appear to be the use of weight-loss diets or VLED meal replacements, which are shown to decrease pancreatic fat and associated cardiometabolic risk.
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Affiliation(s)
- Kok Hong Leiu
- Human Nutrition Unit, School of Biological Sciences, University of Auckland, Auckland 1024, New Zealand
- High Value Nutrition, National Science Challenge, Auckland 1010, New Zealand
| | - Sally D. Poppitt
- Human Nutrition Unit, School of Biological Sciences, University of Auckland, Auckland 1024, New Zealand
- High Value Nutrition, National Science Challenge, Auckland 1010, New Zealand
- Department of Medicine, University of Auckland, Auckland 1010, New Zealand
- Riddet Centre of Research Excellence (CoRE) for Food and Nutrition, Palmerston North 4442, New Zealand
| | - Jennifer L. Miles-Chan
- Human Nutrition Unit, School of Biological Sciences, University of Auckland, Auckland 1024, New Zealand
- High Value Nutrition, National Science Challenge, Auckland 1010, New Zealand
- Riddet Centre of Research Excellence (CoRE) for Food and Nutrition, Palmerston North 4442, New Zealand
| | - Ivana R. Sequeira
- Human Nutrition Unit, School of Biological Sciences, University of Auckland, Auckland 1024, New Zealand
- High Value Nutrition, National Science Challenge, Auckland 1010, New Zealand
- Correspondence: ; Tel.: +64-09-6301162
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16
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Yamamura K, Yamashita Y, Yamao T, Kitano Y, Arima K, Miyata T, Higashi T, Hayashi H, Beppu T, Baba H. Clinical impact of atrophic changes in remnant pancreas on the development of nonalcoholic fatty liver disease after pancreaticoduodenectomy. Ann Gastroenterol Surg 2022; 6:555-561. [PMID: 35847431 PMCID: PMC9271020 DOI: 10.1002/ags3.12554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 01/13/2022] [Accepted: 01/30/2022] [Indexed: 11/21/2022] Open
Abstract
Aim The aim of this study was to evaluate risk factors for nonalcoholic fatty liver disease (NAFLD) after pancreaticoduodenectomy (PD), with a special focus on remnant pancreatic volume (RPV) as assessed using computed tomography (CT). Methods From February 2004 to June 2017, 101 patients who underwent PD in our institution were enrolled. We defined a CT attenuation value of less than 40 HU as hepatic steatosis and measured RPV at 7 days, 3 months, and 1 year after PD using the SYNAPSE VINCENT system. The incidence of NAFLD and RPV were compared between the two groups according to reconstruction with pancreaticogastrostomy (PG) or pancreaticojejunostomy (PJ). Results The incidence of NAFLD at 3 months after PD was 39.6% (40/101). The RPV ratio (RPV at 3 months or 1 year divided by RPV at 7 days after PD) at both 3 months and 1 year was significantly smaller in the PG group than in the PJ group (59% vs 73%, P < .001 and 53% vs 67% P < .01, respectively). A positive correlation between the RPV ratio and liver CT value at 3 months was found. The multivariate analysis identified three independent risk factors for NAFLD: female sex (odds ratio [OR] 8.16, 95% confidence interval [95% CI] 2.27-35.9, P < .001), PG reconstruction (OR 3.87, 95% CI 1.04-15.6, P = .04), and RPV ratio ≤60% (OR 3.44, 95% CI 1.06-11.8, P = .001). Conclusion Atrophic change in the remnant pancreas is significantly associated with the development of NAFLD, and PJ reconstruction may be superior to PG from the viewpoint of NAFLD development.
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Affiliation(s)
- Kensuke Yamamura
- Department of Gastroenterological SurgeryGraduate School of Medical ScienceKumamoto UniversityKumamotoJapan
- Department of SurgeryYamaga City Medical CenterKumamotoJapan
| | - Yo‐ichi Yamashita
- Department of Gastroenterological SurgeryGraduate School of Medical ScienceKumamoto UniversityKumamotoJapan
| | - Takanobu Yamao
- Department of Gastroenterological SurgeryGraduate School of Medical ScienceKumamoto UniversityKumamotoJapan
| | - Yuki Kitano
- Department of Gastroenterological SurgeryGraduate School of Medical ScienceKumamoto UniversityKumamotoJapan
| | - Kota Arima
- Department of Gastroenterological SurgeryGraduate School of Medical ScienceKumamoto UniversityKumamotoJapan
| | - Tatsunori Miyata
- Department of Gastroenterological SurgeryGraduate School of Medical ScienceKumamoto UniversityKumamotoJapan
| | - Takaaki Higashi
- Department of Gastroenterological SurgeryGraduate School of Medical ScienceKumamoto UniversityKumamotoJapan
| | - Hiromitsu Hayashi
- Department of Gastroenterological SurgeryGraduate School of Medical ScienceKumamoto UniversityKumamotoJapan
| | - Toru Beppu
- Department of SurgeryYamaga City Medical CenterKumamotoJapan
| | - Hideo Baba
- Department of Gastroenterological SurgeryGraduate School of Medical ScienceKumamoto UniversityKumamotoJapan
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17
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Shintani S, Inatomi O, Bamba S, Takeda Y, Fujimoto T, Ota S, Tsuji Y, Kutsumi H, Watanabe Y, Andoh A. Larger Volume and Higher Fat Content of the Pancreatic Head Are Predictive Factors for Postendoscopic Retrograde Cholangiopancreatography Pancreatitis. Pancreas 2022; 51:28-34. [PMID: 35195592 DOI: 10.1097/mpa.0000000000001957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Acute pancreatitis is the most critical complication of endoscopic retrograde cholangiopancreatography (ERCP). In this study, we investigated the association between the volume/fat content of the pancreatic head and the incidence of post-ERCP pancreatitis (PEP). METHODS We retrospectively enrolled 157 patients who underwent ERCP. The volume and fat content of the pancreas were calculated by multislice computed tomographic imaging by using a volume analyzer. Multivariate analysis was performed to identify risk factors for PEP. RESULTS The mean volumes of the whole pancreas and pancreatic head were significantly larger, and the fat content of the pancreatic head was significantly higher in the PEP group (P < 0.01). There were no significant differences in the mean volume and fat content of the pancreatic body and tail in the PEP group. Multivariate analysis revealed that the pancreatic guidewire placement (odds ratio [OR], 12.4; P < 0.01), pancreatic head volume (OR, 5.3; P < 0.01), and the pancreatic head fat content (OR, 4.8; P < 0.01) were independent risk factors for PEP. CONCLUSIONS The pancreatic head volume and fat content were independent predicting factors of PEP. Quantitative assessment of the pancreas may contribute to the prediction of PEP onset.
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Affiliation(s)
| | | | | | | | | | - Shinichi Ota
- Radiology, Shiga University of Medical Science, Otsu
| | - Yoshihisa Tsuji
- Department of General Medicine, Sapporo Medical University, Sapporo
| | - Hiromu Kutsumi
- Center for Clinical Research and Advanced Medicine, Shiga University of Medical Science, Otsu, Japan
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18
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Steinkohl E, Olesen SS, Hansen TM, Drewes AM, Frøkjær JB. T1 relaxation times and MR elastography-derived stiffness: new potential imaging biomarkers for the assessment of chronic pancreatitis. Abdom Radiol (NY) 2021; 46:5598-5608. [PMID: 34524501 DOI: 10.1007/s00261-021-03276-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 09/06/2021] [Accepted: 09/06/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE Non-invasive imaging methods to detect morphological changes of the pancreas in patients with mild chronic pancreatitis (CP) are needed. This study aimed to compare magnetic resonance imaging-based parameters, pancreatic volume, T1 mapping, magnetic resonance elastography (MRE), and proton density fat fraction between CP patients and controls, and determine the diagnostic performance for diagnosing different stages of CP. METHODS Nineteen patients with mild CP (Cambridge grade 2 or less or recurring acute pancreatitis; n = 19), 30 with moderate/severe CP (Cambridge grade 3 and 4), and 35 healthy controls underwent pancreatic magnetic resonance imaging to assess the above mentioned magnetic resonance imaging-based parameters. The diagnostic performance of each parameter for detecting any mild and moderate/severe CP was determined using receiver operating characteristic analysis. RESULTS Pancreatic volume, T1 relaxation times, MRE-derived stiffness, and proton density fat fraction differed significantly between patients with mild CP, moderate/severe CP, and healthy controls (all p < 0.05). T1 mapping and MRE showed a very high diagnostic performance for distinguishing the mild CP group from the control group (T1 mapping: receiver operating characteristic area under the curve (ROC-AUC): 0.94; sensitivity: 84%; specificity: 91%, MRE: ROC-AUC: 0.93; sensitivity: 89%; specificity: 94%). T1 mapping and MRE also had the highest performance for diagnosing the presence of any CP from the control group (ROC-AUCs of 0.98 and 0.97, respectively). CONCLUSION Quantitative assessments of T1 relaxation time and MRE-derived stiffness had high performance in detecting mild CP and could probably reflect the early fibrotic changes in CP.
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Affiliation(s)
- Emily Steinkohl
- Mech-Sense, Department of Radiology, Aalborg University Hospital, Hobrovej 18-22, PO. Box 365, 9000, Aalborg, Denmark
- Centre for Pancreatic Diseases, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Mølleparkvej 4, 9000, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Søndre Skovvej 11, 9000, Aalborg, Denmark
| | - Søren Schou Olesen
- Centre for Pancreatic Diseases, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Mølleparkvej 4, 9000, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Søndre Skovvej 11, 9000, Aalborg, Denmark
| | - Tine Maria Hansen
- Mech-Sense, Department of Radiology, Aalborg University Hospital, Hobrovej 18-22, PO. Box 365, 9000, Aalborg, Denmark
- Centre for Pancreatic Diseases, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Mølleparkvej 4, 9000, Aalborg, Denmark
| | - Asbjørn Mohr Drewes
- Centre for Pancreatic Diseases, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Mølleparkvej 4, 9000, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Søndre Skovvej 11, 9000, Aalborg, Denmark
| | - Jens Brøndum Frøkjær
- Mech-Sense, Department of Radiology, Aalborg University Hospital, Hobrovej 18-22, PO. Box 365, 9000, Aalborg, Denmark.
- Department of Clinical Medicine, Aalborg University, Søndre Skovvej 11, 9000, Aalborg, Denmark.
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19
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Li L, Wang S, Wang F, Huang GN, Zhang D, Wang GX. Normal pancreatic volume assessment using abdominal computed tomography volumetry. Medicine (Baltimore) 2021; 100:e27096. [PMID: 34449515 PMCID: PMC8389943 DOI: 10.1097/md.0000000000027096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/12/2021] [Indexed: 01/04/2023] Open
Abstract
To determine the normal range of pancreatic volume (PV) in Chinese adults using computed tomography (CT) volumetry. To assess the relationships of PV with patient demographics and clinical parameters. To analyze the degree of correlation between PV values determined by manual segmentation and those calculated by formulas.A total of 240 adults (120 women, 120 men) between the ages of 18 and 79 years were reviewed. There were 6 groups of patients, with 40 patients in each decade regarding age. PV was segmented manually on computed tomography images slice by slice for each patient, and 2 formulas were used to calculate PV∗ and PV#.The mean PV was 77.44 ± 19.11 cm3 (range from 28.55-138.15 cm3). PV was significantly correlated with height (r = 0.427, P < .001), weight (r = 0.525, P < .001), body mass index (r = 0.377, P < .001), the width of the first lumbar vertebral body (r = 0.166, P = .01), the transverse abdominal diameter (r = 0.455, P < .001), and the sagittal abdominal diameter (r = 0.456, P < .001). There was a negative correlation between PV and age (r = -0.209, P = .001). The correlation coefficients between PV and PV∗ and PV# were 0.676 and 0.376, respectively, with both P < .001.PV associated with patient demographics and clinical parameters. A more accurate and simpler formula should be used in the future to calculate and monitor changes in PV.
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Affiliation(s)
- Lu Li
- Department of Reproduction and Genetics, Health Center for Women and Children, Chongqing, China
| | - Shuang Wang
- Department of Radiology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Fei Wang
- Department of Radiology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Guo-ning Huang
- Department of Reproduction and Genetics, Health Center for Women and Children, Chongqing, China
| | - Dong Zhang
- Department of Radiology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Guang-xian Wang
- Department of Radiology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
- Department of Radiology, People's Hospital of Banan District, Chongqing, China
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Neonatal congenital hyperinsulinism in Indonesia. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2020.101731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Agostini A, Borgheresi A, Bruno F, Natella R, Floridi C, Carotti M, Giovagnoni A. New advances in CT imaging of pancreas diseases: a narrative review. Gland Surg 2020; 9:2283-2294. [PMID: 33447580 PMCID: PMC7804533 DOI: 10.21037/gs-20-551] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/09/2020] [Indexed: 12/13/2022]
Abstract
Computed tomography (CT) plays a pivotal role as a diagnostic tool in many diagnostic and diffuse pancreatic diseases. One of the major limits of CT is related to the radiation exposure of young patients undergoing repeated examinations. Besides the standard CT protocol, the most recent technological advances, such as low-voltage acquisitions with high performance X-ray tubes and iterative reconstructions, allow for significant optimization of the protocol with dose reduction. The variety of CT tools are further expanded by the introduction of dual energy: the production of energy-selective images (i.e., virtual monochromatic images) improves the image contrast and lesion detection while the material-selective images (e.g., iodine maps or virtual unenhanced images) are valuable for lesion detection and dose reduction. The perfusion techniques provide diagnostic and prognostic information lesion and parenchymal vascularization and interstitium. Both dual energy and perfusion CT have the potential for pushing the limits of conventional CT from morphological evaluation to quantitative imaging applied to inflammatory and oncological diseases. Advances in post-processing of CT images, such as pancreatic volumetry, texture analysis and radiomics provide relevant information for pancreatic function but also for the diagnosis, management and prognosis of pancreatic neoplasms. Artificial intelligence is promising for optimization of the workflow in qualitative and quantitative analyses. Finally, basic concepts on the role of imaging on screening of pancreatic diseases will be provided.
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Affiliation(s)
- Andrea Agostini
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Ancona (AN), Italy
- Department of Radiology, University Hospital “Umberto I – Lancisi – Salesi”, Ancona (AN), Italy
| | - Alessandra Borgheresi
- Department of Radiology, University Hospital “Umberto I – Lancisi – Salesi”, Ancona (AN), Italy
| | - Federico Bruno
- Department of Biotechnological and Applied Sciences, University of L’Aquila, L’Aquila, Italy
| | - Raffaele Natella
- Department of Precision Medicine, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Chiara Floridi
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Ancona (AN), Italy
- Department of Radiology, University Hospital “Umberto I – Lancisi – Salesi”, Ancona (AN), Italy
| | - Marina Carotti
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Ancona (AN), Italy
- Department of Radiology, University Hospital “Umberto I – Lancisi – Salesi”, Ancona (AN), Italy
| | - Andrea Giovagnoni
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Ancona (AN), Italy
- Department of Radiology, University Hospital “Umberto I – Lancisi – Salesi”, Ancona (AN), Italy
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Yoon J, Kim KG, Kim YJ, Lim S, Park YH, Kim D, Kang HT, Lee DH. Distribution and Characteristics of Pancreatic Volume Using Computed Tomography Volumetry. Healthc Inform Res 2020; 26:321-327. [PMID: 33190466 PMCID: PMC7674810 DOI: 10.4258/hir.2020.26.4.321] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 09/08/2020] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES Changes in the pancreatic volume (PV) are useful as potential clinical markers for some pancreatic-related diseases. The objective of this study was to measure the volume of the pancreas using computed tomography (CT) volumetry and to evaluate the relationships between sex, age, body mass index (BMI), and sarcopenia. METHODS We retrospectively analyzed the abdominal CT scans of 1,003 subjects whose ages ranged between 10 and 90 years. The pancreas was segmented manually to define the region of interest (ROI) based on CT images, and then the PVs were measured by counting the voxels in all ROIs within the pancreas boundary. Sarcopenia was identified by examination of CT images that determined the crosssectional area of the skeletal muscle around the third lumbar vertebra. RESULTS The mean volume of the pancreas was 62.648 ± 19.094 cm3. The results indicated a negative correlation between the PV and age. There was a positive correlation between the PV and BMI for both sexes, females, and males (r = 0.343, p < 0.001; r = 0.461, p < 0.001; and r = 0.244, p < 0.001, respectively). Additionally, there was a positive correlation between the PV and sarcopenia for females (r = 0.253, p < 0.001) and males (r = 0.200, p < 0.001). CONCLUSIONS CT pancreas volumetry results may help physicians follow up or predict conditions of the pancreas after interventions for pancreatic-related disease in the future.
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Affiliation(s)
- Jihyun Yoon
- Department of Family Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Kwang Gi Kim
- Department of Biomedical Engineering, Medical Devices R&D Center, Gachon University Gil Medical Center, Incheon, Korea
| | - Young Jae Kim
- Department of Biomedical Engineering, Medical Devices R&D Center, Gachon University Gil Medical Center, Incheon, Korea
| | - Sangheon Lim
- Department of Biomedical Engineering, Medical Devices R&D Center, Gachon University Gil Medical Center, Incheon, Korea
| | - Yeon-Ho Park
- Department of Surgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Doojin Kim
- Department of Surgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Hee-Taik Kang
- Department of Family Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Doo-Ho Lee
- Department of Surgery, Gachon University Gil Medical Center, Incheon, Korea
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Pancreatic volume does not correlate with histologic fibrosis in adult patients with recurrent acute and chronic pancreatitis. Pancreatology 2020; 20:1078-1084. [PMID: 32819846 DOI: 10.1016/j.pan.2020.07.409] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/27/2020] [Accepted: 07/28/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Reduced pancreatic volume, often referred to as atrophy, is a commonly reported imaging feature of chronic pancreatitis (CP). This study evaluated whether there is an association between pancreatic volume and fibrosis, the criterion standard of CP, in patients undergoing total pancreatectomy with islet autotransplantation (TPIAT) for recurrent acute pancreatitis (RAP) and CP. METHODS All adult patients who underwent TPIAT between 2010 and 2019 were categorized into 3 groups: RAP, definite CP and indeterminate CP. Pancreatic volume was calculated by summing up the areas from each thin section of the pancreas on 3D CT imaging. Excisional biopsies of the pancreatic head as well as body/tail region were obtained at the time of TPIAT. Two different fibrosis scores were used for histologic assessment. RESULTS A total of 16, 29 and 15 patients underwent TPIAT for RAP, definite CP and indeterminate CP, respectively. The mean pancreatic volumes for patients with RAP, definite CP and indeterminate CP were 65.7 ± 28.5 cc, 54.9 ± 22.9 cc and 61.8 ± 23.6 cc, respectively (p = 0.3). The mean fibrosis scores were significantly higher in patients with definite CP compared to RAP (p < 0.001) and indeterminate CP (p < 0.001). Pancreatic volume was not associated with either fibrosis score after adjusting for age, gender, duration of disease, BMI and diabetes in the multivariable analysis. CONCLUSIONS While the fibrosis scores were higher in definite CP compared to both RAP and indeterminate CP, there was no correlation between pancreatic volume and fibrosis. This suggests that atrophy alone cannot be used to diagnose CP.
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McCleary BM, Trout AT, Dillman JR, Sun Q, Fei L, Abu-El-Haija M. Validation of threshold values for pancreas thickness and T1-weighted signal intensity ratio in the pediatric pancreas. Pediatr Radiol 2020; 50:1381-1386. [PMID: 32556574 DOI: 10.1007/s00247-020-04733-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/14/2020] [Accepted: 05/20/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Pancreas atrophy and the loss of T1-weighted signal intensity by magnetic resonance imaging (MRI) are findings of chronic pancreatitis. OBJECTIVE The purpose of this study was to test published normal values and cutoffs for pancreas thickness and the pancreas:spleen T1-weighted signal intensity ratio in children without pancreatic disease. MATERIALS AND METHODS This was a secondary analysis of prospectively collected MRI data for 50 children (range: 6.3-15.9 years; 27 female) with no history of pancreatic disease. Two observers (R1, R2) measured linear pancreas thickness on axial T1-weighted, fat-saturated gradient recalled echo images and placed regions of interest in the pancreas and spleen to calculate the T1-weighted signal intensity ratio. Measurements were compared to published pediatric normal values (computed tomography [CT], ultrasound [US]) and adult cutoffs (CT, MRI). RESULTS Compared to published pediatric values for CT, 68% (R1: 34/50) or 40% (R2: 22/50) of participants had ≥1 pancreas segment with thickness below the normal range. No participant had a thickness value below the normal range published for US. Compared to cutoff values in adults, 84% (R1: 42/50) or 80% (R2: 40/50) of participants met the criteria for pancreas atrophy. Mean T1-weighted signal intensity ratio was 1.33±0.15 (R1) and 1.32±0.16 (R2). Twelve (R1: 24.5% of 49) or 11/49 (R2: 22.4%) participants had a T1-weighted signal intensity ratio below the threshold associated with exocrine insufficiency in adults. CONCLUSION Previously defined thresholds for pancreas thickness and pancreas:spleen T1-weighted signal intensity ratio appear too restrictive for a pediatric population. Further study is needed to define optimal quantitative metrics for findings of chronic pancreatitis in children.
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Affiliation(s)
- Brendan M McCleary
- Section of Pediatric Imaging, Cleveland Clinic Children's Hospital, Cleveland, OH, USA
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC 5031, Cincinnati, OH, 45229, USA.
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC 5031, Cincinnati, OH, 45229, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Qin Sun
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Lin Fei
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Maisam Abu-El-Haija
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Healthy pancreatic parenchymal volume and its relationship to exocrine function. Pediatr Radiol 2020; 50:684-688. [PMID: 32047986 DOI: 10.1007/s00247-019-04605-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 11/17/2019] [Accepted: 12/19/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Pancreatic atrophy as a finding of chronic pancreatitis has largely been a subjective finding. Cross-sectional imaging should provide a means to quantify pancreatic atrophy. OBJECTIVE The purposes of this study were to: (1) quantify pancreatic volume by magnetic resonance imaging (MRI) in a cohort of children without pancreatic disease, (2) define predictors of pancreatic volume and (3) assess the relationship between pancreatic volume and pancreatic fluid secretion. MATERIALS AND METHODS This study involved further analysis of data collected as part of an institutional review board-approved prospective study of secreted fluid volume in response to secretin in 50 healthy children ages 6-16 years. The pancreas was manually segmented on axial MR images to calculate pancreatic volume. Pearson correlation or the Student's t-test were used to define associations between pancreatic volume and patient characteristics and previously calculated secreted fluid volume. Quantile regression was used to define the 5th percentile for pancreatic volume based on body surface area (BSA) [1]. RESULTS Mean pancreatic volume was 46.0±18.8 mL with no significant difference based on sex (boys: 42.4±19 mL, girls: 49.1±18.3 mL, P=0.21). Pancreatic volume was moderately correlated with age (r=0.51, P=0.002) and strongly correlated with BSA (r=0.75, P<0.0001), with the 5th percentile for pancreatic volume defined by: (24.66×BSA) - 4.97. Pancreatic volume was moderately correlated with volume of fluid secreted after secretin administration (r=0.51, P=0.0002). CONCLUSION We report increasing pancreatic volumes by MRI during childhood in a cohort of children without pancreatic disease. We have also shown that pancreatic volume is associated with secreted fluid volume as measured by MRI.
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Abstract
MRI and MRCP play an important role in the diagnosis of chronic pancreatitis (CP) by imaging pancreatic parenchyma and ducts. MRI/MRCP is more widely used than computed tomography (CT) for mild to moderate CP due to its increased sensitivity for pancreatic ductal and gland changes; however, it does not detect the calcifications seen in advanced CP. Quantitative MR imaging offers potential advantages over conventional qualitative imaging, including simplicity of analysis, quantitative and population-based comparisons, and more direct interpretation of detected changes. These techniques may provide quantitative metrics for determining the presence and severity of acinar cell loss and aid in the diagnosis of chronic pancreatitis. Given the fact that the parenchymal changes of CP precede the ductal involvement, there would be a significant benefit from developing MRI/MRCP-based, more robust diagnostic criteria combining ductal and parenchymal findings. Among cross-sectional imaging modalities, multi-detector CT (MDCT) has been a cornerstone for evaluating chronic pancreatitis (CP) since it is ubiquitous, assesses primary disease process, identifies complications like pseudocyst or vascular thrombosis with high sensitivity and specificity, guides therapeutic management decisions, and provides images with isotropic resolution within seconds. Conventional MDCT has certain limitations and is reserved to provide predominantly morphological (e.g., calcifications, organ size) rather than functional information. The emerging applications of radiomics and artificial intelligence are poised to extend the current capabilities of MDCT. In this review article, we will review advanced imaging techniques by MRI, MRCP, CT, and ultrasound.
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Morphological advantages of endoscopic treatment in obstructive chronic pancreatitis. Pancreatology 2020; 20:199-204. [PMID: 31899135 DOI: 10.1016/j.pan.2019.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 08/09/2019] [Accepted: 12/17/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND and study aims: Chronic pancreatitis is associated with recurrent or persistent abdominal pain over the course of the disease. Ductal hypertension showing obstructed and dilated pancreatic duct has been suggested as a major factor in the mechanism of pain in chronic pancreatitis. Many studies investigating pain relief after endoscopic treatment of pancreatic duct (PD) are available, but the number of studies regarding the morphological changes to pancreas such as changes in PD caliber, pancreatic parenchyma, and especially pancreatic volume is far fewer. As such, we analyzed the changes of ductal caliber and parenchymal volume after endoscopic treatment of PD in patients with obstructive chronic pancreatitis. PATIENTS AND METHODS In this retrospective study, we compared two groups of patients with obstructive chronic pancreatitis that either received endoscopic management of PD or conservative treatment without such endoscopic management. After we obtained age, sex, etiology of chronic pancreatitis, diabetic status, smoking and alcohol abuse status from the database, we compared the incidence for changes in pancreatic parenchymal volume and PD caliber between two groups. RESULT In our study population, total of 480 patients was diagnosed with chronic pancreatitis between January 2006 and December 2016, and 166 (34.5%) of these patients were diagnosed with obstructive chronic pancreatitis with obstructed and dilated PD. After reviewing the population with the exclusion criteria, 71 patients were available for the final analysis. 28 of those patient received endoscopic treatment of pancreatic duct and 43 received conservative treatment without any endoscopic treatment of PD. Statistical analysis with Cox proportional hazards models showed that diabetes and endoscopic PD management were significant predictors for progression of PD caliber and in pancreatic parenchyma, and that only PD management influenced the pancreatic volume loss. CONCLUSION Endoscopic management of PD in obstructive chronic pancreatitis have advantages on morphologic change such as pancreatic volume loss and progression of PD caliber in long follow-up period.
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Saito T, Nakai Y, Mizuno S, Isayama H, Sasahira N, Watanabe T, Matsubara S, Arizumi T, Togawa O, Hirano K, Tsujino T, Ishigaki K, Hakuta R, Saito K, Takahara N, Hamada T, Kogure H, Tada M, Koike K. A randomized-controlled trial of early endotherapy versus wait-and-see policy for mild symptomatic pancreatic stones in chronic pancreatitis. Eur J Gastroenterol Hepatol 2019; 31:979-984. [PMID: 31149913 DOI: 10.1097/meg.0000000000001457] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Although surgical or endoscopic treatment is effective for pain control in symptomatic calcified chronic pancreatitis, it is still unknown whether early intervention in mild symptomatic pancreatic stones would reduce the frequency of acute exacerbation and improve long-term outcomes. The aim of this randomized-controlled trial was to explore the efficacy of early endotherapy for mild symptomatic pancreatic stones in comparison with the wait-and-see policy. MATERIALS AND METHODS Patients with mild symptoms because of pancreatic stones were assigned randomly to the endotherapy or the wait-and-see group. The wait-and-see group received endotherapy only when they developed refractory exacerbation or intractable pain. The primary outcome was the cumulative incidence of intolerable pain attacks and acute exacerbation. The secondary outcomes were the development of pancreatic insufficiency and the progression of pancreatic atrophy. RESULTS A total of 20 patients were enrolled between March 2008 and March 2011. The study was terminated prematurely because of the poor patient enrollment. Early endotherapy tended to reduce the cumulative incidence of pain attacks and exacerbation, (P=0.17) with the composite incidence of pain attacks and exacerbation of 30% in the endotherapy group and 60% in the wait-and-see group. There were no significant differences in terms of diabetic status and the presence of steatorrhea. The thickness of the pancreas decreased significantly in the wait-and-see group (9.2-6.8 mm, P=0.041), but not in the endotherapy group (8.7-9.0 mm, P=0.60). CONCLUSION In a small group of patients, early endotherapy in mild symptomatic chronic pancreatitis was associated with a trend toward a minor number of acute attacks and atrophy progression of the pancreas.
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Affiliation(s)
- Tomotaka Saito
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo
| | - Yousuke Nakai
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo
| | - Suguru Mizuno
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo
| | - Hiroyuki Isayama
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo
- Department of Gastroenterology, Graduate School of Medicine, Juntendo University
| | - Naoki Sasahira
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo
- Department of Gastroenterology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research
| | - Takeo Watanabe
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo
- Department of Gastroenterology, Tokyo Takanawa Hospital
| | - Saburo Matsubara
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo
- Department of Gastroenterology and Hepatology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Toshihiko Arizumi
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo
- Department of Medicine, Teikyo University School of Medicine
| | - Osamu Togawa
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo
- Department of Gastroenterology, Kanto Central Hospital, Tokyo
| | - Kenji Hirano
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo
- Department of Gastroenterology, Tokyo Takanawa Hospital
| | - Takeshi Tsujino
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo
| | - Kazunaga Ishigaki
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo
| | - Ryunosuke Hakuta
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo
| | - Kei Saito
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo
| | - Naminatsu Takahara
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo
| | - Tsuyoshi Hamada
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo
| | - Hirofumi Kogure
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo
| | - Minoru Tada
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo
| | - Kazuhiko Koike
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo
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Djuric-Stefanovic A, Gordanic N, Saponjski D, Koljensic K, Djokic-Kovac J, Knezevic S. Visualization of the fat planes between the pancreas and the adjacent organs and blood vessels using multi-detector computed tomography. Surg Radiol Anat 2019; 41:745-753. [PMID: 30868273 DOI: 10.1007/s00276-019-02214-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 03/05/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE To explore individual variations in visibility of the fat planes between the pancreatic parenchyma and adjacent organs and blood vessels using the multi-detector-computed tomography (MDCT). METHODS Abdominal contrast-enhanced MDCT examinations of 520 consecutive adult individuals were retrospectively analysed by exploring the presence of visible fat planes between the healthy pancreas and the following surrounding structures: stomach, descending duodenum (D2), splenic, portal, superior mesenteric vein (SV, PV, SMV), inferior vena cava (IVC), and coeliac trunk, common hepatic and superior mesenteric artery (CT, HA and SMA). Spearman's rank correlation coefficient (rS) was used to assess the correlation of individual gender, age, body mass and BMI, and visible fat planes towards particular surrounding structures. RESULTS Fat planes between the pancreatic parenchyma and surrounding structures was visible as follows: stomach in 76%, D2 11.7%, SV 51.5%, PV 0%, SMV 28.8%, IVC 80.8%, CT 99.4%, HA 90.4% and SMA in 100% participants. The presence of visible fat planes significantly correlated (p < 0.001) with body mass for stomach (rS = 0.367), D2 (rS = 0.247), SV (rS = 0.355), SMV (rS = 0.384) and IVC (rS = 0.259); BMI for stomach (rS = 0.292), SV (rS = 0.248), SMV (rS = 0.290) and IVC (rS = 0.216); age for D2 (rS = 0.363), SV (rS = 0.276) and SMV (rS = 0.409); and male gender for stomach (rS = 0.160) and SV (rS = 0.198). CONCLUSION Fat planes around the pancreatic parenchyma in the MDCT scan was almost always visible towards the adjacent magistral visceral arteries and IVC, always invisible towards the PV, and variably visible towards the SV, SMV, stomach and duodenum depending on the individual body mass, BMI, age and gender.
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Affiliation(s)
- A Djuric-Stefanovic
- Unit of Digestive Radiology (First Surgery University Clinic), Center of Radiology and MR, Clinical Center of Serbia, Koste Todorovica 6, Belgrade, 11000, Serbia.
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
| | - N Gordanic
- Unit of Digestive Radiology (First Surgery University Clinic), Center of Radiology and MR, Clinical Center of Serbia, Koste Todorovica 6, Belgrade, 11000, Serbia
| | - D Saponjski
- Unit of Digestive Radiology (First Surgery University Clinic), Center of Radiology and MR, Clinical Center of Serbia, Koste Todorovica 6, Belgrade, 11000, Serbia
| | - K Koljensic
- Unit of Digestive Radiology (First Surgery University Clinic), Center of Radiology and MR, Clinical Center of Serbia, Koste Todorovica 6, Belgrade, 11000, Serbia
| | - J Djokic-Kovac
- Unit of Digestive Radiology (First Surgery University Clinic), Center of Radiology and MR, Clinical Center of Serbia, Koste Todorovica 6, Belgrade, 11000, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - S Knezevic
- First Surgery University Clinic, Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Wang Q, Swensson J, Hu M, Cui E, Tirkes T, Jennings SG, Akisik F. Distribution and correlation of pancreatic gland size and duct diameters on MRCP in patients without evidence of pancreatic disease. Abdom Radiol (NY) 2019; 44:967-975. [PMID: 30600375 DOI: 10.1007/s00261-018-1879-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE To use MRCP to investigate age-related changes and gender differences of the pancreas and to correlate pancreatic gland size and duct diameter. METHODS In this institutional review, board-approved, HIPAA-compliant study, 280 patients (age 20-88 years) without a history of pancreatic or liver disease who had undergone MRI/MRCP from 2004 to 2015 were identified. The anteroposterior size and main duct diameter of the pancreatic head, body, and tail were measured. The pancreatic gland and duct sizes were compared between genders, and among seven age subgroups (20-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80-89). RESULTS The pancreatic head and body were significantly larger in males than females (head, p < 0.01; body, p = 0.03), while the tail and the duct diameters of the pancreatic head, body, and tail showed no gender difference. As the age of male participants increased, there was an associated increase in size of the pancreatic gland initially (largest at age 50-59 (body) and 60-69 (head)), followed by subsequent decline in size thereafter. Additionally, the pancreatic duct diameter was found to increase gradually. In females, the size of the pancreatic gland decreased, while the diameter of the pancreatic duct increased with age. Moderate positive correlation for gland size and strong positive correlation for duct diameter among different pancreatic regions were found. Weak negative correlation was found between gland size and duct diameter. CONCLUSIONS There are gender differences in the gland size of the pancreatic head and body. The pancreatic gland size increases until the sixth decade in males, with a more continuous decrease in gland size with age in females. Both males and females demonstrate a marked decrease in gland size after the eighth decade. The duct diameter increases with age in both males and females.
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Affiliation(s)
- Qiushi Wang
- Department of Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, No. 106 Zhong Shan Er Road, Guangzhou, 510080, Guangdong, China
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 550 N University Blvd, Indianapolis, IN, 46202, USA
| | - Jordan Swensson
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 550 N University Blvd, Indianapolis, IN, 46202, USA
| | - Maoqing Hu
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 550 N University Blvd, Indianapolis, IN, 46202, USA
- Department of Radiology, Jiangmen Central Hospital, No. 23 Haibang Street, Jiangmen, 529030, Guangdong, China
| | - Enming Cui
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 550 N University Blvd, Indianapolis, IN, 46202, USA
- Department of Radiology, Jiangmen Central Hospital, No. 23 Haibang Street, Jiangmen, 529030, Guangdong, China
| | - Temel Tirkes
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 550 N University Blvd, Indianapolis, IN, 46202, USA
| | - Samuel G Jennings
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 550 N University Blvd, Indianapolis, IN, 46202, USA
| | - Fatih Akisik
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 550 N University Blvd, Indianapolis, IN, 46202, USA.
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Kipp JP, Olesen SS, Mark EB, Frederiksen LC, Drewes AM, Frøkjær JB. Normal pancreatic volume in adults is influenced by visceral fat, vertebral body width and age. Abdom Radiol (NY) 2019; 44:958-966. [PMID: 30298430 DOI: 10.1007/s00261-018-1793-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The aim was to describe the pancreatic volume (PV) in a cohort of subjects with no prior history of pancreatic disease, and to explore the relationship between PV and conventional two-point measurements of the pancreas. Associations between PV, gender, age, abdominal body composition, and human height were explored as well. METHODS CT scans from 204 trauma patients (20-80 years, 100 males) were evaluated. PV was measured with semi-automatic segmentation. Standardized two-point measurements of the pancreas were obtained together with L1 vertebral body size (a proxy for human height) and abdominal body composition. Associations between PV and the other parameters were explored using uni- and multivariate linear regression. RESULTS The mean PV was 77.9 ± 21.7(SD) cm3 with an interindividual variability from 18.8 to 139.8 cm3. The transversal diameter of the pancreatic head showed the strongest correlation to PV (r = 0.500, p < 0.001). Age, width of the L1 vertebral body, and visceral fat cross-sectional area were all independently associated with PV (all p < 0.001), while no independent association was seen for gender (p = 0.441). CONCLUSIONS The pancreatic volume is subject to a large interindividual variability and is associated with age, human height and body composition, while gender had no independent influence on the pancreatic volume. Thus, future studies using PV as an outcome parameter should be evaluated in the context of anthropometric profiles.
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Affiliation(s)
| | - Søren Schou Olesen
- Department of Gastroenterology & Hepatology, Centre for Pancreatic Disease, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Esben Bolvig Mark
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - Lida Changiziyan Frederiksen
- Department of Gastroenterology & Hepatology, Centre for Pancreatic Disease, Aalborg University Hospital, Aalborg, Denmark
| | - Asbjørn Mohr Drewes
- Department of Gastroenterology & Hepatology, Centre for Pancreatic Disease, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - Jens Brøndum Frøkjær
- Department of Radiology, Aalborg University Hospital, Aalborg, Denmark.
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
- Mech-Sense, Department of Radiology, Aalborg University Hospital, P.O. Box 365, 9100, Aalborg, Denmark.
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Avanesov M, Löser A, Smagarynska A, Keller S, Guerreiro H, Tahir E, Karul M, Adam G, Yamamura J. Clinico-radiological comparison and short-term prognosis of single acute pancreatitis and recurrent acute pancreatitis including pancreatic volumetry. PLoS One 2018; 13:e0206062. [PMID: 30359398 PMCID: PMC6201910 DOI: 10.1371/journal.pone.0206062] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 10/06/2018] [Indexed: 02/07/2023] Open
Abstract
PURPOSE The necrosis-fibrosis hypothesis describes a continuum between single attacks of acute pancreatitis (SAP), recurrent acute pancreatitis (RAP) and chronic pancreatitis (CP) with endocrine and exocrine pancreatic insufficiency. For prevention purposes we evaluated clinico-radiological parameters and pancreatic volumetry to compare SAP and RAP and provide prognostic relevance on short-term mortality, need for intervention and the hospitalization duration. MATERIALS AND METHODS We retrospectively investigated 225 consecutive patients (150 males, range 19-97years) with acute pancreatitis (74%SAP, 26%RAP) according to the revised Atlanta classification. All patients received an intravenous contrast-enhanced CT after a median time of 5 (IQR 5-7) days after onset of symptoms. Two experienced observers rated the severity of AP by 3 CT scores (CTSI, mCTSI, EPIC). Moreover, total pancreatic volumes and additional parenchymal necrosis volumes were assessed, when appropriate. Clinical parameters were etiology of AP, lipase on admission, CRP 48 hours after admission (CRP48), and the presence of organ dysfunction, assessed by the modified Marshall score. The modified Marshall score included systolic blood pressure, serum creatinine, and the ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2 ratio) and was assessed on admission and 48 hours after admission to find patients with persistent organ failure. Outcome parameters were total hospitalization duration, short-term mortality and need for intervention. RESULTS Lipase, CRP48, etiology of AP, EPIC, PaO2/FiO2 ratio, and the presence of a pleural effusion differed significantly in both groups (p<0.05). In 109 patients with interstitial edematous AP, the total pancreatic volume was significantly smaller in patients with RAP compared to those with SAP (69±35cm3; (RAP) vs 106±45cm3; (SAP), p<0.001). All outcome parameters including the mortality rates (SAP vs. RAP: 15% vs. 7%) were comparable in both groups (p>0.05). In the necrotizing RAP group, only the necrotic volume correlated significantly with total hospitalization time (r = 0.72, p<0.001), whereas the systolic blood pressure was the only, but weak predictor for short-term mortality (β-coefficient: -0.05, p = 0.03) and the need for intervention (β-coefficient: -0.02, p = 0.048) in the total RAP group. In patients with SAP, the modified Marshall score was the strongest predictor of short-term mortality, followed by the mCTSI on multivariate logistic regression (Marshall score: β-coefficient: 1.79, p<0.001; mCTSI: β-coefficient: 0.40, p<0.001). CTSI was the best predictor for required intervention in necrotizing SAP (β-coefficient: 0.46, p<0.001), followed by the volume of intrapancreatic necrosis (β-coefficient: 0.17, p = 0.03). CONCLUSION Total pancreatic volume differed significantly between interstitial RAP and SAP and intrapancreatic necrosis volume revealed prognostic value for the total hospitalization duration in necrotizing RAP. Although all outcome parameters were comparable between SAP and RAP, only systolic blood pressure and pancreatic volumetry were prognostic in RAP. In SAP, only the modified Marshall score and mCTSI revealed prognostic value for short-term mortality, whereas CTSI was predictive for the need for intervention.
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Affiliation(s)
- Maxim Avanesov
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anastassia Löser
- Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alla Smagarynska
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sarah Keller
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Helena Guerreiro
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Enver Tahir
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Murat Karul
- Department of Diagnostic and Interventional Radiology, Marienkrankenhaus, Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jin Yamamura
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Desouza SV, Yoon HD, Singh RG, Petrov MS. Quantitative determination of pancreas size using anatomical landmarks and its clinical relevance: A systematic literature review. Clin Anat 2018; 31:913-926. [DOI: 10.1002/ca.23217] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 05/16/2018] [Indexed: 12/30/2022]
Affiliation(s)
- S. V. Desouza
- Department of Surgery; University of Auckland; Auckland 1023 New Zealand
| | - H. D. Yoon
- Department of Surgery; University of Auckland; Auckland 1023 New Zealand
| | - R. G. Singh
- Department of Surgery; University of Auckland; Auckland 1023 New Zealand
| | - M. S. Petrov
- Department of Surgery; University of Auckland; Auckland 1023 New Zealand
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DeSouza SV, Singh RG, Yoon HD, Murphy R, Plank LD, Petrov MS. Pancreas volume in health and disease: a systematic review and meta-analysis. Expert Rev Gastroenterol Hepatol 2018; 12:757-766. [PMID: 29972077 DOI: 10.1080/17474124.2018.1496015] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The pancreas plays a central role in metabolism and is involved in the pathogenesis of several diseases. Pancreas volume is a holistic quantitative measure of pancreas size but the clinical relevance of pancreas volumetry is poorly understood. Areas covered: The aim was to systematically review studies in adults that used computed tomography or magnetic resonance imaging to measure pancreas volume in health and disease, to determine normal pancreas volume range, and to quantify changes in pancreas volume that are associated with disease. Expert commentary: The normal pancreas volume range in adults is 71-83 cm3, with no statistically significant difference between men and women. Type 2 diabetes and type 1 diabetes are associated with a progressively reduced pancreas volume. Overweight and obesity are associated with a progressively increased pancreas volume. There is a paucity of studies on pancreas volume in the setting of diseases of the exocrine pancreas, which should become a research priority in the future.
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Affiliation(s)
- Steve V DeSouza
- a School of Medicine , University of Auckland , Auckland , New Zealand
| | - Ruma G Singh
- a School of Medicine , University of Auckland , Auckland , New Zealand
| | - Harry D Yoon
- a School of Medicine , University of Auckland , Auckland , New Zealand
| | - Rinki Murphy
- a School of Medicine , University of Auckland , Auckland , New Zealand
| | - Lindsay D Plank
- a School of Medicine , University of Auckland , Auckland , New Zealand
| | - Maxim S Petrov
- a School of Medicine , University of Auckland , Auckland , New Zealand
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Abstract
OBJECTIVE The purpose of this article is to discuss the advances in CT acquisition and image postprocessing as they apply to imaging the pancreas and to conceptualize the role of radiogenomics and machine learning in pancreatic imaging. CONCLUSION CT is the preferred imaging modality for assessment of pancreatic diseases. Recent advances in CT (dual-energy CT, CT perfusion, CT volumetry, and radiogenomics) and emerging computational algorithms (machine learning) have the potential to further increase the value of CT in pancreatic imaging.
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Secrest S, Sharma A, Bugbee A. Computed Tomographic Angiography of the Pancreas in Cats with Chronic Diabetes Mellitus Compared to Normal Cats. J Vet Intern Med 2018; 32:962-966. [PMID: 29498098 PMCID: PMC5980261 DOI: 10.1111/jvim.14899] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 10/24/2017] [Accepted: 11/15/2017] [Indexed: 12/01/2022] Open
Abstract
Background Diabetes mellitus (DM) is a common endocrinopathy in cats. No known diagnostic test or patient characteristic at the time of diagnosis can predict likely disease course, unlike in people in whom computed tomographic angiography (CTA) is used. No published data exist regarding the CTA appearance of the pancreas in cats with DM, and thus, it is unknown what if any CTA variables should be further assessed for associations with pancreatic endocrine function. Hypothesis/Objectives A significant difference in pancreatic attenuation, volume, and size will be identified between normal cats and those with chronic DM on CTA. Animals Ten healthy control cats and 15 cats with naturally occurring DM present for >12 months. Methods Prospective cross‐sectional study comparing pancreatic attenuation, enhancement pattern, size, volume, pancreatic volume‐to‐body weight ratio (V:BW), pancreatic arterial: portal phase ratio (A:P), time‐to‐arterial enhancement, and time‐to‐peak portal enhancement on CTA between sedated healthy control cats and those with chronic DM. Results The pancreas in cats with chronic DM was significantly larger, had higher volume, higher V:BW, and shorter time‐to‐peak portal enhancement on CTA when compared to normal cats. Conclusions and Clinical Importance Peak portal enhancement time, pancreatic size, pancreatic volume, and V:BW can be used to differentiate normal sedated cats from those with chronic DM by CTA. These variables warrant further investigation to identify possible associations with endocrine function.
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Affiliation(s)
- S Secrest
- Department of Veterinary Biosciences and Diagnostic Imaging, University of Georgia College of Veterinary Medicine, Athens, GA
| | - A Sharma
- Department of Veterinary Biosciences and Diagnostic Imaging, University of Georgia College of Veterinary Medicine, Athens, GA
| | - A Bugbee
- Department of Small Animal Medicine and Surgery, University of Georgia College of Veterinary Medicine, Athens, GA
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Secrest S, Sharma A, Bugbee A. Triple phase computed tomography of the pancreas in healthy cats. Vet Radiol Ultrasound 2017; 59:163-168. [PMID: 29193526 DOI: 10.1111/vru.12577] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 08/30/2017] [Accepted: 09/03/2017] [Indexed: 11/29/2022] Open
Abstract
While the availability and use of computed tomography (CT) continues to grow, no study has described the size and multiphase CT appearance of the normal feline pancreas. This information is important to not only allow more accurate identification and differentiation of disease, but it may also be useful in assessing pancreatic function. In this prospective analytical study, we described a triple phase CT protocol of the pancreas for use in sedated cats and the attenuation, enhancement pattern, size, and volume of the pancreas for a group of healthy cats. Fifteen healthy cats were enrolled in the study and a standardized protocol for acquiring arterial, portal, and delayed phase CT images of the pancreas was developed and described. The pancreas was hypo to isoattenuating to both the liver and spleen in all phases in the majority of cats with a homogenous enhancement pattern noted in all 15. Mean pancreatic attenuation was 48, 79, 166, and 126 Hounsfield units (HU) respectively on precontrast, arterial, portal, and delayed phase images. In addition, mean height, length, and width of the left lobe of the pancreas were larger than the right lobe in all 15 cats. There were no associations between volume and volume: body weight ratio with age (P = 0.6518, P = 0.6968) or sex (P = 0.7013, P = 0.2043). This baseline information may be beneficial for use in future studies characterizing pancreatic disease in cats as well as future research studies evaluating pancreatic endocrine function.
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Affiliation(s)
- Scott Secrest
- University of Georgia College of Veterinary Medicine, Department of Veterinary Biosciences and Diagnostic Imaging, Athens, GA, 30602, USA
| | - Ajay Sharma
- University of Georgia College of Veterinary Medicine, Department of Veterinary Biosciences and Diagnostic Imaging, Athens, GA, 30602, USA
| | - Andrew Bugbee
- University of Georgia College of Veterinary Medicine, Department of Small Animal Medicine and Surgery, Athens, GA, 30602, USA
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Lee JE, Shin SS, Kim SJ, Heo SH, Lim HS, Kim JW, Jeong YY. A pictorial review of diagnostic pitfalls of developmental anomalies and variants in pancreatic imaging. Clin Imaging 2017; 48:32-39. [PMID: 29028511 DOI: 10.1016/j.clinimag.2017.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 09/05/2017] [Accepted: 09/11/2017] [Indexed: 11/25/2022]
Abstract
Developmental anomalies and anatomic variants of the pancreas vary widely, and most of them are encountered incidentally during radiologic evaluation. However, some of these anomalies and variants are potentially pathologic and may cause various clinical presentations in childhood or adulthood. The early identification of these entities in various imaging modalities including ultrasound, computed tomography (CT), and magnetic resonance (MR) imaging would be valuable in making correct diagnoses and, in turn, preventing unnecessary additional procedures. In order to differentiate these entities, it is fundamental to understand the embryologic development and normal anatomical structure of the pancreas. In this article, we review the embryology and normal anatomy of the pancreas, and diagnostic pitfalls of developmental anomalies and anatomic variants in various pancreatic imaging modalities.
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Affiliation(s)
- Jong Eun Lee
- Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun-gun, South Korea
| | - Sang Soo Shin
- Department of Radiology, Chonnam National University Medical School, Gwangju, South Korea; Center for Aging and Geriatrics, Chonnam National University Medical School, Gwangju, South Korea.
| | - Shin Jung Kim
- Department of Radiology, Chonnam National University Hospital, Gwangju, South Korea
| | - Suk Hee Heo
- Department of Radiology, Chonnam National University Medical School, Gwangju, South Korea
| | - Hyo Soon Lim
- Department of Radiology, Chonnam National University Medical School, Gwangju, South Korea
| | - Jin Woong Kim
- Department of Radiology, Chonnam National University Medical School, Gwangju, South Korea
| | - Yong Yeon Jeong
- Department of Radiology, Chonnam National University Medical School, Gwangju, South Korea
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40
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Park SY, Park KM, Shin WY, Choe YM, Hur YS, Lee KY, Ahn SI. Functional and morphological evolution of remnant pancreas after resection for pancreatic adenocarcinoma. Medicine (Baltimore) 2017; 96:e7495. [PMID: 28700497 PMCID: PMC5515769 DOI: 10.1097/md.0000000000007495] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 05/31/2017] [Accepted: 06/21/2017] [Indexed: 01/05/2023] Open
Abstract
Functional and morphological evolution of remnant pancreas after resection for pancreatic adenocarcinoma is investigated.The medical records of 45 patients who had undergone radical resection for pancreatic adenocarcinoma from March 2010 to September 2013 were reviewed retrospectively. There were 34 patients in the pancreaticoduodenectomy (PD) group and 10 patients in the distal pancreatectomy (DP) group. One patient received total pancreatectomy. The endocrine function was measured using the glucose tolerance index (GTI), which was derived by dividing daily maximum serum glucose fluctuation by daily minimum glucose. Remnant pancreas volume (RPV) was estimated by considering pancreas body and tail as a column, and head as an ellipsoid, respectively. The pancreatic atrophic index (PAI) was defined as the ratio of pancreatic duct width to total pancreas width. Representative indices of each patient were compared before and after resection up to 2 years postoperatively.The area under receiver operating characteristic curve of GTI for diagnosing DM was 0.823 (95% confidence interval, 0.699-0.948, P < .001). Overall, GTI increased on postoperative day 1 (POD#1, mean ± standard deviation, 1.79 ± 1.40 vs preoperative, 1.02 ± 1.41; P = .001), and then decreased by day 7 (0.89 ± 1.16 vs POD#1, P < .001). In the PD group, the GTI on POD#14 became lower than preoperative (0.51 ± 0.38 vs 0.96 ± 1.37; P = .03). PAI in the PD group was significantly lower at 1 month postoperatively (0.22 ± 0.12 vs preoperative, 0.38 ± 0.18; P < .001). In the PD group, RPV was significantly lower at 1 month postoperatively (25.3 ± 18.3 cm vs preoperative, 32.4 ± 20.1 cm; P = .02), due to the resolution of pancreatic duct dilatation. RPV of the DP group showed no significant change. GTI was negatively related to RPV preoperatively (r = -0.317, P = .04), but this correlation disappeared postoperatively (r = -0.044, P = .62).Pancreatic endocrine functional deterioration in pancreatic adenocarcinoma patients may in part be due to pancreatic duct obstruction and dilatation caused by the tumor. After resection, this proportion of endocrine insufficiency is corrected.
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Biliary and pancreatic complications of molecular targeted therapies in cancer imaging. Abdom Radiol (NY) 2017; 42:1721-1733. [PMID: 28160038 DOI: 10.1007/s00261-017-1050-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The purpose of this review is to familiarize radiologists with the different imaging manifestations of biliary and pancreatic toxicity of molecular targeted therapies. The advent of molecular targeted therapies for cancer treatment has prompted radiologists to be familiar with these new molecules, their patterns of response, and their class-specific toxicities. While liver and bowel toxicities have been extensively reported in literature, less is known about the pathogenesis and imaging of toxicity involving the pancreatobiliary system. Biliary and pancreatic toxicity of molecular targeted therapies present with variable manifestations and varying degrees of severity, from asymptomatic liver function tests elevation to acute pancreatitis or cholecystitis. Management of these conditions depends on the clinical scenario and the severity of the findings. In this article, we will (1) present the various classes of molecular targeted therapies most commonly associated with biliary and pancreatic toxicity; (2) illustrate imaging findings of drug-associated biliary and pancreatic injuries and their possible differential diagnosis; and (3) provide a guide for management of these conditions.
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Demoulin N, Issa Z, Crott R, Morelle J, Danse E, Wallemacq P, Jadoul M, Deprez PH. Enteric hyperoxaluria in chronic pancreatitis. Medicine (Baltimore) 2017; 96:e6758. [PMID: 28489752 PMCID: PMC5428586 DOI: 10.1097/md.0000000000006758] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Chronic pancreatitis may lead to steatorrhea, enteric hyperoxaluria, and kidney damage. However, the prevalence and determinants of hyperoxaluria in chronic pancreatitis patients as well as its association with renal function decline have not been investigated.We performed an observational study. Urine oxalate to creatinine ratio was assessed on 2 independent random urine samples in consecutive adult patients with chronic pancreatitis followed at the outpatient clinic from March 1 to October 31, 2012. Baseline characteristics and annual estimated glomerular filtration rate (eGFR) change during follow-up were compared between patients with hyper- and normo-oxaluria.A total of 48 patients with chronic pancreatitis were included. The etiology of the disease was toxic (52%), idiopathic (27%), obstructive (11%), autoimmune (6%), or genetic (4%). Hyperoxaluria (defined as urine oxalate to creatinine ratio >32 mg/g) was found in 23% of patients. Multivariate regression analysis identified clinical steatorrhea, high fecal acid steatocrit, and pancreatic atrophy as independent predictors of hyperoxaluria. Taken together, a combination of clinical steatorrhea, steatocrit level >31%, and pancreatic atrophy was associated with a positive predictive value of 100% for hyperoxaluria. On the contrary, none of the patients with a fecal elastase-1 level >100 μg/g had hyperoxaluria. Longitudinal evolution of eGFR was available in 71% of the patients, with a mean follow-up of 904 days. After adjustment for established determinants of renal function decline (gender, diabetes, bicarbonate level, baseline eGFR, and proteinuria), a urine oxalate to creatinine ratio >32 mg/g was associated with a higher risk of eGFR decline.Hyperoxaluria is highly prevalent in patients with chronic pancreatitis and associated with faster decline in renal function. A high urine oxalate to creatinine ratio in patients with chronic pancreatitis is best predicted by clinical steatorrhea, a high acid steatocrit, and pancreatic atrophy. Further studies will need to investigate the mechanisms of renal damage in chronic pancreatitis and the potential benefits of therapies reducing oxaluria.
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Affiliation(s)
- Nathalie Demoulin
- Division of Nephrology, Cliniques universitaires Saint-Luc
- Institut de Recherche Expérimentale et Clinique
| | - Zaina Issa
- Division of Nephrology, Cliniques universitaires Saint-Luc
| | - Ralph Crott
- Institut de Recherche Santé et Société, Université catholique de Louvain
| | - Johann Morelle
- Division of Nephrology, Cliniques universitaires Saint-Luc
- Institut de Recherche Expérimentale et Clinique
| | - Etienne Danse
- Institut de Recherche Expérimentale et Clinique
- Department of Radiology
| | - Pierre Wallemacq
- Institut de Recherche Expérimentale et Clinique
- Department of Clinical Chemistry
| | - Michel Jadoul
- Division of Nephrology, Cliniques universitaires Saint-Luc
- Institut de Recherche Expérimentale et Clinique
| | - Pierre H. Deprez
- Institut de Recherche Expérimentale et Clinique
- Department of Hepato-Gastroenterology, Cliniques universitaires Saint-Luc, Brussels, Belgium
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Takahashi H, Nasu K, Minami M, Kojima T, Nishiyama H, Ishiguro T, Konishi T. Organ Atrophy Induced by Sorafenib and Sunitinib - Quantitative Computed Tomography (CT) Evaluation of the Pancreas, Thyroid Gland and Spleen. Pol J Radiol 2016; 81:557-565. [PMID: 27956943 PMCID: PMC5129701 DOI: 10.12659/pjr.898936] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 06/08/2016] [Indexed: 11/13/2022] Open
Abstract
Background To evaluate organ atrophy induced by sorafenib and sunitinib, we retrospectively reviewed the CT scans of renal cell carcinoma (RCC) patients receiving molecular targeted therapy (MTT) using sorafenib or sunitinib, and performed volumetric analysis of the pancreas, thyroid gland, and spleen. Material/Methods Thirteen RCC patients receiving MTT were assigned as the evaluation cases (MTT group), while thirteen additional RCC patients not receiving MTT were retrieved as the Control group. We evaluated the baseline and follow-up CT studies. The volume of the three organs estimated by CT volumetry was compared between the baseline and follow-up CTs. The atrophic ratio of the organ volume in the follow-up CT to that in the baseline CT was calculated, and compared between the MTT and Control groups. Results All measured organs in the MTT group showed statistically significant volume loss, while no significant change was observed in the Control group. Mean atrophic ratio in the MTT group was 0.74, 0.58, and 0.82 for the pancreas, thyroid and spleen, respectively. The differences in atrophic ratios between both groups were all statistically significant (P<0.05). Conclusions Single-agent sorafenib or sunitinib therapy induced statistically significant atrophy in the pancreas, thyroid, and spleen.
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Affiliation(s)
- Hiroaki Takahashi
- Department of Diagnostic and Interventional Radiology, University of Tsukuba, Faculty of Medicine, Ibaraki, Japan
| | - Katsuhiro Nasu
- Department of Diagnostic and Interventional Radiology, University of Tsukuba, Faculty of Medicine, Ibaraki, Japan
| | - Manabu Minami
- Department of Diagnostic and Interventional Radiology, University of Tsukuba, Faculty of Medicine, Ibaraki, Japan
| | - Takahiro Kojima
- Department of Urology, University of Tsukuba, Faculty of Medicine, Ibaraki, Japan
| | - Hiroyuki Nishiyama
- Department of Urology, University of Tsukuba, Faculty of Medicine, Ibaraki, Japan
| | - Toshitaka Ishiguro
- Department of Diagnostic and Interventional Radiology, University of Tsukuba, Faculty of Medicine, Ibaraki, Japan
| | - Takahiro Konishi
- Department of Diagnostic and Interventional Radiology, University of Tsukuba, Faculty of Medicine, Ibaraki, Japan
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Planimetric correlation between the submandibular glands and the pancreas: a postmortem ductographic study. Anat Sci Int 2016; 93:114-118. [PMID: 27832478 DOI: 10.1007/s12565-016-0382-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 11/02/2016] [Indexed: 10/20/2022]
Abstract
The salivary glands and pancreas have comparable anatomic and antigenic properties and can share common pathogenetic mechanisms involving toxic or autoimmune processes. The aim of this study is to assess the correlation in size between the normal submandibular glands and the pancreas. The study was based on human autopsy specimens of the pancreas, neck and oral base from 22 adults, both sexes (mean age, 57.9 years). The pancreatic and submandibular ducts were injected with a contrast medium, and the area of the salivary and pancreatic glandular ductograms was measured with the aid of software for quantification of visual information. Samples of tissue from the salivary glands and the pancreas were studied by means of light microscopy. A high correlation was found between the planimetric size of the pancreas and the submandibular glands (correlation coefficient 0.497 and 0.699 for the right and the left gland, respectively). This ratio was close to 5:1. There were no significant differences in size for the left vs. right submandibular gland (p = 0.39). The ductograms were significantly larger in size in males than in females (p < 0.001). This study has proven a positive correlation in planimetric size between the normal submandibular glands and pancreas, a result that is expected to have possible clinical implications in the long-term follow-up of patients with chronic pancreatitis.
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Phillip V, Zahel T, Bärtl K, Rasch S, Ebert O, Schmid RM, Rummeny E, Algül H. Influence of Sorafenib and Bevacizumab on pancreatic volume - A monocentric CT based analysis. Pancreatology 2016; 16:621-4. [PMID: 26968257 DOI: 10.1016/j.pan.2016.02.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 02/02/2016] [Accepted: 02/16/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND/OBJECTIVES Angiogenesis plays a central role in tumor growth and metastasis and tyrosine kinases are crucial in the modulation of growth factor signaling. Several side effects of tyrosine kinase inhibitors have been reported, including diarrhea due to pancreatic insufficiency. The suspected mechanism is the anti-angiogenetic effect of the inhibited vascular endothelial growth factor (VEGF) causing a disturbance of the microvasculation. The aim of the present study was to determine the volume of the pancreas before and after a therapy both with the multi-tyrosine kinase inhibitor Sorafenib and Bevacizumab, which is a humanized monoclonal immunoglobulin G1 antibody against VEGF. METHODS Retrospective monocentric study including 42 patients who received either Sorafenib, Bevacizumab combined with Flourouracil and/or Irinotecan, or singly Flourouracil and Irinotecan for different non-pancreatic malignancies. The volume of the pancreas was measured before and after therapy by CT-scan based volumetry. RESULTS The pancreatic volume was statistically significantly lower after treatment with Sorafenib (75.4 mL vs. 71.0 mL; p = 0.006) or Bevacizumab and Fluorouracil ± Irinotecan (71.8 mL vs. 62.6 mL; p = 0.020). The pancreatic volume did not change statistically significantly after treatment with Fluorouracil ± Irinotecan only (51.1 mL vs. 49.9 mL; p = 0.142). CONCLUSIONS Pancreatic volume decreases statistically significantly under treatment with both the multi-tyrosine kinase inhibitor Sorafenib and the angiogenesis inhibitor Bevacizumab. This volume reduction is most likely due to a reduced microvasculation by inhibition of VEGF.
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Affiliation(s)
- Veit Phillip
- II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, 81675 München, Germany
| | - Tina Zahel
- Institut für diagnostische und interventionelle Radiologie, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, 81675 München, Germany
| | - Klaus Bärtl
- Chirurgische Abteilung, Kreisklinik Wolfratshausen, Moosbauerweg 5, 82515 Wolfratshausen, Germany
| | - Sebastian Rasch
- II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, 81675 München, Germany
| | - Oliver Ebert
- II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, 81675 München, Germany
| | - Roland M Schmid
- II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, 81675 München, Germany
| | - Ernst Rummeny
- Institut für diagnostische und interventionelle Radiologie, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, 81675 München, Germany
| | - Hana Algül
- II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, 81675 München, Germany.
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Ohgi K, Okamura Y, Yamamoto Y, Ashida R, Ito T, Sugiura T, Aramaki T, Uesaka K. Perioperative Computed Tomography Assessments of the Pancreas Predict Nonalcoholic Fatty Liver Disease After Pancreaticoduodenectomy. Medicine (Baltimore) 2016; 95:e2535. [PMID: 26871772 PMCID: PMC4753867 DOI: 10.1097/md.0000000000002535] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD) after pancreaticoduodenectomy (PD) has become a clinically important issue. Although pancreatic exocrine insufficiency has been reported to be a main cause of NAFLD after PD, a clinically practical examination to assess the pancreatic exocrine function has not been established. The aim of this study was to evaluate risk factors for NAFLD after PD with a focus on perioperative computed tomography (CT) assessments of the pancreas.A retrospective review of 245 patients followed for more than 6 months after PD was conducted. We evaluated several pancreatic CT parameters, including the pancreatic parenchymal thickness, pancreatic duct-to-parenchymal ratio, pancreatic attenuation, and remnant pancreatic volume (RPV) on pre- and/or postoperative CT around 6 months after surgery. The variables, including the pancreatic CT parameters, were compared between the groups with and without NAFLD after PD.The incidence of NAFLD after PD was 19.2%. A multivariate analysis identified 5 independent risk factors for NAFLD after PD: a female gender (odds ratio [OR] 5.66, P < 0.001), RPV < 12 mL (OR 4.73, P = 0.001), preoperative pancreatic attenuation of <30 Hounsfield units (OR 4.50, P = 0.002), dissection of the right-sided nerve plexus around the superior mesenteric artery (OR 3.02, P = 0.017) and a preoperative serum carbohydrate antigen 19-9 level of ≥70 U/mL (OR 2.58, P = 0.029).Our results showed that 2 pancreatic CT parameters, the degree of preoperative pancreatic attenuation and RPV, significantly influence the development of NAFLD after PD. Perioperative CT assessments of the pancreas may be helpful for predicting NAFLD after PD.
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Affiliation(s)
- Katsuhisa Ohgi
- From the Division of Hepato-Biliary-Pancreatic Surgery (KO, YO, YY, RA, TI, TS, KU) and Division of Interventional Radiology (TA), Shizuoka Cancer Center, Shizuoka, Japan
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Cancer therapy related complications in the liver, pancreas, and biliary system: an imaging perspective. Insights Imaging 2015; 6:665-77. [PMID: 26443452 PMCID: PMC4656242 DOI: 10.1007/s13244-015-0436-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 09/14/2015] [Accepted: 09/18/2015] [Indexed: 02/08/2023] Open
Abstract
UNLABELLED Awareness of cancer therapy-induced toxicities is important for all clinicians treating patients with cancer. Cancer therapy has evolved to include classic cytotoxic agents in addition to newer options such as targeted agents and catheter-directed chemoembolisation. Several adverse affects can result from the wide array of treatments including effects on the liver, pancreas, and biliary system that can be visualised on imaging. These complications include sinusoidal obstruction syndrome, fatty liver, pseudocirrhosis, acute hepatitis, pancreatitis, pancreatic atrophy, cholecystitis, biliary sclerosis, and biliary stasis. Many of these toxicities are manageable and reversible with supportive therapies and/or cessation of cancer therapy. The objective of this review is to discuss the imaging findings associated with cancer therapy-induced toxicity of the liver, biliary system, and pancreas. TEACHING POINTS • Cancer therapy can have adverse effects on the hepatobiliary system and pancreas. • Cancer therapy-induced toxicities can be visualised on imaging. • Knowledge of imaging changes associated with cancer therapy complications can improve treatment.
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Chantarojanasiri T, Hirooka Y, Ratanachu-Ek T, Kawashima H, Ohno E, Goto H. Evolution of pancreas in aging: degenerative variation or early changes of disease? J Med Ultrason (2001) 2015; 42:177-183. [PMID: 26576570 DOI: 10.1007/s10396-014-0576-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 08/19/2014] [Indexed: 02/07/2023]
Abstract
Pancreatic changes in aging have been described for many decades. They involve not only pancreatic parenchyma but also pancreatic ductal, microscopic, and exocrine functional changes. There have been many studies of these changes based on pathology and various imaging modalities, as well as functional studies. The pancreatic volume was found to decrease with advancing age, with a higher incidence of pancreatic steatosis, as demonstrated in autopsy and imaging studies. The pancreatic ductal structure has been described with wide ranges of normal variation, but many studies have shown a tendency toward enlargement with advancing age. By endoscopic ultrasound imaging, the aging pancreas may exhibit abnormal findings similar to chronic pancreatitis. Microscopically, there has been evidence of patchy lobular fibrosis and papillary hyperplasia and demonstrable k-ras mutation in both normal and dysplastic ductal mucosa. The evidence of pancreatic exocrine insufficiency has yielded conflicting results, but most studies have shown a tendency toward decreased pancreatic exocrine function in the elderly. Differentiating pancreatic change in the elderly from early chronic pancreatitis may be difficult as there are limited studies to compare these two conditions in terms of structural and functional changes.
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Affiliation(s)
- Tanyaporn Chantarojanasiri
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshiki Hirooka
- Department of Endoscopy, Nagoya University Hospital, 65 Tsuruma-cho, Showa-ku, Nagoya City, 466-8550, Japan.
| | | | - Hiroki Kawashima
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Eizaburo Ohno
- Department of Endoscopy, Nagoya University Hospital, 65 Tsuruma-cho, Showa-ku, Nagoya City, 466-8550, Japan
| | - Hidemi Goto
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Endoscopy, Nagoya University Hospital, 65 Tsuruma-cho, Showa-ku, Nagoya City, 466-8550, Japan
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Lim S, Bae JH, Chun EJ, Kim H, Kim SY, Kim KM, Choi SH, Park KS, Florez JC, Jang HC. Differences in pancreatic volume, fat content, and fat density measured by multidetector-row computed tomography according to the duration of diabetes. Acta Diabetol 2014; 51:739-48. [PMID: 24671510 DOI: 10.1007/s00592-014-0581-3] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 03/12/2014] [Indexed: 12/23/2022]
Abstract
Pancreatic volume and fat content might be associated with β-cell function or insulin resistance (IR). We investigated the difference in pancreatic volume and fat content between age- and body mass index (BMI)-matched normal subjects and patients with having different durations of type 2 diabetes (T2D). We compared pancreatic volume and fat parameters between 50 age- and BMI-matched normal subjects, 51 subjects with newly diagnosed type 2 diabetes (T2D-new), 53 subjects with T2D <5 years (T2D<5Y), and 52 subjects with T2D ≥5 years (T2D≥5Y). Age and BMI were matched to range of ±2 years and ±0.5 kg/m(2), respectively. Pancreatic volume and fat were measured by multidetector-row computed tomography with 64 detector-row scanner. The difference in Hounsfield units between pancreas and spleen (HUp-s) was investigated for fat density. Anthropometric and biochemical parameters including the homeostasis model assessment of IR (HOMA-IR) and the insulinogenic index (IGI) were measured. Compared with normal subjects, patients with T2D had significantly smaller pancreatic volume, greater pancreatic fat, and lower HUp-s. Among the groups with T2D, pancreatic volume decreased and pancreatic fat percentage and HUp-s increased from the T2D-new to the T2D<5Y and T2D>5Y groups. Pancreatic volume and fat and HUp-s values were associated with HbA1c and triglyceride levels. Pancreatic volume was correlated with IGI while pancreatic fat and HUp-s values were correlated with HOMA-IR. The current study suggests that pancreatic volume and fat deposition might be associated with the development and progression of T2D in Korean subjects.
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Affiliation(s)
- Soo Lim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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Szczepaniak EW, Malliaras K, Nelson MD, Szczepaniak LS. Measurement of pancreatic volume by abdominal MRI: a validation study. PLoS One 2013; 8:e55991. [PMID: 23418491 PMCID: PMC3572142 DOI: 10.1371/journal.pone.0055991] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 01/04/2013] [Indexed: 01/07/2023] Open
Abstract
Objective To develop abdominal magnetic resonance imaging (MRI) protocol to measure pancreatic volume in humans and to validate it in large animals. Materials and Methods We performed abdominal MRI in eight mini-pigs using a clinical 3T MRI system. We used consecutive parallel abdominal slices, covering the entire pancreas to calculate pancreatic volume. Following MRI, animals were sacrificed, the pancreas was removed, and the volume of the pancreas was measured by water displacement. We used the same MRI protocol to measure pancreatic volume in 21 humans. To assess reproducibility of in vivo measurement we repeated MRI pancreas volume evaluation within 24 hours in additional five humans. Results In mini-pigs the measurements of pancreatic volume by MRI and by water displacement were almost identical (R2 = 0.9867; p<0.0001). In humans the average pancreas volume was 72.7+/−4.5 ml, range from 35.0 to 105.5 ml. This result is in strong agreement with results of previous large postmortem and computed tomography (CT) studies. Repeated measurements of pancreatic volume in humans were highly reproducible. Pancreatic volume measured in vivo was negatively correlated with age, body fat mass, pancreatic TG levels, and visceral fat mass. Conclusions These initial results are highly encouraging and our protocol for pancreatic volume estimation in vivo may prove useful in obesity research to follow in vivo changes of pancreatic volume and structure during time course of obesity and type 2 diabetes development.
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Affiliation(s)
| | | | - Michael D. Nelson
- Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - Lidia S. Szczepaniak
- Cedars-Sinai Medical Center, Los Angeles, California, United States of America
- * E-mail:
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