MRI appearance of the pancreas in patients with cystic fibrosis: a comparison of pancreas volume in diabetic and non-diabetic patients

Abstract

ABSTRACT. We investigated differences in the volume of the pancreas in cystic fibrosis (CF) patients with and without diabetes using MRI to study the natural history of CFrelated diabetes (CFRD). We investigated 29 pancreas-insufficient adult CF patients, 13 with CFRD and 16 without diabetes. Patients with CFRD were receiving insulin therapy at the time of study. None of the non-diabetic CF patients had evidence of impaired glucose tolerance. Pancreas volume was estimated by MRI scans using T 1 weighted fatsuppression sequences and assessed by an examiner who was unaware of the patients' diabetes status. Pancreas volume of CF patients was measured and subsequently compared with that of non-CF age-matched Type 1 diabetes (T1DM) patients and healthy controls previously investigated. The two CF groups were matched for age and gender. There were no differences in spirometry values, body mass index or pancreatic exocrine function. The pancreas was visible by MRI in only 3 of 13 (23.1%) patients with CFRD and in 5 of 16 (31.3%) patients without diabetes (p-value50.7). In total, the pancreas was not detected by MRI as an anatomical entity in 21 of 29 (72.4%) CF patients, irrespective of their diabetes status. When comparing the four study groups, the pancreas was significantly smaller in CF patients than in T1DM patients and healthy controls.

Abnormalities of the Exocrine Pancreas in Type 1 Diabetes

“…Smaller pancreata in patients with T1D have been reported by several groups [4•, 5, 34–37]. The autopsy findings were corroborated by radiographic studies using US, CT, and MRI of the pancreas [5, 31, 38–42]. Taken collectively, autopsy weights and clinical imaging studies show pancreatic weights or volumes are reduced by 20–50 % in children and adults with T1D compared to nondiabetic controls.…”

“…It is now evident that exocrine function and morphology should be evaluated in patients with diabetes, at least at the time of diagnosis. Imaging techniques like ultrasound (US), computerized tomography (CT), and magnetic resonance imaging (MRI) can greatly facilitate the assessment of the pancreas and correlate volume with exocrine function [29–31]. …”

Reduced beta‐cell reserve and pancreatic volume in survivors of childhood acute lymphoblastic leukaemia treated with bone marrow transplantation and total body irradiation

“…A number of previous studies have reported the lack of association between pancreatic volume and function. Sequeiros et al . described a group of nondiabetic cystic fibrosis patients with very small pancreatic size and suggested that sufficient insulin production only requires very small amounts of β‐cell mass.…”

Cystic fibrosis: An update for clinicians. Part 2: Hepatobiliary and pancreatic manifestations

“…The interstitial pools of zymogen elicit an inflammatory response, with eventual loss of exocrine tissue and replacement by connective tissue . The destruction of the pancreas can be so extensive, that in one study, 72% of patients imaged with magnetic resonance imaging did not have a pancreas detected as an anatomical entity …”