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Diabetology International

, Volume 9, Issue 4, pp 257–265 | Cite as

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

  • Ayumi Tokunaga
  • Akihisa Imagawa
  • Hiroshi Nishio
  • Satoshi Hayata
  • Iichiro Shimomura
  • 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
  • For the consultation of Japan Diabetes Society Committee on Fulminant Type 1 Diabetes Mellitus Research
Original Article
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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

Fulminant Type 1 diabetes Magnetic resonance imaging Diffusion-weighted imaging Apparent diffusion coefficient 

Notes

Acknowledgements

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.

References

  1. 1.
    Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care. 2003;26(Suppl 1):S5–20.Google Scholar
  2. 2.
    Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med. 1998;15:539–53.CrossRefGoogle Scholar
  3. 3.
    Cho YM, Kim JT, Ko KS, et al. Fulminant type 1 diabetes in Korea: high prevalence among patients with adult-onset type 1 diabetes. Diabetologia. 2007;50:2276–9.CrossRefGoogle Scholar
  4. 4.
    Luo S, Zhang Z, Li X, et al. Fulminant type 1 diabetes: a collaborative clinical cases investigation in China. Acta Diabetol. 2013;50:53–9.CrossRefGoogle Scholar
  5. 5.
    Imagawa A, Hanafusa T, Miyagawa J, Matsuzawa Y, For the Osaka IDDM Study Group. A novel subtype of type 1 diabetes mellitus characterized by a rapid onset and an absence of diabetes-related antibodies. N Engl J Med. 2000;342:301–7.CrossRefGoogle Scholar
  6. 6.
    Imagawa A, Hanafusa T, Uchigata Y, et al. Fulminant type 1 diabetes: a nationwide survey in Japan. Diabetes Care. 2003;26:2345–52.CrossRefGoogle Scholar
  7. 7.
    Hanafusa T, Imagawa A. Fulminant type 1 diabetes: a novel clinical entity requiring special attention by all medical practitioners. Nat Clin Pract Endocrinol Metab. 2007;3:36–45.CrossRefGoogle Scholar
  8. 8.
    Tanaka S, Kobayashi T, Momotsu T. A novel subtype of type 1 diabetes mellitus. N Engl J Med. 2000;342:1835–7.CrossRefGoogle Scholar
  9. 9.
    Seitz RJ, Meisel S, Weller P, Junghans U, Wittsack HJ, Siebler M. Initial ischemic event: perfusion-weighted MR imaging and apparent diffusion coefficient for stroke evolution. Radiology. 2005;237:1020–8.CrossRefGoogle Scholar
  10. 10.
    Yamasaki F, Kurisu K, Satoh K, et al. Apparent diffusion coefficient of human brain tumors at MR imaging. Radiology. 2005;235:985–91.CrossRefGoogle Scholar
  11. 11.
    Taouli B, Tolia AJ, Losada M, et al. Diffusion-weighted MRI for quantification of liver fibrosis: preliminary experience. Am J Roentgenol. 2007;189:799–806.CrossRefGoogle Scholar
  12. 12.
    Hordonneau C, Buisson A, Scanzi J, et al. Diffusion-weighted magnetic resonance imaging in ileocolonic Crohn’s disease: validation of quantitative index of activity. Am J Gastroenterol. 2014;109:89–98.CrossRefGoogle Scholar
  13. 13.
    Shinya S, Sasaki T, Nakagawa Y, et al. The efficacy of diffusion-weighted imaging for the detection and evaluation of acute pancreatitis. Hepatogastroenterology. 2009;56:1407–10.PubMedGoogle Scholar
  14. 14.
    Thomas S, Kayhan A, Lakadamyali H, et al. Diffusion MRI of acute pancreatitis and comparison with normal individuals using ADC values. Emerg Radiol. 2012;19:5–9.CrossRefGoogle Scholar
  15. 15.
    Sandrasegaran K, Nutakki K, Tahir B, et al. Use of diffusion-weighted MRI to differentiate chronic pancreatitis from pancreatic cancer. Am J Roentgenol. 2013;201:1002–8.CrossRefGoogle Scholar
  16. 16.
    Taniguchi T, Kobayashi H, Nishikawa K, et al. Diffusion-weighted magnetic resonance imaging in autoimmune pancreatitis. Jpn J Radiol. 2009;27:138–42.CrossRefGoogle Scholar
  17. 17.
    Kamisawa T, Takuma K, Anjiki H, et al. Differentiation of autoimmune pancreatitis from pancreatic cancer by diffusion-weighted MRI. Am J Gastroenterol. 2010;105:1870–5.CrossRefGoogle Scholar
  18. 18.
    Akisik MF, Aisen AM, Sandrasegaran K, et al. Assessment of chronic pancreatitis: utility of diffusion-weighted MR imaging with secretin enhancement. Radiology. 2009;250:103–9.CrossRefGoogle Scholar
  19. 19.
    Fattahi R, Balci NC, Perman WH, et al. Pancreatic diffusion-weighted imaging (DWI): comparison between mass-forming focal pancreatitis (FP), pancreatic cancer (PC), and normal pancreas. J Magn Reson Imaging. 2009;29:350–6.CrossRefGoogle Scholar
  20. 20.
    Imagawa A, Hanafusa T, Awata T, et al. Report of the Committee of the Japan Diabetes Society on the Research of Fulminant and Acute-onset Type 1 Diabetes Mellitus: new diagnostic criteria of fulminant type 1 diabetes mellitus (2012). J Diabetes Investig. 2012;3:536–9.CrossRefGoogle Scholar
  21. 21.
    Sasaki M, Yamada K, Watanabe Y, et al; Acute Stroke Imaging Standardization Group-Japan (ASIST-Japan) Investigators. Variability in absolute apparent diffusion coefficient values across different platforms may be substantial: a multivendor, multi-institutional comparison study. Radiology 2008;249:624–30.CrossRefGoogle Scholar
  22. 22.
    Donati OF, Chong D, Nanz D, et al. Diffusion-weighted MR imaging of upper abdominal organs: field strength and intervendor variability of apparent diffusion coefficients. Radiology. 2014;270:454–63.CrossRefGoogle Scholar
  23. 23.
    Tanaka S, Nishida Y, Aida K, et al. Enterovirus infection, CXC chemokine ligand 10 (CXCL10), and CXCR3 circuit: a mechanism of accelerated beta-cell failure in fulminant type 1 diabetes. Diabetes. 2009;58:2285–91.CrossRefGoogle Scholar
  24. 24.
    Shibasaki S, Imagawa A, Tauriainen S, et al. Expression of toll-like receptors in the pancreas of recent-onset fulminant type 1 diabetes. Endocr J. 2010;57:211–9.CrossRefGoogle Scholar
  25. 25.
    Watanabe H, Kanematsu M, Tanaka K, et al. Fibrosis and postoperative fistula of the pancreas: correlation with MR imaging findings—preliminary results. Radiology. 2014;270:791–9.CrossRefGoogle Scholar
  26. 26.
    Li Q, Li J, Zhang L, Chen Y, Zhang M, Yan F. Diffusion-weighted imaging in assessing renal pathology of chronic kidney disease: a preliminary clinical study. Eur J Radiol. 2014;83:756–62.CrossRefGoogle Scholar
  27. 27.
    Ma C, Pan CS, Zhang HG, et al. Diffusion-weighted MRI of the normal adult pancreas: the effect of age on apparent diffusion coefficient values. Clin Radiol. 2013;68:e532–7.CrossRefGoogle Scholar
  28. 28.
    Park JJ, Kim CK, Park SY, et al. Assessment of early response to concurrent chemoradiotherapy in cervical cancer: value of diffusion-weighted and dynamic contrast-enhanced MR imaging. Magn Reson Imaging. 2014;32:993–1000.CrossRefGoogle Scholar
  29. 29.
    Horger M, Claussen C, Kramer U, Fenchel M, Lichy M, Kaufmann S. Very early indicators of response to systemic therapy in lymphoma patients based on alterations in water diffusivity—a preliminary experience in 20 patients undergoing whole-body diffusion-weighted imaging. Eur J Radiol. 2014;83:1655–64.CrossRefGoogle Scholar

Copyright information

© The Japan Diabetes Society 2018

Authors and Affiliations

  • Ayumi Tokunaga
    • 1
  • Akihisa Imagawa
    • 1
    • 19
  • Hiroshi Nishio
    • 2
  • Satoshi Hayata
    • 3
  • Iichiro Shimomura
    • 1
  • Norio Abiru
    • 4
  • Takuya Awata
    • 5
  • Hiroshi Ikegami
    • 6
  • Yasuko Uchigata
    • 7
  • Yoichi Oikawa
    • 8
    • 12
  • Haruhiko Osawa
    • 9
  • Hiroshi Kajio
    • 10
  • Eiji Kawasaki
    • 11
  • Yumiko Kawabata
    • 6
  • Junji Kozawa
    • 1
  • Akira Shimada
    • 12
  • Kazuma Takahashi
    • 13
  • Shoichiro Tanaka
    • 14
  • Daisuke Chujo
    • 10
  • Tomoyasu Fukui
    • 15
  • Junnosuke Miura
    • 7
  • Kazuki Yasuda
    • 16
  • Hisafumi Yasuda
    • 17
  • Tetsuro Kobayashi
    • 18
  • Toshiaki Hanafusa
    • 19
    • 20
  • For the consultation of Japan Diabetes Society Committee on Fulminant Type 1 Diabetes Mellitus Research
  1. 1.Department of Metabolic Medicine, Graduate School of MedicineOsaka UniversitySuitaJapan
  2. 2.Department of RadiologyIkeda HospitalHigashi OsakaJapan
  3. 3.Department of SurgeryIkeda HospitalHigashi OsakaJapan
  4. 4.Department of Endocrinology and MetabolismNagasaki University HospitalNagasakiJapan
  5. 5.Department of Diabetes, Endocrinology and MetabolismInternational University of Health and Welfare HospitalTochigiJapan
  6. 6.Department of Endocrinology, Metabolism and DiabetesKinki University School of MedicineOsakasayamaJapan
  7. 7.Diabetes CenterTokyo Women’s Medical University School of MedicineTokyoJapan
  8. 8.Department of Internal MedicineTokyo Saiseikai Central HospitalTokyoJapan
  9. 9.Department of Laboratory MedicineEhime University School of MedicineToonJapan
  10. 10.Department of Diabetes, Endocrinology, and Metabolism, Center HospitalNational Center for Global Health and MedicineTokyoJapan
  11. 11.Department of Diabetes and EndocrinologyShin-Koga HospitalKurumeJapan
  12. 12.Department of Endocrinology and DiabetesSaitama Medical UniversitySaitamaJapan
  13. 13.Department of Fundamental NursingIwate Prefectural UniversityTakizawaJapan
  14. 14.Ai Home Clinic ToshimaTokyoJapan
  15. 15.Division of Diabetes, Metabolism and Endocrinology, Department of MedicineShowa University School of MedicineTokyoJapan
  16. 16.Department of Metabolic Disorder, Diabetes Research Center, Research InstituteNational Center for Global Health and MedicineTokyoJapan
  17. 17.Division of Health Sciences, Department of Community Health SciencesKobe University Graduate School of Health SciencesKobeJapan
  18. 18.Okinaka Memorial Institute for Medical ResearchTokyoJapan
  19. 19.Department of Internal Medicine (I)Osaka Medical CollegeTakatsukiJapan
  20. 20.Sakai City Medical CenterSakaiJapan

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