• computed tomography
• conventional B‐mode ultrasound
• pancreatic fibrosis
• pancreatic steatosis
• two‐dimensional shear‐wave elastography

• Humans
• Elasticity Imaging Techniques/methods
• Male
• Female
• Middle Aged
• Diagnosis, Differential
• Pancreas/diagnostic imaging
• Adult
• Pancreatic Diseases/diagnostic imaging
• Reproducibility of Results
• Fibrosis/diagnostic imaging
• Aged
• Sensitivity and Specificity

• 81971623 National Natural Science Foundation of China

• guideline
• pancreas
• reference values
• student
• ultrasound measurements

• Fatty pancreas
• Hyperechoic pancreas
• Postoperative pancreatic fistula
• Ultrasonography

• fatty infiltration of the pancreas
• metabolic syndrome
• obesity
• pancreatic duct adenocarcinoma
• type 2 diabetes mellitus

• EUS
• aging
• diameter
• ductal adenocarcinoma
• pancreatic duct

• Age
• fat deposition
• pancreatic echogenicity
• pancreatic parenchyma

• Hypoechoic pancreas
• pancreatic
• pancreatitis
• prognosis
• ultrasound

• Animals
• Cats
• Retrospective Studies
• Ultrasonography/standards
• Pancreatitis/diagnostic imaging
• Pancreatitis/veterinary
• Predictive Value of Tests
• Pancreas/diagnostic imaging
• Cat Diseases/diagnostic imaging

• Children
• Interobserver agreement
• Pancreas
• Pancreatic duct
• Pancreatitis
• Ultrasound

• Metabolic Dysfunction
• Metabolic Syndrome
• Pancreatic Cancer
• Pancreatic Fat

• K23 AA025387 NIAAA NIH HHS
• UL1 TR002389 NCATS NIH HHS

• Elastography
• Metabolic syndrome
• NAFPD
• Pancreas stiffness
• Pancreatic steatosis
• Shear wave measurement

This study investigated risk factors for hyperechoic pancreas (HP) on ultrasonography (US) according to HP severity.

Between December 2008 and February 2014, 1,459 subjects who underwent abdominal US as part of health examinations were retrospectively included. Two radiologists assessed and categorized the severity of HP as normal, mild, moderate, and severe. Subjects were allocated to two groups as follows: fatty pancreas 1 (FP1; mild to severe HP) and fatty pancreas 2 (FP2; moderate to severe HP). Clinico-metabolic parameters such as the body mass index and blood test profile of subjects with normoglycemia and prediabetes/diabetes were compared (normal vs. FP1; normal or mild HP vs. FP2). Logistic regression analysis was used to evaluate the associations between HP, nonalcoholic fatty liver disease (NAFLD), and diabetes/prediabetes with adjustment for clinico-metabolic parameters.

Of the 1,459 subjects, 71.2% and 40.4% showed HP and NAFLD on US, respectively. Normoglycemia and prediabetes/diabetes were present in 74.3% and 25.7% of subjects, respectively. Univariable analysis revealed that all the clinico-metabolic parameters were significantly associated with HP (all P<0.05). In the adjusted multivariable analysis, prediabetes/diabetes, NAFLD, age, and body mass index were significantly associated with HP with the FP1 and FP2 criteria. The independent factor with the strongest association with HP was NAFLD using the FP1 criterion (odds ratio [OR], 7.93; P<0.001) and prediabetes/diabetes using the FP2 criterion (OR, 6.96; P<0.001).

NAFLD and prediabetes/diabetes were associated with US-diagnosed HP. Moderate to severe HP was a better predictor of prediabetes/diabetes, suggesting that evaluating HP severity may be useful in clinical practice.

• Diabetes
• Fatty pancreas
• Hyperechoic pancreas
• Nonalcoholic fatty liver disease
• Ultrasonography

Nonalcoholic fatty pancreas disease (NAFPD) is an emerging disease that has gained an increasing amount of attention in recent years. It describes fat accumulation in the pancreas with insignificant alcohol consumption, but the pathogenesis is largely unknown. A wide range of terms have been used to describe the phenomenon of pancreatic fat accumulation, but NAFPD remains an under-recognized and non-independent disorder. Obesity, age, sex, race, and unhealthy lifestyle are established independent risk factors for NAFPD, which is strongly associated with metabolic syndrome, type 2 diabetes, pancreatitis, pancreatic fistula, pancreatic cancer, and nonalcoholic fatty liver disease. At present, imaging techniques are common diagnostic aids, but uniform criteria and consensus are lacking. Therapeutically, healthy diet, weight loss, and exercise are the mainstays to reduce pancreatic fat accumulation. It can be seen that there is a limited understanding of NAFPD at this stage and further exploration is needed. Previous studies have revealed that NAFPD may directly affect diagnosis and clinical decision-making. Therefore, exploring the pathophysiological mechanism and clinical associations of NAFPD is a major challenge for researchers and clinicians.

• Nonalcoholic fatty pancreatic disease
• Pancreatic steatosis
• Obesity
• Metabolic syndrome
• Pancreatic disease
• Pancreas

• Fat
• lipomatous pseudohypertrophy
• pancreas

• insulin resistance
• nonalcoholic fatty liver disease
• nonalcoholic pancreatic steatosis
• ultrasound

The aim of this study was to evaluate the association between the severity of hyperechoic pancreas (HP) on ultrasonography (US) and glycemic progression.

In total, 1,386 participants who underwent abdominal US as part of health examinations between December 2008 and May 2014 were included in this retrospective study. We classified pancreatic echogenicity on a 4-point scale, and compared it using two distinct criteria: fatty pancreas (FP) 1 criterion (normal vs. ≥mild HP) and FP2 criterion (normal/mild HP vs. ≥moderate HP). According to the presence of nonalcoholic fatty liver disease (NAFLD), participants were subdivided into four groups: non-NAFLD and non-HP, isolated NAFLD, isolated HP, and HP with NAFLD. Glycemic progression was defined as progression from normoglycemia to prediabetes or diabetes or progression from prediabetes to diabetes.

During the follow-up (median, 5.9 years), 262 of the 1,386 participants developed glycemic progression. Using FP2, the probability of glycemic progression across the four subgroups showed cumulative aggravation for NAFLD and HP (all P<0.05). Isolated HP showed a higher probability of glycemic progression than isolated NAFLD according to FP2 (P<0.001). The highest probability of glycemic progression was observed in patients with both NAFLD and HP (P<0.001). The hazard ratio for glycemic progression increased with the severity of HP.

Increasing severity of HP on US was found to be significantly correlated with glycemic progression. Moreover, isolated HP of moderate or greater severity predicted glycemic progression independent of NAFLD.

• Diabetes
• Fatty pancreas
• Hyperechoic pancreas
• Nonalcoholic fatty liver disease
• Ultrasonography

• Adipose Tissue/diagnostic imaging
• Adipose Tissue/pathology
• Adult
• Age Factors
• Body Mass Index
• Cystic Fibrosis/complications
• Cystic Fibrosis/diagnostic imaging
• Cystic Fibrosis/pathology
• Cystic Fibrosis/physiopathology
• Diffusion Magnetic Resonance Imaging
• Exocrine Pancreatic Insufficiency/complications
• Female
• Humans
• Male
• Pancreas, Exocrine/physiopathology
• Ultrasonography

• Norwegian CF foundation
• Norwegian Gastroenterology assosiation
• Norwegian gastroenterology assosiation
• Norwegian Gastroenterology Assosiation

• diabetes mellitus
• fatty pancreas
• obesity
• pancreatitis
• steatosis

To examine the relationship between pancreatic hyperechogenicity and risk factors for metabolic syndrome.

A general population-based survey of lifestyle-related diseases was conducted from 2005 to 2006 in Japan. The study involved 551 participants older than 40 year of age. Data for 472 non-diabetic adults were included in the analysis. The measures included the demographic factors, blood parameters, results of a 75 g oral glucose tolerance test, and abdominal ultrasonography. The echogenicity of the pancreas and liver was compared, and then the subjects were separated into two groups: cases with pancreatic hyperechogenicity (n = 208) and cases without (controls, n = 264). The differences between both groups were compared using an unpaired t-test or Fisher’s exact test. Multiple logistic regression analysis was used to determine the relationship between the pancreatic hyperechogenicity and clinical and biochemical parameters.

Subjects with pancreatic hyperechogenicity had decreased serum adiponectin concentration compared to control subjects [8.9 (6.5, 12.8) vs 11.1 (7.8, 15.9), P < 0.001] and more frequently exhibited features of metabolic syndrome. Logistic regression analysis showed that the following variables were significantly and independently associated with pancreatic hyperechogenicity: Presence of hypoadiponectinemia, increased body mass index (BMI), higher homeostasis model assessment of insulin resistance (HOMA-IR) score, and presence of fatty liver. Similar associations were also observed in subjects with pancreatic hyperechogenicity without fatty liver. Multivariate association analysis of data from participants without fatty liver showed that hypoadiponectinemia was significantly associated with pancreatic hyperechogenicity (OR = 0.93, 95%CI: 0.90 - 0.97, P < 0.001). This association was independent of other confounding variables. Additionally, an increased BMI and higher HOMA-IR score were significantly associated with pancreatic hyperechogenicity.

Pancreatic hyperechogenicity is independently associated with increased BMI, insulin resistance, and hypoadiponectinemia in the general population.

• Pancreatic hyperechogenicity
• Metabolic syndrome
• Obesity
• Adiponectin
• The Takahata study

• Aging
• Elastography
• Pancreas
• Ultrasonography

• Adult
• Aged
• Aging/physiology
• Compressive Strength/physiology
• Computer Simulation
• Elastic Modulus/physiology
• Elasticity Imaging Techniques/standards
• Female
• Hardness/physiology
• Humans
• Image Interpretation, Computer-Assisted/methods
• Male
• Middle Aged
• Models, Biological
• Pancreas/diagnostic imaging
• Pancreas/physiology
• Reproducibility of Results
• Sensitivity and Specificity
• Stress, Mechanical
• Tensile Strength/physiology
• Young Adult

• canine pancreas
• chronic pancreatitis
• hyperadrenocorticism
• hyperechoic pancreas
• pancreatic variability

Pancreatic destruction affects the majority of patients with cystic fibrosis. We aimed to relate ultrasound findings to exocrine pancreatic function and cystic fibrosis genotype.

Patients with cystic fibrosis and a matched group of healthy controls were included. We performed transabdominal ultrasound, and recorded echo intensities of the pancreas and parenchymal characteristics according to endoscopic ultrasound based Rosemont criteria.

We included 39 patients and 29 healthy controls. The cystic fibrosis patients were grouped according to exocrine pancreatic function; Cystic fibrosis, insufficient (n = 20) and sufficient (n = 19). Echo intensity measures and visual score demonstrated hyper-echogenicity in the pancreas insufficient group compared to the pancreas sufficient groups (p<0.001). Ductal and parenchymal changes were not prevalent in any of the groups.

The hyper-echoic pancreas was the most frequent ultrasonographic finding in exocrine pancreas insufficient cystic fibrosis patients. Pancreatic echo levels correlated to pancreatic phenotype.

• Adolescent
• Adult
• Aged
• Case-Control Studies
• Cystic Fibrosis/diagnostic imaging
• Cystic Fibrosis/genetics
• Cystic Fibrosis/physiopathology
• Cystic Fibrosis Transmembrane Conductance Regulator/genetics
• Exocrine Pancreatic Insufficiency/diagnostic imaging
• Exocrine Pancreatic Insufficiency/physiopathology
• Female
• Forecasting
• Genetic Association Studies
• Humans
• Male
• Middle Aged
• Pancreas/diagnostic imaging
• Pancreas/physiopathology
• Ultrasonography/methods

• abdomen
• metabolic syndrome
• pancreas
• pancreatic echogenicity
• transabdominal ultrasonography

• Adult
• Female
• Humans
• Intra-Abdominal Fat/diagnostic imaging
• Male
• Metabolic Syndrome/diagnostic imaging
• Pancreas/diagnostic imaging
• Reproducibility of Results
• Retrospective Studies
• Risk Factors
• Ultrasonography

• Fatty infiltration
• Multidetector computed tomography
• pancreas
• pancreatic lipomatosis
• visceral fat

• Diabetes mellitus
• Fatty pancreas
• Glucose
• Nonalcoholic steatohepatitis
• Prediabetes

• Adult
• Blood Glucose/metabolism
• Case-Control Studies
• Diabetes Mellitus, Type 2/epidemiology
• Diabetes Mellitus, Type 2/metabolism
• Female
• Glucose Tolerance Test
• Glycated Hemoglobin/metabolism
• Humans
• Insulin/blood
• Insulin Resistance
• Male
• Middle Aged
• Non-alcoholic Fatty Liver Disease/epidemiology
• Non-alcoholic Fatty Liver Disease/metabolism
• Pancreatic Diseases/diagnostic imaging
• Pancreatic Diseases/epidemiology
• Pancreatic Diseases/metabolism
• Prediabetic State/epidemiology
• Prediabetic State/metabolism
• Prospective Studies
• Ultrasonography

• Age-related change
• Pancreas

• Chronic pancreatitis
• Diabetes mellitus
• Exocrine pancreatic insufficiency
• Fecal elastase 1
• Glycemic control
• Pancreatic enzyme replacement

• Adult
• Aged
• Aged, 80 and over
• Aging/pathology
• Female
• Humans
• Magnetic Resonance Imaging/methods
• Male
• Middle Aged
• Organ Size
• Pancreas/anatomy & histology
• Reference Values
• Reproducibility of Results
• Sensitivity and Specificity
• Young Adult

AIM: To identify the associated risk factors for hyperechogenic pancreas (HP) which may be observed on endoscopic ultrasound (EUS) and to assess the relationship between HP and obesity.

METHODS: From January 2007 to December 2007, we prospectively enrolled 524 consecutive adults who were scheduled to undergo EUS. Patients with a history of pancreatic disease or with hepatobiliary or advanced gastrointestinal cancer were excluded. Finally, 284 patients were included in the analyses. We further analyzed the risk of HP according to the categories of visceral adipose tissue (VAT) and subcutaneous adipose tissue in 132 patients who underwent abdominal computed tomography scans.

RESULTS: On univariate analysis, age older than 60 years, obesity (body mass index > 25 kg/m²), fatty liver, diabetes mellitus, hypertension and hypercholesterolemia were identified as risk factors associated with HP (P < 0.05). On multivariate analysis, fatty liver [P = 0.008, odds ratio (OR) = 2.219], male gender (P = 0.013, OR = 2.636), age older than 60 years (P = 0.001, OR = 2.874) and hypertension (P = 0.044, OR = 2.037) were significantly associated with HP. In the subgroup analysis, VAT was a statistically significant risk factor for HP (P = 0.010, OR = 5.665, lowest quartile vs highest quartile).

CONCLUSION: HP observed on EUS was associated with fatty liver, male gender, age older than 60 years, hypertension and VAT.

• Endoscopic Ultrasound
• Hyperechogenic pancreas
• Obesity

AIM: To investigate the clinical implications of lipid deposition in the pancreas (fatty pancreas).

METHODS: The subjects of this study were 293 patients who had undergone abdominal computed tomography (CT) and sonography. Fatty pancreas was diagnosed by sonographic findings and subdivided into mild, moderate, and severe fatty pancreas groups comparing to the retroperitoneal fat echogenicity.

RESULTS: Fatty pancreas was associated with higher levels for visceral fat, waist circumference, aspartate aminotransferase (AST), alanine aminotransferase (ALT), total cholesterol, triglyceride, high density lipoprotein, free fatty acid, γ-GTP, insulin, and the homeostasis model assessment of insulin resistance (HOMA-IR) than the control group (P < 0.05). HOMA-IR, visceral fat, triglyceride, and ALT also tended to increase with the degree of fat deposition in the pancreas on sonography. In a multivariate logistic regression analysis, HOMA-IR, visceral fat, and ALT level were independently related to fatty pancreas after adjustment for age, body mass index, and lipid profile. The incidence of metabolic syndrome in the fatty pancreas group was significantly higher than in the control group, and the numbers of metabolic syndrome parameters were significantly higher in the fatty pancreas group (P < 0.05).

CONCLUSION: Sonographic fatty pancrease showed higher insulin resistance, visceral fat area, triglyceride, and ALT levels than normal pancreases. Fatty pancreas also showed a strong correlation with metabolic syndrome.

• Fatty pancreas
• Metabolic syndrome
• Insulin resistance

Our aims were (1) by computed tomography (CT) to establish a population database for pancreas volume (parenchyma and fat) from birth to age 100 years, (2) in adults, to establish the impact of gender, obesity, and the presence or absence of type-2 diabetes on pancreatic volume (parenchyma and fat), and (3) to confirm the latter histologically from pancreatic tissue obtained at autopsy with a particular emphasis on whether pancreatic fat is increased in type-2 diabetes. We measured pancreas volume in 135 children and 1,886 adults (1,721 nondiabetic and 165 with type-2 diabetes) with no history of pancreas disease who had undergone abdominal CT scan between 2003 and 2006. Pancreas volume was computed from the contour of the pancreas on each CT image. In addition to total pancreas volume, parenchymal volume, fat volume, and fat/parenchyma ratio (F/P ratio) were determined by CT density. We also quantified pancreatic fat in autopsy tissue of 47 adults (24 nondiabetic and 23 with type-2 diabetes). During childhood and adolescence, the volumes of total pancreas, pancreatic parenchyma, and fat increase linearly with age. From age 20–60 years, pancreas volume reaches a plateau (72.4 ± 25.8 cm³ total; 44.5 ± 16.5 cm³ parenchyma) and then declines thereafter. In adults, total (∼32%), parenchymal (∼13%), and fat (∼68%) volumes increase with obesity. Pancreatic fat content also increases with aging but is not further increased in type-2 diabetes. We provide lifelong population data for total pancreatic, parenchymal, and fat volumes in humans. Although pancreatic fat increases with aging and obesity, it is not increased in type-2 diabetes. Clin. Anat. 20:933–942, 2007. © 2007 Wiley-Liss, Inc.

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Aging
• Autopsy
• Body Mass Index
• Child
• Child, Preschool
• Diabetes Mellitus, Type 2/physiopathology
• Female
• Humans
• Infant
• Infant, Newborn
• Male
• Middle Aged
• Obesity/physiopathology
• Organ Size
• Pancreas/anatomy & histology
• Phantoms, Imaging
• Sex Characteristics
• Thinness/physiopathology
• Tomography, X-Ray Computed

• DK 59579 NIDDK NIH HHS
• DK 61539 NIDDK NIH HHS

• Adipose Tissue/pathology
• Adult
• Aged
• Diagnosis, Differential
• Endosonography
• Exocrine Pancreatic Insufficiency/etiology
• Female
• Humans
• Lipomatosis/complications
• Magnetic Resonance Imaging
• Male
• Pancreatic Diseases/complications
• Steatorrhea/etiology
• Tomography, X-Ray Computed

• Adipose Tissue/pathology
• Adult
• Cholangiopancreatography, Endoscopic Retrograde
• Contrast Media
• Diagnosis, Differential
• Humans
• Islets of Langerhans/pathology
• Lipomatosis/diagnosis
• Male
• Pancreas/pathology
• Pancreatic Diseases/diagnosis
• Pancreatic Ducts/pathology
• Tomography, X-Ray Computed

• Adolescent
• Exocrine Pancreatic Insufficiency/diagnostic imaging
• Exocrine Pancreatic Insufficiency/genetics
• Female
• Humans
• Male
• Syndrome
• Ultrasonography

• Bone Marrow Diseases
• Bone and Bones/diagnostic imaging
• Child
• Child, Preschool
• Exocrine Pancreatic Insufficiency/diagnostic imaging
• Female
• Humans
• Infant
• Male
• Neutropenia
• Osteochondrodysplasias/diagnostic imaging
• Pancreas/diagnostic imaging
• Radiography
• Syndrome
• Ultrasonography

• Bone Marrow/abnormalities
• Child
• Child, Preschool
• Dysostoses/diagnosis
• Dysostoses/diagnostic imaging
• Exocrine Pancreatic Insufficiency/diagnostic imaging
• Female
• Humans
• Infant
• Male
• Radiography
• Ultrasonography

• Adult
• Analysis of Variance
• Fasting
• Female
• Humans
• Male
• Pancreas/anatomy & histology
• Pancreas/diagnostic imaging
• Reproducibility of Results
• Ultrasonography/instrumentation
• Ultrasonography/statistics & numerical data

• Adolescent
• Anemia, Sickle Cell/therapy
• Child
• Child, Preschool
• Hemosiderosis/diagnostic imaging
• Hemosiderosis/etiology
• Hemosiderosis/metabolism
• Humans
• Iron/metabolism
• Liver/diagnostic imaging
• Liver/metabolism
• Pancreas/diagnostic imaging
• Pancreas/metabolism
• Transfusion Reaction
• Ultrasonography

• Adult
• Female
• Humans
• Male
• Pancreas/anatomy & histology
• Ultrasonography/standards

• Humans
• Infant
• Infant, Newborn
• Infant, Premature
• Pancreas/anatomy & histology
• Prospective Studies
• Reference Values
• Ultrasonography