. 2018 Apr 12;9(4):257-265.

doi: 10.1007/s13340-018-0355-1. eCollection 2018 Oct.

Diffusion-weighted magnetic resonance imaging in the pancreas of fulminant type 1 diabetes

Ayumi Tokunaga¹, Akihisa Imagawa^{1

2}, Hiroshi Nishio³, Satoshi Hayata⁴, Iichiro Shimomura¹, Norio Abiru⁵, Takuya Awata⁶, Hiroshi Ikegami⁷, Yasuko Uchigata⁸, Yoichi Oikawa^{9

10}, Haruhiko Osawa¹¹, Hiroshi Kajio¹², Eiji Kawasaki¹³, Yumiko Kawabata⁷, Junji Kozawa¹, Akira Shimada¹⁰, Kazuma Takahashi¹⁴, Shoichiro Tanaka¹⁵, Daisuke Chujo¹², Tomoyasu Fukui¹⁶, Junnosuke Miura⁸, Kazuki Yasuda¹⁷, Hisafumi Yasuda¹⁸, Tetsuro Kobayashi¹⁹, Toshiaki Hanafusa^{2

20}; consultation of Japan Diabetes Society Committee on Fulminant Type 1 Diabetes Mellitus Research

Collaborators, Affiliations

Collaborators

consultation of 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

Affiliations

¹ 1Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Suita, Japan.
² 19Department of Internal Medicine (I), Osaka Medical College, Takatsuki, Japan.
³ Department of Radiology, Ikeda Hospital, Higashi Osaka, Japan.
⁴ Department of Surgery, Ikeda Hospital, Higashi Osaka, Japan.
⁵ 4Department of Endocrinology and Metabolism, Nagasaki University Hospital, Nagasaki, Japan.
⁶ 5Department of Diabetes, Endocrinology and Metabolism, International University of Health and Welfare Hospital, Tochigi, Japan.
⁷ 6Department of Endocrinology, Metabolism and Diabetes, Kinki University School of Medicine, Osakasayama, Japan.
⁸ 7Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan.
⁹ 8Department of Internal Medicine, Tokyo Saiseikai Central Hospital, Tokyo, Japan.
¹⁰ 12Department of Endocrinology and Diabetes, Saitama Medical University, Saitama, Japan.
¹¹ 9Department of Laboratory Medicine, Ehime University School of Medicine, Toon, Japan.
¹² 10Department of Diabetes, Endocrinology, and Metabolism, Center Hospital, National Center for Global Health and Medicine, Tokyo, Japan.
¹³ 11Department of Diabetes and Endocrinology, Shin-Koga Hospital, Kurume, Japan.
¹⁴ 13Department of Fundamental Nursing, Iwate Prefectural University, Takizawa, Japan.
¹⁵ Ai Home Clinic Toshima, Tokyo, Japan.
¹⁶ 15Division of Diabetes, Metabolism and Endocrinology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan.
¹⁷ 16Department of Metabolic Disorder, Diabetes Research Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan.
¹⁸ 17Division of Health Sciences, Department of Community Health Sciences, Kobe University Graduate School of Health Sciences, Kobe, Japan.
¹⁹ 18Okinaka Memorial Institute for Medical Research, Tokyo, Japan.
²⁰ Sakai City Medical Center, Sakai, Japan.

PMID: 30603375
PMCID: PMC6224878
DOI: 10.1007/s13340-018-0355-1

Diffusion-weighted magnetic resonance imaging in the pancreas of fulminant type 1 diabetes

Ayumi Tokunaga et al. Diabetol Int. 2018.

. 2018 Apr 12;9(4):257-265.

doi: 10.1007/s13340-018-0355-1. eCollection 2018 Oct.

Authors

Collaborators

consultation of 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

Affiliations

¹ 1Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Suita, Japan.
² 19Department of Internal Medicine (I), Osaka Medical College, Takatsuki, Japan.
³ Department of Radiology, Ikeda Hospital, Higashi Osaka, Japan.
⁴ Department of Surgery, Ikeda Hospital, Higashi Osaka, Japan.
⁵ 4Department of Endocrinology and Metabolism, Nagasaki University Hospital, Nagasaki, Japan.
⁶ 5Department of Diabetes, Endocrinology and Metabolism, International University of Health and Welfare Hospital, Tochigi, Japan.
⁷ 6Department of Endocrinology, Metabolism and Diabetes, Kinki University School of Medicine, Osakasayama, Japan.
⁸ 7Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan.
⁹ 8Department of Internal Medicine, Tokyo Saiseikai Central Hospital, Tokyo, Japan.
¹⁰ 12Department of Endocrinology and Diabetes, Saitama Medical University, Saitama, Japan.
¹¹ 9Department of Laboratory Medicine, Ehime University School of Medicine, Toon, Japan.
¹² 10Department of Diabetes, Endocrinology, and Metabolism, Center Hospital, National Center for Global Health and Medicine, Tokyo, Japan.
¹³ 11Department of Diabetes and Endocrinology, Shin-Koga Hospital, Kurume, Japan.
¹⁴ 13Department of Fundamental Nursing, Iwate Prefectural University, Takizawa, Japan.
¹⁵ Ai Home Clinic Toshima, Tokyo, Japan.
¹⁶ 15Division of Diabetes, Metabolism and Endocrinology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan.
¹⁷ 16Department of Metabolic Disorder, Diabetes Research Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan.
¹⁸ 17Division of Health Sciences, Department of Community Health Sciences, Kobe University Graduate School of Health Sciences, Kobe, Japan.
¹⁹ 18Okinaka Memorial Institute for Medical Research, Tokyo, Japan.
²⁰ Sakai City Medical Center, Sakai, Japan.

PMID: 30603375
PMCID: PMC6224878
DOI: 10.1007/s13340-018-0355-1

Abstract

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.

Keywords: Apparent diffusion coefficient; Diffusion-weighted imaging; Fulminant; Magnetic resonance imaging; Type 1 diabetes.

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Conflict of interest statement

The authors declare no conflicts of interest.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.

Figures

**Fig. 1**
DWI images of a representative case of fulminant type 1 diabetes. DWI images of low b value (b = 50 s/mm²) (a), high b value (b = 800 s/mm²) (b), ADC map (c)

**Fig. 2**
Comparison of ADC values of pancreas between patients with fulminant type 1 diabetes patients and non-diabetic control subjects. ADC values were measured in each part of the head (a), body (b), and tail (c) of the pancreas. The mean ADC values of three parts were calculated (d). Fulminant type 1 diabetic patients using the same MRI systems as control subjects were indicated by opened circles (Magnetom Avanto 1.5 T from Siemens Medical Solutions). The three vendors include Siemens Medical Solutions, GE Healthcare, and Philips Healthcare. Data are presented as mean ± SD. Two atypical cases of fulminant type 1 diabetes (with type 2 diabetes, without elevation of exocrine pancreatic enzymes, respectively) were indicated by opened triangles. *p < 0.05, **p < 0.01

**Fig. 3**
Correlation between ADC values of patients with fulminant type 1 diabetes and plasma glucose level or arterial pH level at the onset of the disease. They were evaluated in each part of the head (a, e), body (b, f), tail (c, g), and mean (d, h) of the pancreas. Correlation between ADC values and plasma glucose levels (a–d). Correlation between ADC values and arterial pH level (e–h). Two atypical cases of fulminant type 1 diabetes (with type 2 diabetes, without elevation of exocrine pancreatic enzymes, respectively) were indicated by opened triangles. r_s = correlation coefficient. A p value < 0.05 indicated a significant difference

**Fig. 4**
Chronological changes in ADC values in each part of the head (a), body (b), tail (c), and mean (d) of the pancreas in patients with fulminant type 1 diabetes after the onset of disease and the initiation of insulin treatment. Boxes, circles, and triangles indicate individual patients

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Diffusion-weighted magnetic resonance imaging in the pancreas of fulminant type 1 diabetes

Collaborators

Affiliations

Diffusion-weighted magnetic resonance imaging in the pancreas of fulminant type 1 diabetes

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

Figures

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