Pancreatic extracellular volume fraction using T1 mapping in patients with impaired glucose intolerance

Pancreatic volume, fat content and T1 relaxation time using magnetic resonance imaging in patients with prior gestational diabetes mellitus

PURPOSE

To compare the volume, fat content, and T1 relaxation time of the pancreas in participants with and without prior gestational diabetes mellitus (GDM).

METHODS

In this prospective case-control study, we enrolled 29 women with prior GDM, and divided them into three groups (normoglycemic, prediabetic, and diabetic) based on their glycaemic status in the postpartum period; and a group of 13 participants as controls who had normoglycemia during pregnancy. Participants underwent MR examination including an axial multi-echo DIXON-based sequence and an axial-oblique T1 mapping sequence. The average proton density fat fraction (PDFF) and T1 value of the pancreas were measured by drawing multiple circular regions of interest (ROIs). Average hepatic PDFF was similarly calculated. Pancreatic volume was computed by summating cleaned freehand ROIs outlining pancreatic parenchyma.

RESULTS

Women were evaluated at a mean age of 32.9 ± 4.0 years and with a mean BMI of 25.2 ± 2.9 kg/m2. The median (IQR) duration of follow-up after childbirth was 24 (34-44) months. In controls, the pancreatic PDFF, T1 value, and volume were 5.4 ± 2.3%, 850.6 ± 101.6 ms, and 69.3 ± 16.2 cm³, respectively, while in subjects with a history of GDM, these values were 4.7 ± 2.0%, 844.6 ± 91.8 ms, and 69.8 ± 16.6 cm³, respectively. No statistical differences were observed (all p > 0.05). Mean hepatic PDFF was significantly higher in the diabetic and prediabetic groups (12.2 ± 6.4% and 11.0 ± 7.6% respectively) than in the control and normoglycemic groups (7.9 ± 7.3 and 4.7 ± 1.6% respectively; p -0.01).

CONCLUSION

We did not find any significant changes in pancreatic volume, fat content, or fibrosis in women with prior GDM and with different glycaemic categories when evaluated in the early postpartum period, compared to the control group. These findings may be a consequence of the transient state of insulin resistance in GDM and the finite duration of the disease course in new-onset prediabetes and diabetes patients.

Whole pancreas water T1 mapping at 3 Tesla

PURPOSE

A fast T1 mapping method of the whole pancreas remains a challenge, due to the complex anatomy of the organ. In addition, a technique for pancreas water T1 mapping is needed, since the T1 is biased in the presence of fat. The purpose of this work is to accelerate the acquisition of water selective T1 (wT1) mapping for the whole pancreas at 3 T.

METHODS

The proposed method combines a continuous inversion-recovery Look-Locker acquisition with a single-shot gradient echo spiral readout, water-fat separation and dictionary matching for wT1 mapping of the whole pancreas at 3 T. The bias of T1 in the presence of fat was evaluated in a phantom by comparing the modified Look-Locker inversion-recovery (MOLLI) and the proposed method to MRS measurements. The present method was validated in 11 volunteers by evaluating its pancreas coverage and repeatability and by comparing it to MOLLI. Four pancreatitis patients were evaluated using the proposed method and clinical scans.

RESULTS

The phantom wT1 results are in better agreement to MRS (wT 1 = 1.02 *wT 1 MRS - 47.81 , R 2 = 0.99 ) than MOLLI (T 1 MOLLI = 1.13 ∗ wT 1 MRS - 74.65 , R 2 = 0.98 ) . The volunteer wT1 results demonstrate the whole pancreas coverage capability for different fat fractions, good repeatability (wT 1 , 2 ∘ = 0.98 ∗ wT 1 , 1 ∘ + 17.40 , R 2 = 0.69 ) and lower T1 values than MOLLI (wT 1 = 0.34 *T 1 MOLLI + 383.65 , R 2 = 0.26 ) . The wT1 maps in patients captured diverse pancreatitis regions with higher values ( wT 1 Patients = 831 - 1696 ms ) than in the volunteerswT 1 Volunteers = 605 - 799 ms , thus showing their potential clinical feasibility.

CONCLUSION

The present work proposes a wT1 mapping methodology of the whole pancreas at 3 T, where 24 slices ( 2 × 2 × 5 mm 3 ) were acquired in three short breath-holds of 12 s each.

Multiparametric Magnetic Resonance Imaging Findings of the Pancreas: A Comparison in Patients with Type 1 and 2 Diabetes

BACKGROUND/OBJECTIVES

Diabetes-related pancreatic changes on MRI remain unclear. Thus, we evaluated the pancreatic changes on MRI in patients with both type 1 diabetes (T1D) and type 2 diabetes (T2D) using multiparametric MRI.

METHODS

This prospective study involved patients with T1D or T2D who underwent upper abdominal 3-T MRI. Additionally, patients without impaired glucose metabolism were retrospectively included as a control. The imaging data included pancreatic anteroposterior (AP) diameter, pancreas-to-muscle signal intensity ratio (SIR) on fat-suppressed T1-weighted image (FS-T1WI), apparent diffusion coefficient (ADC) value, T1 value on T1 map, proton density fat fraction (PDFF), and mean secretion grade of pancreatic juice flow on cine-dynamic magnetic resonance cholangiopancreatography (MRCP). The MR measurements were compared using one-way analysis of variance and the Kruskal-Wallis test.

RESULTS

Sixty-one patients with T1D (n = 7) or T2D (n = 54) and 21 control patients were evaluated. The pancreatic AP diameters were significantly smaller in patients with T1D than in patients with T2D (p < 0.05). The average SIR on FS-T1WI was significantly lower in patients with T1D than in controls (p < 0.001). The average ADC and T1 values of the pancreas were significantly higher in patients with T1D than in patients with T2D (p < 0.01) and controls (p < 0.05). The mean secretion grade of pancreatic juice flow was significantly lower in patients with T1D than in controls (p = 0.019). The average PDFF of the pancreas was significantly higher in patients with T2D than in controls (p = 0.029).

CONCLUSIONS

Patients with T1D had reduced pancreas size, increased pancreatic T1 and ADC values, and decreased pancreatic juice flow on cine-dynamic MRCP, whereas patients with T2D had increased pancreatic fat content.

Pancreatic extracellular volume fraction on routine contrast-enhanced computed tomography can predict pancreatic fibrosis and postoperative pancreatic fistula

BACKGROUND/OBJECTIVES

Postoperative pancreatic fistula (POPF) is a critical complication of pancreatectomy, with a higher risk associated with the absence of pancreatic fibrosis. We investigated whether pancreatic extracellular volume fraction (ECV) calculated from preoperative contrast-enhanced computed tomography (CE-CT) images can be used to predict pancreatic fibrosis and POPF.

METHODS

This retrospective study included patients who underwent CE-CT before pancreatectomy. ECV map was created by subtracting unenhanced from equilibrium-phase images. We assessed the relationship between pancreatic ECV, the histopathological grade of fibrosis at the pancreatic resection margin, and the occurrence of POPF.

RESULTS

Among the 107 patients included, 66 underwent pancreaticoduodenectomy (PD) and 41 underwent distal pancreatectomy (DP). The median ECV at the pancreatic resection margin was 22.5 %. Pancreatic ECV significantly correlated with the histopathological grade of pancreatic fibrosis (ρ = 0.689; p < 0.001). In PD cases, the ECV was an independent risk factor for all-grade POPF (odds ratio, 0.852; 95 % confidence interval, 0.755-0.934), with excellent predictive capability (area under the curve, 0.912; 95 % confidence interval, 0.842-0.983). In DP cases, pancreatic thickness was the only factor associated with all-grade POPF.

CONCLUSIONS

Pancreatic ECV obtained from routine CE-CT images accurately predicted the histopathological grade of pancreatic fibrosis and was an independent risk factor for POPF after PD.

Imaging abnormalities of the pancreas in diabetes: implications for diagnosis and treatment

PURPOSE OF REVIEW

Radiographic imaging of the pancreas has drawn recent interest as pancreas volume may serve as a biomarker in identifying the likelihood of diabetes development, subtyping diabetes, and identifying prognostic indicators of poor ultimate outcomes. In this review, the role of pancreas imaging is discussed in various forms of diabetes including type 1 diabetes (T1D), type 2 diabetes (T2D), and diabetes of the exocrine pancreas, particularly diabetes following acute or chronic pancreatitis.

RECENT FINDINGS

Recent literature of quantitative pancreatic imaging correlating with various forms of diabetes was reviewed. Imaging-derived pancreas volumes are lower in individuals with diabetes, in particular those with T1D. Additionally, morphologic changes, enhancement characteristics, fat content, and MRI signal changes have been observed in different diabetes subtypes. These characteristics, as well as potential confounding variables, are reviewed. Additionally, future areas of research in MRI, CT radiomics, and pancreatitis-related imaging predictors of diabetes are discussed.

SUMMARY

Increased understanding of pancreas imaging features which predict diabetes and gauge prognosis has the potential to identify at-risk individuals and will become increasingly important in diabetes care. This article reviews the current knowledge of common pancreas imaging features as well as future directions of ongoing research in diabetes imaging.

Cross-sectional imaging of the pancreas in diabetes

Diabetes mellitus presents a global health challenge characterized by dysregulated glucose metabolism and insulin resistance. Pancreas dysfunction contributes to the development and progression of diabetes. Cross-sectional imaging modalities have provided new insight into the structural and functional alterations of the pancreas in individuals with diabetes. This review summarizes MRI and CT studies that characterize pancreas alterations in both type 1 and type 2 diabetes and discusses future applications of these techniques.

Hepatic and pancreatic extracellular volume fraction analysis using contrast-enhanced CT in patients with diabetes mellitus and pre-diabetes

PURPOSE

Liver and pancreatic fibrosis is associated with diabetes mellitus (DM), and liver fibrosis is associated with pancreatic fibrosis. This study aimed to investigate the relationship between the hepatic and pancreatic extracellular volume fractions (fECVs), which correlate with tissue fibrosis, and their relationships with DM and pre-DM (pDM).

MATERIAL AND METHODS

We included 100 consecutive patients with known or suspected liver and/or pancreatic diseases who underwent contrast-enhanced CT. Patients were classified as nondiabetes, pDM, and DM with hemoglobin A1c (HbA1c) levels of < 5.7%, 5.7%-6.5%, and ≥ 6.5% or fasting plasma glucose (FPG) levels of < 100, 100-125 mg/dL, and ≥ 126 mg/dL, respectively. Subtraction images between unenhanced and equilibrium-phase images were prepared. The liver and the pancreas were automatically extracted using a high-speed, three-dimensional image analysis system, and their respective mean CT values were calculated. The enhancement degree of the aorta (Δaorta) was measured. fECV was calculated using the following equation: fECV = (100 - hematocrit) * Δliver or pancreas/Δaorta. Differences were investigated in hepatic and pancreatic fECVs among the three groups, and the correlation between each two in hepatic fECV, pancreatic fECV, and HbA1c was determined.

RESULTS

The pancreatic fECV, which was positively correlated with the hepatic fECV and HbA1c (r = 0.51, P < 0.001, and r = 0.51, P < 0.001, respectively), significantly differed among the three groups (P < 0.001) and was significantly greater in DM than in pDM or nondiabetes and in pDM with nondiabetes (P < 0.001). Hepatic fECV was significantly greater in DM than in nondiabetes (P < 0.05).

CONCLUSION

The pancreatic fECV and pDM/DM are closely related.

T1 and T2-mapping in pancreatic MRI: Current evidence and future perspectives

Conventional T1- and T2-weighted magnetic resonance imaging (MRI) of the pancreas can vary significantly due to factors such as scanner differences and pulse sequence variations. This review explores T1 and T2 mapping techniques, modern MRI methods providing quantitative information about tissue relaxation times. Various T1 and T2 mapping pulse sequences are currently under investigation. Clinical and research applications of T1 and T2 mapping in the pancreas include their correlation with fibrosis, inflammation, and neoplasms. In chronic pancreatitis, T1 mapping and extracellular volume (ECV) quantification demonstrate potential as biomarkers, aiding in early diagnosis and classification. T1 mapping also shows promise in evaluating pancreatic exocrine function and detecting glucose metabolism disorders. T2* mapping is valuable in quantifying pancreatic iron, offering insights into conditions like thalassemia major. However, challenges persist, such as the lack of consensus on optimal sequences and normal values for healthy pancreas relaxometry. Large-scale studies are needed for validation, and improvements in mapping sequences are essential for widespread clinical integration. The future holds potential for mixed qualitative and quantitative models, extending the applications of relaxometry techniques to various pancreatic lesions and enhancing routine MRI protocols for pancreatic pathology diagnosis and prognosis.

Quantitative Magnetic Resonance Imaging for the Pancreas: Current Status

ABSTRACT

Magnetic resonance imaging (MRI) is important for evaluating pancreatic disorders, and anatomical landmarks play a major role in the interpretation of results. Quantitative MRI is an effective diagnostic modality for various pathologic conditions, as it allows the investigation of various physical parameters. Recent advancements in quantitative MRI techniques have significantly improved the accuracy of pancreatic MRI. Consequently, this method has become an essential tool for the diagnosis, treatment, and monitoring of pancreatic diseases. This comprehensive review article presents the currently available evidence on the clinical utility of quantitative MRI of the pancreas.

Quantitative assessment of extraocular muscles in Graves' ophthalmopathy using T1 mapping

OBJECTIVE

To evaluate the performance of T1 mapping in the characterization of extraocular muscles (EOMs) of Graves' ophthalmopathy (GO) patients and investigate its feasibility in assessing the response to glucocorticoid therapy in active GO patients.

METHODS

A total of 133 participants (78 active GO, 23 inactive GO, 18 Graves' disease (GD) patients, and 14 healthy volunteers) were consecutively enrolled from July 2018 to December 2020. Native T1 (nT1) and postcontrast T1 (cT1) values of EOMs were measured and compared. The variations in T1 mapping metrics of EOMs were compared pre/post glucocorticoid treatment in 23 follow-up active GO patients. Logistic regression analysis and receiver operating characteristic (ROC) curve analysis were performed.

RESULTS

The nT1 of EOMs in GO patients was higher than that in GD patients and healthy volunteers. The nT1 of superior rectus (SR) in active GO was higher than that in inactive GO patients, and it could be used as a potential marker of GO activity (OR: 1.003; 95% CI: 1.001, 1.004), with a diagnostic sensitivity of 86.3% and specificity of 43.7%. Meanwhile, the cT1 of SR, inferior rectus (IR), and medial rectus (MR) in inactive GO patients were higher than those in active GO patients. The nT1 of EOMs achieved sufficient diagnostic performance in evaluating the response to glucocorticoid therapy for follow-up active GO patients (AUC, 0.797; sensitivity, 71.9%; specificity, 85.7%).

CONCLUSIONS

T1 mapping could quantitatively assess the activity of GO and the response to glucocorticoid therapy in active GO patients and may even potentially reflect the fibrosis of EOMs.

CLINICAL RELEVANCE STATEMENT

T1 values can reflect the pathological status of the extraocular muscle. T1 mapping could help to quantitatively assess the clinical activity of GO and the response to glucocorticoid therapy in active GO patients.

KEY POINTS

• Graves' ophthalmopathy patients had greater nT1 of extraocular muscles than Graves' disease patients and healthy volunteers, and nT1 of the superior rectus could be a potential marker of Graves' ophthalmopathy activity. • The cT1 of extraocular muscles in inactive Graves' ophthalmopathy patients was higher than that in active Graves' ophthalmopathy patients, and it might be associated with muscle fibrosis. • nT1 of extraocular muscles could offer sufficient diagnostic performance in evaluating the response to glucocorticoid therapy for follow-up active Graves' ophthalmopathy patients.

Correlations between contrast-enhanced CT-measured extracellular volume fraction, histopathological features, and MYCN amplification status in abdominal neuroblastoma: a retrospective study

PURPOSE

To retrospectively investigate the correlations between contrast-enhanced CT (CECT)-measured extracellular volume fraction (fECV) and histopathological features, as well as MYCN amplification status, in abdominal neuroblastoma.

MATERIALS AND METHODS

One hundred and forty-one patients with abdominal neuroblastoma who underwent CECT scanning were retrospectively enrolled. Calculation of fECV involved the measurement of CT values within regions of interest located within the neuroblastoma and aorta on both non-contrast-enhanced CT and equilibrium CECT. The correlations between fECV and various factors, including pathological subtype, mitosis karyorrhexis index (MKI), Shimada classification, MYCN amplification status, International Neuroblastoma Risk Group (INRG) stage, and risk group were analyzed using either the Mann-Whitney U test or Kruskal-Wallis test.

RESULTS

Neuroblastoma and ganglioneuroblastoma exhibited fECV values of 0.349 (0.252, 0.424) and 0.438 (0.327, 0.508), respectively, indicating a statistically significant difference (Z = 2.200, P = 0.028). Additionally, the fECV decreased significantly in neuroblastoma with high MKI (H = 8.314, P = 0.016) or unfavorable histology (Z = 3.880, P < 0.001), as well as in those with MYCN amplification (Z = 5.486, P < 0.001). Notably, a significant variation in fECV was observed among different INRG stages (H = 16.881, P <0.001) and risk groups (H = 29.014, P < 0.001).

CONCLUSION

CECT-derived fECV is associated with histopathological features, MYCN amplification status, INRG stage, and risk stratification of abdominal neuroblastoma, reflecting a potential correlation between the extracellular matrix and the biological behavior of neuroblastoma.

Extracellular volume fraction of the pancreas predicts glucose intolerance in patients undergoing major pancreatic surgeries

PURPOSE

Pancreatic T1 value and extracellular volume fraction (ECV) are potential imaging biomarkers for pancreatic exocrine and endocrine function. This study aims to evaluate the ability of native T1 value and ECV of the pancreas in predicting postoperative new-onset diabetes (NODM) and worsened glucose tolerance in patients undergoing major pancreatic surgeries.

METHODS

This retrospective study involved 73 patients who underwent 3 T pancreatic MRI with pre- and postcontrast T1 mapping before major pancreatic surgeries. Patients were divided into non-diabetic, pre-diabetic and diabetic groups based on their glycated hemoglobin (HbA1c) value. Preoperative native T1 value and ECV of the pancreas were compared among the three groups. The correlation of pancreatic T1 value and ECV with HbA1c was assessed by linear regression analysis, and the ability of pancreatic T1 value and ECV for predicting postoperative NODM and worsened glucose tolerance was assessed using Cox Proportional hazards regression analysis.

RESULTS

Native pancreatic T1 value and ECV were both significantly higher in diabetic patients compared to pre-diabetic/non-diabetic patients, and ECV was also significantly higher in pre-diabetic patients compared to non-diabetic patients (all p < 0.05). Both native pancreatic T1 value and ECV showed positive correlation with preoperative HbA1c value (r = 0.50 and 0.55, respectively, both p < 0.001). ECV > 30.7% was the only independent predictor for NODM (HR = 5.687, 95% CI: 1.557, 13.468, p = 0.012) and worsened glucose tolerance (HR = 6.783, 95% CI:, 1.753, 15.842, p = 0.010) after surgery.

CONCLUSIONS

Pancreatic ECV predicts the risk of postoperative NODM and worsened glucose tolerance in patients undergoing major pancreatic surgeries.

Image or scope: Magnetic resonance imaging and endoscopic testing for exocrine and endocrine pancreatic insufficiency in children

OBJECTIVES

We sought to evaluate associations between Magnetic Resonance Imaging (MRI) findings, exocrine pancreatic insufficiency (EPI) and endocrine insufficiency (prediabetes or diabetes) in children.

METHODS

This was a retrospective study that included patients<21 years of age who underwent MRI and endoscopic pancreatic function testing (ePFT; reference standard for pancreatic exocrine function) within 3 months. MRI variables included pancreas parenchymal volume, secreted fluid volume in response to secretin, and T1 relaxation time. Data were analyzed for the full sample as well as the subset without acute pancreatitis (AP) at the time of imaging.

RESULTS

Of 72 patients, 56% (40/72) were female with median age 11.4 years. A 5 mL decrease in pancreas parenchymal volume was associated with increased odds of exocrine pancreatic dysfunction by both ePFT (OR = 1.16, p = 0.02 full sample; OR = 1.29, p = 0.01 no-AP subset), and fecal elastase (OR = 1.16, p = 0.04 full sample; OR = 1.23, p = 0.02 no-AP subset). Pancreas parenchymal volume had an AUC 0.71 (95% CI: 0.59, 0.83) for predicting exocrine pancreatic dysfunction by ePFT and when combined with sex and presence of AP had an AUC of 0.82 (95% CI: 0.72, 0.92). Regarding endocrine function, decreased pancreas parenchymal volume was associated with increased odds of diabetes (OR = 1.16, p = 0.03), and T1 relaxation time predicted glycemic outcomes with an AUC 0.78 (95% CI: 0.55-1), 91% specificity and 73% sensitivity.

CONCLUSIONS

Pancreas parenchymal volume is an MRI marker of exocrine and endocrine pancreatic dysfunction in children. A model including sex, AP, and pancreas volume best predicted exocrine status. T1 relaxation time is also an MRI marker of endocrine insufficiency.

Changes in pancreatic exocrine function, fat and fibrosis in diabetes mellitus: analysis using MR imaging

OBJECTIVE

To evaluate the relationships between hemoglobin A1c (HbA1c) levels with exocrine pancreatic function using cine-dynamic magnetic resonance cholangiopancreatography (MRCP) and the pancreatic parenchyma using fat-suppressed T1 mapping and the proton density fat fraction (PDFF).

METHODS

Patients who underwent 3T-MRI and HbA1c measurement were retrospectively recruited. MRI included cine-dynamic MRCP with a spatially selective inversion-recovery (SS-IR) pulse, fat-suppressed Look-Locker T1 mapping and multiecho 3D Dixon-based PDFF mapping. The pancreatic exocrine secretion grade on cine-dynamic MRCP, T1 values, and PDFF were analyzed in non-diabetic (n = 32), pre-diabetic (n = 44) and diabetic (n = 23) groups defined using HbA1c.

RESULTS

PDFF was weakly correlation with HbA1c (ρ = 0.30, p = 0.002). No correlations were detected between HbA1c and secretion grade (ρ = - 0.16, p = 0.118) or pancreatic parenchymal T1 (ρ = 0.13, p = 0.19). The secretion grade was comparable between the three groups. The T1 value was higher in diabetic (T1 = 1006.2+/- 224.8 ms) than in non-diabetic (T1 = 896.2+/- 86.3 ms, p = 0.010) and pre-diabetic (T1 = 870.1+/- 91.7 ms, p < 0.010) patients. The PDFF was higher in diabetic (FF = 11.8+/- 8.7 %) than in non-diabetic (FF = 6.8+/- 4.2 %, p = 0.014) patients.

CONCLUSION

Pancreatic exocrine function, T1, and FF showed no correlation with HbA1c. Pancreatic T1 and fat fraction is increased in patients with Type 2 diabetes mellitus.

ADVANCES IN KNOWLEDGE

This study demonstrates unaffected exocrine function in pre-diabetes and diabetes and confirms that pancreatic parenchymal T1 and FF are increased in patients with diabetes.

A Preliminary Pathological Evaluation of Extracellular Volume Fraction with Contrast-enhanced Computed Tomography as a Novel Quantitative Parameter of Pancreatic Fibrosis

Objective The extracellular volume (ECV) calculated based on contrast-enhanced computed tomography (CT) has been reported as a novel imaging parameter reflecting the morphological change of fibrosis in several parenchymal organs. Our retrospective study assessed the validity of the ECV fraction for diagnosing pancreatic fibrosis and the appropriate imaging condition as the "equilibrium phase". Methods In 27 patients undergoing multiphasic CT and subsequent pancreaticoduodenectomy, we investigated pathological fibrotic changes related to the ECV fraction and conducted analyses using the value obtained by subtracting the equilibrium CT value of the portal vein from that of the abdominal aorta (Ao-PV_equilibrium) to estimate eligibility of the equilibrium phase. Results In all patients, the ECV fraction showed a weak positive correlation with the collagenous compartment ratio (r=0.388, p=0.045). All patients were divided into two groups - the high-Ao-PV_equilibrium group and low-Ao-PV_equilibrium group - based on the median value. No significant correlation was found in the high-Ao-PV_equilibrium group, whereas a significant correlation was observed in the low-Ao-PV_equilibrium group (r=0.566, p=0.035). Conclusion The ECV fraction is a possible predictive factor for histopathological pancreatic fibrosis. In its clinical application, the eligibility of the "equilibrium phase" may affect the diagnostic capability. It will be necessary to verify the imaging conditions in order to improve the accuracy of the diagnosis.

Therapeutic and diagnostic targeting of fibrosis in metabolic, proliferative and viral disorders

Fibrosis is a common denominator in many pathologies and crucially affects disease progression, drug delivery efficiency and therapy outcome. We here summarize therapeutic and diagnostic strategies for fibrosis targeting in atherosclerosis and cardiac disease, cancer, diabetes, liver diseases and viral infections. We address various anti-fibrotic targets, ranging from cells and genes to metabolites and proteins, primarily focusing on fibrosis-promoting features that are conserved among the different diseases. We discuss how anti-fibrotic therapies have progressed over the years, and how nanomedicine formulations can potentiate anti-fibrotic treatment efficacy. From a diagnostic point of view, we discuss how medical imaging can be employed to facilitate the diagnosis, staging and treatment monitoring of fibrotic disorders. Altogether, this comprehensive overview serves as a basis for developing individualized and improved treatment strategies for patients suffering from fibrosis-associated pathologies.

Pancreas and kidney changes in type 2 diabetes patients: the role of diffusion-weighted imaging

Background/aim

The aim of this study was to compare renal and pancreatic apparent diffusion-coefficient (ADC) values of diabetic patients and control subjects and to examine their potential association with several diabetes-related clinical parameters.

Materials and methods

A total of 80 sex- and age-matched patients were included in the study. Of them, 40 were patients with type 2 diabetes and 40 were nondiabetic participants. Abdominal diffusion-weighted MRIs of both groups were retrospectively reviewed. Diabetes-related clinical parameters were recorded.

Results

The difference between the mean ADC values of the patient group and the control group was significant (p = 0.012). It was also found that the mean pancreatic ADC values of diabetic patients and the control group significantly differed (p = 0.02). Besides, there were positive correlations between the mean pancreatic ADC values and age, Hb1Ac level, treatment type, and disease duration (p < 0.05). While eGFR values positively correlated with the mean renal ADC values (p < 0.05), there were negative correlations between such values and age, serum creatinine level, and disease duration (p < 0.05).

Conclusion

Renal and pancreatic ADC values of diabetic patients could potentially play a role, as markers of renal and pancreatic functions, in clinical decisions in the follow-up of such patients.

Quantitative Magnetic Resonance Imaging of the Pancreas of Individuals With Diabetes

Magnetic resonance imaging (MRI) has the potential to improve our understanding of diabetes and improve both diagnosis and monitoring of the disease. Although the spatial resolution of MRI is insufficient to directly image the endocrine pancreas in people, the increasing awareness that the exocrine pancreas is also involved in diabetes pathogenesis has spurred new MRI applications. These techniques build upon studies of exocrine pancreatic diseases, for which MRI has already developed into a routine clinical tool for diagnosis and monitoring of pancreatic cancer and pancreatitis. By adjusting the imaging contrast and carefully controlling image acquisition and processing, MRI can quantify a variety of tissue pathologies. This review introduces a number of quantitative MRI techniques that have been applied to study the diabetic pancreas, summarizes progress in validating and standardizing each technique, and discusses the need for image analyses that account for spatial heterogeneity in the pancreas.