Diffusion-weighted magnetic resonance imaging in the pancreas of fulminant type 1 diabetes
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Abrupt disease onset and severe metabolic disorders are main characteristics of fulminant type 1 diabetes. Diffusion-weighted magnetic resonance imaging (DWI) is an imaging technique that reflects restricted diffusion in organs and can detect mononuclear cell infiltration into the pancreas at the onset of the disease. Fourteen patients with fulminant type 1 diabetes who underwent abdominal magnetic resonance imaging were recruited for the measurement of apparent diffusion coefficient (ADC) values of the pancreas that were compared with those of 21 non-diabetic controls. The ADC values of all parts of the pancreas were significantly lower in fulminant type 1 diabetes than in controls (head, 1.424 ± 0.382 × 10−3 vs. 1.675 ± 0.227 × 10−3 mm2/s; body, 1.399 ± 0.317 × 10−3 vs. 1.667 ± 0.170 × 10−3 mm2/s; tail, 1.336 ± 0.247 × 10−3 vs. 1.561 ± 0.191 × 10−3 mm2/s; mean, 1.386 ± 0.309 × 10−3 vs. 1.634 ± 0.175 × 10−3 mm2/s) (p < 0.01). The best cut-off value indicated that the sensitivity was 86% and the specificity was 71% when using DWI, which was also efficient in two atypical patients with fulminant type 1 diabetes without elevated levels of exocrine pancreatic enzymes or with high HbA1c levels due to the preexistence of type 2 diabetes. The ADC values were significantly correlated to plasma glucose levels and arterial pH, and tended to increase with the lapse of time. DWI may be an additional tool for making an efficient diagnosis of fulminant type 1 diabetes.
KeywordsFulminant Type 1 diabetes Magnetic resonance imaging Diffusion-weighted imaging Apparent diffusion coefficient
The authors thank another member of the Japan Diabetes Society Committee on Fulminant Type 1 Diabetes Mellitus Research, Seiho Nagafuchi (Department of Medical Science and Technology, Graduate School of Medical Sciences, Kyushu University) for discussion. Japan Diabetes Society Committee on Fulminant Type 1 Diabetes Mellitus Research: Akihisa Imagawa, Norio Abiru, Takuya Awata, Hiroshi Ikegami, Yasuko Uchigata, Yoichi Oikawa, Haruhiko Osawa, Hiroshi Kajio, Eiji Kawasaki, Yumiko Kawabata, Junji Kozawa, Akira Shimada, Kazuma Takahashi, Shoichiro Tanaka, Daisuke Chujo, Tomoyasu Fukui, Junnosuke Miura, Kazuki Yasuda, Hisafumi Yasuda, Tetsuro Kobayashi, Toshiaki Hanafusa.
Compliance with ethical standards
Conflict of interest
The authors declare no conflicts of interest.
Human rights statement
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Opt-out opportunities are provided to study subjects.
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