Pancreatic perfusion and subsequent response to glucose in healthy individuals and patients with type 1 diabetes

Abstract

Aims/hypothesis The aim of this study was to investigate pancreatic perfusion and its response to a glucose load in patients with type 1 diabetes mellitus compared with non-diabetic ('healthy') individuals. Methods Eight individuals with longstanding type 1 diabetes and ten sex-, age-and BMI-matched healthy controls underwent dynamic positron emission tomography scanning with 15 O-labelled water before and after intravenous administration of glucose. Perfusion in the pancreas was measured. Portal and arterial hepatic perfusion were recorded as references. Results Under fasting conditions, total pancreatic perfusion was on average 23% lower in the individuals with diabetes compared with healthy individuals. Glucose increased total pancreatic and portal hepatic blood perfusion in healthy individuals by 48% and 38%, respectively. In individuals with diabetes there was no significant increase in either total pancreatic or portal hepatic perfusion.Conclusions/interpretation Individuals with type 1 diabetes have reduced basal pancreatic perfusion and a severely impaired pancreatic and splanchnic perfusion response to intravenous glucose stimulation.

[11C]5-hydroxy-tryptophan PET for Assessment of Islet Mass During Progression of Type 2 Diabetes

“…The secondary outcomes demonstrated a tendency for decreased perfusion of the T2D pancreas in lean individuals, which is in agreement with previously reported results (26) and as also seen in subjects with T1D (27). We found increased pancreatic size, as well as increased hepatic fat content, in both groups of obese individuals with T2D, which is also in agreement with previous studies.…”

Pancreatic perfusion and arterial‐transit‐time quantification using pseudocontinuous arterial spin labeling at 3T

“…Our study clearly demonstrated pancreatic perfusion signal, permitting an assessment of image quality, artifacts, and heterogeneity of flow, showing benefits of a localized pCASL labeling strategy in the abdomen, where residual vascular signal associated with a global labeling approach (e.g., FAIR) could compromise image quality and robustness as seen in some earlier reports and in the current work. The absolute PBF estimated in our study is nonetheless in‐line with previous reports using MRI and [ 15 O]H 2 0‐PET, although substantial variability was found in existing literature. For instance, our results are in agreement with previous ASL work by Cox et al and DCE by Bali et al, but lower by 30% than another ASL study by Schraml et al, while remaining within the SD of that study.…”

“…Noninvasive functional pancreas imaging presents high clinical relevance to diagnose, grade and monitor multiple neoplastic, inflammatory or metabolic diseases. For instance, pancreas perfusion could be a valuable marker of endocrine dysfunction in diabetes, assess necrosis and fibrosis in acute/chronic pancreatitis, help discrimination between benign and malignant pancreatic masses or different disease phenotypes, and assess treatment response in pancreatic cancer, for example by monitoring antiangiogenic effects of targeted therapies …”

“…Arterial spin labeling (ASL) is an interesting alternative to more widely used contrast‐enhanced modalities ( 15 O‐PET, CT perfusion, or DCE‐MRI) due to several advantages, such as repeatability due to the absence of contrast agent injection or ionizing radiation, applicability in patients with poor renal function, and simplified straightforward quantification compared with DCE‐MRI. However, while clinically relevant, abdominal ASL has not been as successfully translated to clinical applications as in neuroimaging.…”

Pancreatic perfusion modulation following glucose stimulation assessed by noninvasive arterial spin labeling (ASL) MRI

“…Although tissue perfusion can be measured, in principle, by multiple modalities (positron emission tomography [PET], contrast‐enhanced computed tomography, dynamic contrast‐enhanced [DCE], arterial spin labeling [ASL], magnetic resonance imaging [MRI]), imaging‐based studies of pancreatic perfusion modulation following a glucose challenge are not conclusive. A previous study using 15 O‐PET successfully showed flow modulation following an IV glucose injection, but another study using ASL could not highlight any perfusion changes during a hyperglycemic clamp . Using ASL would be highly desirable because the absence of exogenous contrast facilitates repeated examinations and absolute blood‐flow calculation is relatively straightforward.…”