Pancreatic steatosis: Is it related to either obesity or diabetes mellitus?

Abstract

The accumulation of fat in the pancreatic gland has been referred to using various synonyms, such as pancreatic lipomatosis, fatty replacement, fatty infiltration, fatty pancreas, lipomatous pseudohypertrophy, non-alcoholic fatty pancreatic disease and pancreatic steatosis We believe that pancreatic steatosis is the best description of fat accumulation in the pancreatic gland without fat replacement, and this term also describes the possibility that the fat accumulation is a reversible process. A review of the existing literature was carried out, and it was found that there was notable evidence from both the pathological and the imaging point of view that pancreatic steatosis is an increasing problem due to the increasing incidence of obesity. The conclusion was that pancreatic steatosis was easily detectable using modern imaging techniques, such as ultrasonography, endoscopic ultrasonography, computed tomography and magnetic resonance imaging. Pancreatic steatosis was not due to the presence of diabetes mellitus but was highly associated with the metabolic syndrome. The possible presence of steatopancreatitis should be better evaluated, especially regarding the inflammatory cascade, and additional studies are needed which are capable of assessing whether non-alcoholic steatopancreatitis really exists as does non-alcoholic steatohepatitis. Finally, the presence of exocrine pancreatic function should be extensively evaluated in patients with pancreatic steatosis.

Keywords: Computed tomography; Endoscopic ultrasonography; Magnetic resonance imaging; Metabolic syndrome; Pancreatic steatosis; Pathology; Type 2 diabetes mellitus; Ultrasonography.

Figure 1

Magnetic resonance imaging using force sensitive resistor T2 sequence, showing the presence of fat infiltration in body and tail of the pancreas. The fat present is hyperintense (white) as the abdominal fat, while the pancreatic normal tissue is hypointense.

Figure 2

Magnetic resonance imaging during the arterial phase showing the presence of diffuse fat infiltration in the body and tail of the pancreas. The fat present in the pancreatic gland is black using LAVA sequence (LAVA combines contrast-enhanced, multi-phase imaging of the abdomen with high resolution, large coverage and uniform fat suppression).

Figure 3

Percent of fat fraction according to three pancreatic regions; data are reported as mean and standard deviation (modified from reference[13]).