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Almutairi FF. The feasibility of point shear wave elastography (pSWE) in the assessment of pancreas stiffness in diabetic patients and healthy volunteers. PLoS One 2024; 19:e0303098. [PMID: 38857243 PMCID: PMC11164356 DOI: 10.1371/journal.pone.0303098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 04/17/2024] [Indexed: 06/12/2024] Open
Abstract
Type 1 diabetes mellitus (T1DM) is an autoimmune disease characterized by the dysfunctional metabolism of carbohydrates, fats, and proteins caused by impaired insulin secretion and insulin resistance. This study investigated the feasibility of using point shear wave elastography (pSWE) of the pancreas by comparing the shear wave velocity (SWV) measurements of three anatomical areas in patients with T1DM and healthy volunteers. This study included 30 patients with T1DM (9 male, 21 female) and 23 healthy controls (11 men, 12 women). Two experienced certified operators performed the examinations and took the SWV measurements. The mean SWV of the entire pancreas parenchyma differed significantly between patients and controls (1.1 ± 0.29 and 0.74 ± 0.19 m/s, respectively; p ≤ 0.001). Moreover, the SWVs of the pancreatic segments were significantly different in patients and controls; the mean SWV values of the pancreas head, body, and tail (respectively) in patients vs. controls were 0.99 ± 0.36 vs. 0.76 ± 0.26 m/s (p = 0.012), 1.1 ± 0.52 vs. 0.74 ± 0.23 (p ≤ 0.001), and 1.0 ± 0.34 vs. 0.73 ± 0.28 (p ≤ 0.001). This study confirmed the feasibility of quantifying pancreas tissue stiffness with pSWE and revealed that patients with T1DM had higher pancreas tissue stiffness than controls. Further studies are required to determine the potential value of pSWE as a screening tool in patients with prediabetes.
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Affiliation(s)
- Fahad Farhan Almutairi
- Department of Radiologic Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
- Animal House Unit, King Fahd Medical Research Centre, King Abdulaziz University, Jeddah, Saudi Arabia
- Smart Medical Imaging Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
- Medical Imaging and Artificial Intelligence Research Unit, Center of Modern Mathematical Sciences and its Applications, King Abdulaziz University, Jeddah, Saudi Arabia
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Șolea SF, Brisc MC, Orășeanu A, Venter FC, Brisc CM, Șolea RM, Davidescu L, Venter A, Brisc C. Revolutionizing the Pancreatic Tumor Diagnosis: Emerging Trends in Imaging Technologies: A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:695. [PMID: 38792878 PMCID: PMC11122838 DOI: 10.3390/medicina60050695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 04/19/2024] [Accepted: 04/21/2024] [Indexed: 05/26/2024]
Abstract
Background and Objectives: The pancreas, ensconced within the abdominal cavity, requires a plethora of sophisticated imaging modalities for its comprehensive evaluation, with ultrasonography serving as a primary investigative technique. A myriad of pancreatic pathologies, encompassing pancreatic neoplasia and a spectrum of inflammatory diseases, are detectable through these imaging strategies. Nevertheless, the intricate anatomical confluence and the pancreas's deep-seated topography render the visualization and accurate diagnosis of its pathologies a formidable endeavor. The objective of our paper is to review the best diagnostic imagistic tools for the pancreas. Materials and Methods: we have gathered several articles using Prisma guidelines to determine the best imagistic methods. The imperative of pancreatic scanning transcends its diagnostic utility, proving to be a pivotal element in a multitude of clinical specialties, notably surgical oncology. Within this domain, multidetector computed tomography (MDCT) of the pancreas holds the distinction of being the paramount imaging modality, endorsed for its unrivaled capacity to delineate the staging and progression of pancreatic carcinoma. In synergy with MDCT, there has been a notable advent of avant-garde imaging techniques in recent years. These advanced methodologies, including ultrasonography, endoscopic ultrasonography, contrast-enhanced ultrasonography, and magnetic resonance imaging (MRI) conjoined with magnetic resonance cholangiopancreatography (MRCP), have broadened the horizon of tumor characterization, offering unparalleled depth and precision in oncological assessment. Other emerging diagnostic techniques, such as elastography, also hold a lot of potential and promise for the future of pancreatic imaging. Fine needle aspiration (FNA) is a quick, minimally invasive procedure to evaluate lumps using a thin needle to extract tissue for analysis. It is less invasive than surgical biopsies and usually performed as an outpatient with quick recovery. Its accuracy depends on sample quality, and the risks include minimal bleeding or discomfort. Results, guiding further treatment, are typically available within a week. Elastography is a non-invasive medical imaging technique that maps the elastic properties and stiffness of soft tissue. This method, often used in conjunction with ultrasound or MRI, helps differentiate between hard and soft areas in tissue, providing valuable diagnostic information. It is particularly useful for assessing liver fibrosis, thyroid nodules, breast lumps, and musculoskeletal conditions. The technique is painless and involves applying gentle pressure to the area being examined. The resulting images show tissue stiffness, indicating potential abnormalities. Elastography is advantageous for its ability to detect diseases in early stages and monitor treatment effectiveness. The procedure is quick, safe, and requires no special preparation, with results typically available immediately. Results: The assembled and gathered data shows the efficacy of various techniques in discerning the nature and extent of neoplastic lesions within the pancreas. Conclusions: The most common imaging modalities currently used in diagnosing pancreatic neoplasms are multidetector computed tomography (MDCT), endoscopic ultrasound (EUS), and magnetic resonance imaging (MRI), alongside new technologies, such as elastography.
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Affiliation(s)
- Sabina Florina Șolea
- Doctoral School of Biological and Biomedical Sciences, University of Oradea, 410087 Oradea, Romania; (S.F.Ș.); (A.O.); (F.C.V.); (R.M.Ș.); (A.V.); (C.B.)
- Bihor Clinical County Emergency Hospital, 410169 Oradea, Romania
| | - Mihaela Cristina Brisc
- Bihor Clinical County Emergency Hospital, 410169 Oradea, Romania
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
| | - Alexandra Orășeanu
- Doctoral School of Biological and Biomedical Sciences, University of Oradea, 410087 Oradea, Romania; (S.F.Ș.); (A.O.); (F.C.V.); (R.M.Ș.); (A.V.); (C.B.)
- Bihor Clinical County Emergency Hospital, 410169 Oradea, Romania
| | - Florian Ciprian Venter
- Doctoral School of Biological and Biomedical Sciences, University of Oradea, 410087 Oradea, Romania; (S.F.Ș.); (A.O.); (F.C.V.); (R.M.Ș.); (A.V.); (C.B.)
- Bihor Clinical County Emergency Hospital, 410169 Oradea, Romania
| | - Ciprian Mihai Brisc
- Faculty of Medicine and Pharmacy, University of Oradea, 410068 Oradea, Romania; (C.M.B.); (L.D.)
| | - Răzvan Mihai Șolea
- Doctoral School of Biological and Biomedical Sciences, University of Oradea, 410087 Oradea, Romania; (S.F.Ș.); (A.O.); (F.C.V.); (R.M.Ș.); (A.V.); (C.B.)
| | - Lavinia Davidescu
- Faculty of Medicine and Pharmacy, University of Oradea, 410068 Oradea, Romania; (C.M.B.); (L.D.)
| | - Amina Venter
- Doctoral School of Biological and Biomedical Sciences, University of Oradea, 410087 Oradea, Romania; (S.F.Ș.); (A.O.); (F.C.V.); (R.M.Ș.); (A.V.); (C.B.)
| | - Ciprian Brisc
- Doctoral School of Biological and Biomedical Sciences, University of Oradea, 410087 Oradea, Romania; (S.F.Ș.); (A.O.); (F.C.V.); (R.M.Ș.); (A.V.); (C.B.)
- Bihor Clinical County Emergency Hospital, 410169 Oradea, Romania
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
- Faculty of Medicine and Pharmacy, University of Oradea, 410068 Oradea, Romania; (C.M.B.); (L.D.)
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Huang J, Peng J, Long H, Ruan S, Yao L, Xie X, Lin M, Zhang X. Feasibility and Measurement Value of Pancreatic 2-D Shear Wave Elastography in Healthy Adults: Evaluation, Influencing Factors, Reference Range, Measurement Stability and Reproducibility. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:184-190. [PMID: 37880058 DOI: 10.1016/j.ultrasmedbio.2023.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/15/2023] [Accepted: 09/20/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVE The present study was aimed at assessing the success rate and measurement value, determining the influencing factors and reference range and examining the intra-operator stability and inter-operator reproducibility of pancreatic 2-D shear wave elastography (SWE) measurement in healthy adults. METHODS In 2022, 387 healthy adults were prospectively recruited. Logistic regression and linear regression analyses were used to explore the factors influencing the success rate and the measurement value of pancreatic 2-D SWE measurement, respectively. A two-sided 95% reference range was estimated accordingly. The intraclass correlation coefficient was calculated to evaluate the intra-operator stability and inter-operator reproducibility of the pancreatic 2-D SWE measurement. RESULTS The pancreatic body (89.6%) bore the highest while the tail (72.8%) bore the lowest success rate of pancreatic 2-D SWE measurement. Sex and body mass index (BMI) were the independent factors influencing measurement success rate in all three parts of the pancreas. Mean measurement values (Emean) were not the same in the three parts of the pancreas of the same participant. BMI and image depth were the independent factors influencing Emean in the pancreatic body, while region of interest depth and BMI were the only independent factors influencing Emean in the pancreatic head and tail, respectively. The intra-operator stability of pancreatic 2-D SWE measurement was found to be excellent, whereas its inter-operator reproducibility was poor to good. CONCLUSION Pancreatic 2-D SWE is a reliable technique for evaluating pancreatic stiffness in healthy adults, but its success rate and measurement value are influenced by multiple factors.
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Affiliation(s)
- Jiayao Huang
- Department of Medical Ultrasonics, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
| | - Jianyun Peng
- Department of Medical Ultrasonics, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
| | - Haiyi Long
- Department of Medical Ultrasonics, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
| | - Simin Ruan
- Department of Medical Ultrasonics, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
| | - Lu Yao
- Department of Medical Ultrasonics, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
| | - Xiaoyan Xie
- Department of Medical Ultrasonics, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
| | - Manxia Lin
- Department of Medical Ultrasonics, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
| | - Xiaoer Zhang
- Department of Medical Ultrasonics, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China.
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Hristov B, Nacheva-Georgieva E, Stanchev D, Kraev K, Uchikov P, Kostov G, Valova S, Tilkiyan E, Doykova K, Doykov M. Estimating reference values of parenchymal stiffness of normal pancreatic parenchyma by means of point shear wave elastography. Folia Med (Plovdiv) 2023; 65:958-968. [PMID: 38351786 DOI: 10.3897/folmed.65.e106764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/21/2023] [Indexed: 02/16/2024] Open
Abstract
INTRODUCTION There are numerous imaging modalities available to describe pancreatic parenchyma. None of the broadly accepted diagnostic methods uses elasticity as an indicator of tissue damage.
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Choudhury SR, Verma M, Gupta P, Singh H, Sharma V, Kochhar R. Ultrasound Shear Wave Elastography of Normal Pancreas in Adult Subjects. JOURNAL OF GASTROINTESTINAL AND ABDOMINAL RADIOLOGY 2022. [DOI: 10.1055/s-0042-1758126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Abstract
Background and Purpose Transabdominal ultrasound (US)-based shear wave elastography (SWE) provides an attractive method of estimating pancreatic stiffness. There is limited data on the SWE values of the healthy pancreas in Indian subjects. The current study aimed to evaluate SWE of the normal pancreas.
Methods We performed a study from January 2019 to March 2019. We included adult patients who presented for the US of the upper abdomen for vague abdominal symptoms, unrelated to the pancreas. The SWE values were obtained from the pancreatic head and body. The association of pancreatic SWE with age, gender, fatty liver, chronic liver disease, and cholelithiasis was recorded.
Results During the study period, 205 subjects underwent SWE of the pancreas. The mean age of subjects was 41.3 (standard deviation [SD] 15.3) years. There were 93 males and 112 females. The mean SWE value in the head of the pancreas was 8.98 (SD 2.46 kPa), and that in the body region was 8.67 (SD 2.67 kPa). There was a positive correlation of SWE with age. The SWE of the pancreatic body was significantly higher in patients who had a fatty liver on US (p < 0.05). There was no significant association of SWE of the pancreas with gender, presence of chronic liver disease, or gallstones.
Conclusion The normal values of pancreatic SWE are correlated with age and fatty change in the liver.
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Affiliation(s)
- Shayeri Roy Choudhury
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Mansi Verma
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Gupta
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harjeet Singh
- Department of Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakesh Kochhar
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Shi SY, Wang L, Peng Z, Wang Y, Lin Z, Hu X, Yuan J, Huang L, Feng ST, Luo Y. Multi-frequency magnetic resonance elastography of the pancreas: measurement reproducibility and variance among healthy volunteers. Gastroenterol Rep (Oxf) 2022; 10:goac033. [PMID: 35910246 PMCID: PMC9336557 DOI: 10.1093/gastro/goac033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 04/08/2022] [Accepted: 07/05/2022] [Indexed: 12/13/2022] Open
Abstract
Background Patients with chronic pancreatitis often have irreversible pancreatic insufficiency before a clinical diagnosis. Pancreatic cancer is a fatal malignant tumor in the advanced stages. Patients having high risk of pancreatic diseases must be screened early to obtain better outcomes using new imaging modalities. Therefore, this study aimed to investigate the reproducibility of tomoelastography measurements for assessing pancreatic stiffness and fluidity and the variance among healthy volunteers. Methods Forty-seven healthy volunteers were prospectively enrolled and underwent two tomoelastography examinations at a mean interval of 7 days. Two radiologists blindly and independently measured the pancreatic stiffness and fluidity at the first examination to determine the reproducibility between readers. One radiologist measured the adjacent pancreatic slice at the first examination to determine the reproducibility among slices and measured the pancreas at the second examination to determine short-term repeatability. The stiffness and fluidity of the pancreatic head, body, and tail were compared to determine anatomical differences. The pancreatic stiffness and fluidity were compared based on sex, age, and body mass index (BMI). Results Bland–Altman analyses (all P > 0.05) and intraclass correlation coefficients (all >0.9) indicated near perfect reproducibility among readers, slices, and examinations at short intervals. Neither stiffness (P = 0.477) nor fluidity (P = 0.368) differed among the pancreatic anatomical regions. The mean pancreatic stiffness was 1.45 ± 0.09 m/s; the mean pancreatic fluidity was 0.83 ± 0.06 rad. Stiffness and fluidity did not differ by sex, age, or BMI. Conclusion Tomoelastography is a promising and reproducible tool for assessing pancreatic stiffness and fluidity in healthy volunteers.
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Affiliation(s)
- Si-Ya Shi
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Liqin Wang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Zhenpeng Peng
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Yangdi Wang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Zhi Lin
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Xuefang Hu
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Jiaxin Yuan
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Li Huang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Shi-Ting Feng
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Yanji Luo
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
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Zhuo M, Zhang X, Tang Y, Yan Y, Chen Z. Two-dimensional shear wave elastography of the pancreas: measurement success rate, repeatability, and factors affecting measurement values. J Med Ultrason (2001) 2022; 49:261-268. [PMID: 35312874 DOI: 10.1007/s10396-022-01198-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 01/24/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE We aimed to evaluate the success rate, repeatability, and factors affecting the measurement values of two-dimensional ultrasonic shear wave elastography (2D-SWE) for measuring pancreatic stiffness. METHODS This prospective study recruited 100 healthy participants. 2D-SWE was performed on the pancreatic head, body, and tail. We compared the success rates of pancreatic stiffness measurements of different body positions and ultrasonic scans, with and without probe pressurization, as well as the effects of sex, age, body mass index (BMI), and region of interest (ROI) depth on measurement values. Intra- and inter-operator repeatabilities were assessed in 20 participants. The influence of ROI depth was verified using a tissue-like phantom. RESULTS The median 2D-SWE measurements of the pancreatic head, body, and tail were 1.44, 1.45, and 1.56 m/s, respectively. The success rates for the pancreatic head and body were significantly higher than that of the tail. The success rate for the semi-recumbent position was higher than that of the supine position (P < 0.001). The intra-operator values for same-day and inter-operator reliability were excellent. Univariate analyses showed that probe pressurization, age, BMI, and ROI depth were correlated with pancreatic shear wave velocity (SWV) (P < 0.05); only ROI depth had a significant effect on SWV values. The inclusion phantom showed that the SWV value increased as the ROI depth increased. CONCLUSIONS 2D-SWE had a high success rate and good repeatability for measuring pancreatic head and body stiffness. The ROI depth was the main factor affecting pancreatic SWV, which increased with ROI depth.
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Affiliation(s)
- Minling Zhuo
- Department of Ultrasound, Fujian Medical University Affiliated Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian, China
| | - Xiujuan Zhang
- Department of Ultrasound, Fujian Medical University Affiliated Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian, China
| | - Yi Tang
- Department of Ultrasound, Fujian Medical University Affiliated Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian, China
| | - Yan Yan
- Department of Ultrasound, Fujian Medical University Affiliated Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian, China
| | - Zhikui Chen
- Department of Ultrasound, Fujian Medical University Affiliated Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian, China.
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Pancreatic shear wave elastography in children with type 1 diabetes: relation to diabetes duration, glycemic indices, fasting C-peptide and diabetic complications. Pediatr Radiol 2022; 52:2348-2358. [PMID: 35460036 PMCID: PMC9616782 DOI: 10.1007/s00247-022-05363-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/02/2022] [Accepted: 03/19/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Little is known about changes in the pancreas as the course of type 1 diabetes progresses. Recently, shear wave elastography (SWE) emerged as a tool for assessing pancreatic stiffness in chronic pancreatitis and pancreatic cancer with a few studies assessing it in diabetes. OBJECTIVE To compare pancreatic SWE in children with recent-onset and long-standing type 1 diabetes to healthy controls and to correlate it with diabetes duration, glycated hemoglobin (HbA1C), functional B cell reserve (fasting C-peptide) and diabetic complications. MATERIALS AND METHODS Fifty children with type 1 diabetes (25 with recent-onset and 25 with long-standing type 1 diabetes) and 50 controls were enrolled. Diabetes duration, insulin therapy, fundoscopic examination of the eyes and the neuropathy disability score were assessed. Fasting C-peptide, lipids, HbA1C and urinary albumin-creatinine ratio were measured. Pancreatic SWE was measured using the General Electric Logiq P9 ultrasound system. RESULTS The mean SWE of the studied children with recent-onset type 1 diabetes was 4.81±0.62 kilopascals (Kpa), those with long-standing type 1 diabetes was 7.10±1.56Kpa and for controls was 5.57±0.27 Kpa (P<0.001). SWE was positively correlated to diabetes duration (P<0.001) and negatively correlated to fasting C-peptide (P<0.001). Regarding diabetes complications, SWE was positively correlated to frequency of severe hypoglycemia (P=0.005), HbA1C (P=0.03), low-density lipoproteins (P<0.001) and cholesterol (P<0.001) and significantly related to diabetic neuropathy (P=0.04) and nephropathy (P=0.05). Diabetes duration, fasting C-peptide, HbA1C and frequency of severe hypoglycemia were the significant independent variables related to SWE increase by multivariable regression analysis. CONCLUSION Pancreatic SWE changes significantly with duration of type 1 diabetes, being lowest in those with recent-onset type 1 diabetes and highest in those with long-standing type 1 diabetes, particularly those with diabetic nephropathy and neuropathy.
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Pancreas ultrasound two-dimensional shear wave elastography in healthy children. Pediatr Radiol 2021; 51:403-409. [PMID: 33156431 DOI: 10.1007/s00247-020-04863-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/26/2020] [Accepted: 09/29/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Pancreas shear wave speed might be a biomarker of pancreatic disease in children. OBJECTIVE This study aimed to measure pancreas shear wave speed by two-dimensional (2-D) ultrasound shear wave elastography (SWE) in a balanced cohort of presumed healthy children. MATERIALS AND METHODS This was a prospective study of 120 children (<18 years of age) without a known history of pancreatic disease, who underwent ultrasound 2-D SWE of the pancreas. Five shear wave speed measurements in the pancreas body and/or tail were obtained for each participant using a Canon Aplio i800 system, i8CX1 transducer. The Mann-Whitney U test or Kruskal-Wallis test were used to compare continuous distributions. Spearman's correlation was used to assess univariate relationships between continuous variables. Multivariable regression with stepwise selection was used to evaluate independent predictors of pancreas shear wave speed. RESULTS The median age for the study population was 5.0 years (range: 7 days to 17.8 years) and 61 (50.8%) of the participants were female. The median depth of shear wave speed measurement was 4.7 cm (interquartile range [IQR]: 4.2-5.3). The median pancreas shear wave speed was 1.31 m/s (IQR: 1.21-1.40). On multivariable analysis, female biological sex (P=0.051), the number of hours nil per os (P=0.097), the median depth of measurement (P=0.001) and the median liver shear wave speed (P=0.020) were positively associated with pancreas shear wave speed. CONCLUSION We report pancreas shear wave speed in a large, balanced cohort of children without a known history of pancreatic disease, providing reference values for normal.
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Abstract
MRI and MRCP play an important role in the diagnosis of chronic pancreatitis (CP) by imaging pancreatic parenchyma and ducts. MRI/MRCP is more widely used than computed tomography (CT) for mild to moderate CP due to its increased sensitivity for pancreatic ductal and gland changes; however, it does not detect the calcifications seen in advanced CP. Quantitative MR imaging offers potential advantages over conventional qualitative imaging, including simplicity of analysis, quantitative and population-based comparisons, and more direct interpretation of detected changes. These techniques may provide quantitative metrics for determining the presence and severity of acinar cell loss and aid in the diagnosis of chronic pancreatitis. Given the fact that the parenchymal changes of CP precede the ductal involvement, there would be a significant benefit from developing MRI/MRCP-based, more robust diagnostic criteria combining ductal and parenchymal findings. Among cross-sectional imaging modalities, multi-detector CT (MDCT) has been a cornerstone for evaluating chronic pancreatitis (CP) since it is ubiquitous, assesses primary disease process, identifies complications like pseudocyst or vascular thrombosis with high sensitivity and specificity, guides therapeutic management decisions, and provides images with isotropic resolution within seconds. Conventional MDCT has certain limitations and is reserved to provide predominantly morphological (e.g., calcifications, organ size) rather than functional information. The emerging applications of radiomics and artificial intelligence are poised to extend the current capabilities of MDCT. In this review article, we will review advanced imaging techniques by MRI, MRCP, CT, and ultrasound.
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Xu Y, Cai X, Shi Y, Yin M, Lan G, Zhang X, Ji R, Chang Liu. Normative Pancreatic Stiffness Levels and Related Influences Established by Magnetic Resonance Elastography in Volunteers. J Magn Reson Imaging 2020; 52:448-458. [PMID: 31943515 DOI: 10.1002/jmri.27052] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 12/24/2019] [Accepted: 12/27/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Large-scale normative studies of pancreatic stiffness and potential influences have yet to be pursued via magnetic resonance elastography (MRE). PURPOSE To determine normative MRE-based pancreatic stiffness values and to examine related influential factors. STUDY TYPE Prospective. SUBJECTS In all, 361 volunteers (men, 199; women, 162) with a median age of 54.0 years and a median body mass index (BMI) of 22.86 kg/m2 were prospectively recruited. Those with no histories of smoking, alcohol abuse, and diabetes mellitus (DM) were grouped as healthy volunteers, designating all others as positive controls. FIELD STRENGTH/SEQUENCE Each volunteer underwent 3.0T pancreatic MRI at a frequency of 40 Hz. ASSESSMENT Pancreatic stiffness values, pancreatic width and volume, waist circumference, and wave distance were measured in all subjects. STATISTICAL TESTS Multiple linear regression analyses were performed to determine variables that influence MRE-determined stiffness. RESULTS The mean pancreatic stiffness in all volunteers was 1.20 ± 0.16 kPa. Stiffness levels in positive control volunteers proved significantly greater than levels in healthy volunteers (1.29 ± 0.17 kPa vs. 1.14 ± 0.13 kPa; P < 0.001). In multiple linear regression analysis, sex (P = 0.004), BMI (P < 0.001), pancreatic width (P = 0.005), smoking (P < 0.001), alcohol abuse (P < 0.001), and DM (P = 0.001) emerged as significant independent factors impacting pancreatic stiffness. Smoking, alcohol abuse, DM, and wide pancreas were associated with greater pancreatic stiffness (coefficients = 0.202, 0.183, 0.149, and 0.160, respectively), while reduced pancreatic stiffness corresponded with female sex and larger BMI (coefficient = -0.155 and -0.192, respectively). DATA CONCLUSION MRE-based pancreatic stiffness values are impacted by sex, BMI, pancreatic width, smoking, alcohol abuse, and DM. Reference values are essential for future clinical studies. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2020;52:448-458.
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Affiliation(s)
- Youli Xu
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xiaoli Cai
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yu Shi
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Meng Yin
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Gongyu Lan
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xianyi Zhang
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ruoyun Ji
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Chang Liu
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
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