Skip to main content
SpringerLink
Log in

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

  • Original Article
  • Published:
Diabetology International Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  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. 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.

    Article  CAS  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  6. Imagawa A, Hanafusa T, Uchigata Y, et al. Fulminant type 1 diabetes: a nationwide survey in Japan. Diabetes Care. 2003;26:2345–52.

    Article  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  8. Tanaka S, Kobayashi T, Momotsu T. A novel subtype of type 1 diabetes mellitus. N Engl J Med. 2000;342:1835–7.

    Article  CAS  Google Scholar 

  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.

    Article  Google Scholar 

  10. Yamasaki F, Kurisu K, Satoh K, et al. Apparent diffusion coefficient of human brain tumors at MR imaging. Radiology. 2005;235:985–91.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  16. Taniguchi T, Kobayashi H, Nishikawa K, et al. Diffusion-weighted magnetic resonance imaging in autoimmune pancreatitis. Jpn J Radiol. 2009;27:138–42.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  CAS  Google Scholar 

Download references

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.

Author information

Authors and Affiliations

  1. Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Suita, Japan

    Ayumi Tokunaga, Akihisa Imagawa, Iichiro Shimomura & Junji Kozawa

  2. Department of Radiology, Ikeda Hospital, Higashi Osaka, Japan

    Hiroshi Nishio

  3. Department of Surgery, Ikeda Hospital, Higashi Osaka, Japan

    Satoshi Hayata

  4. Department of Endocrinology and Metabolism, Nagasaki University Hospital, Nagasaki, Japan

    Norio Abiru

  5. Department of Diabetes, Endocrinology and Metabolism, International University of Health and Welfare Hospital, Tochigi, Japan

    Takuya Awata

  6. Department of Endocrinology, Metabolism and Diabetes, Kinki University School of Medicine, Osakasayama, Japan

    Hiroshi Ikegami & Yumiko Kawabata

  7. Diabetes Center, Tokyo Women’s Medical University School of Medicine, Tokyo, Japan

    Yasuko Uchigata & Junnosuke Miura

  8. Department of Internal Medicine, Tokyo Saiseikai Central Hospital, Tokyo, Japan

    Yoichi Oikawa

  9. Department of Laboratory Medicine, Ehime University School of Medicine, Toon, Japan

    Haruhiko Osawa

  10. Department of Diabetes, Endocrinology, and Metabolism, Center Hospital, National Center for Global Health and Medicine, Tokyo, Japan

    Hiroshi Kajio & Daisuke Chujo

  11. Department of Diabetes and Endocrinology, Shin-Koga Hospital, Kurume, Japan

    Eiji Kawasaki

  12. Department of Endocrinology and Diabetes, Saitama Medical University, Saitama, Japan

    Yoichi Oikawa & Akira Shimada

  13. Department of Fundamental Nursing, Iwate Prefectural University, Takizawa, Japan

    Kazuma Takahashi

  14. Ai Home Clinic Toshima, Tokyo, Japan

    Shoichiro Tanaka

  15. Division of Diabetes, Metabolism and Endocrinology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan

    Tomoyasu Fukui

  16. Department of Metabolic Disorder, Diabetes Research Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan

    Kazuki Yasuda

  17. Division of Health Sciences, Department of Community Health Sciences, Kobe University Graduate School of Health Sciences, Kobe, Japan

    Hisafumi Yasuda

  18. Okinaka Memorial Institute for Medical Research, Tokyo, Japan

    Tetsuro Kobayashi

  19. Department of Internal Medicine (I), Osaka Medical College, Takatsuki, Japan

    Akihisa Imagawa & Toshiaki Hanafusa

  20. Sakai City Medical Center, Sakai, Japan

    Toshiaki Hanafusa

Authors
  1. Ayumi Tokunaga
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Akihisa Imagawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hiroshi Nishio
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Satoshi Hayata
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Iichiro Shimomura
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Norio Abiru
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Takuya Awata
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Hiroshi Ikegami
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Yasuko Uchigata
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Yoichi Oikawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Haruhiko Osawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Hiroshi Kajio
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Eiji Kawasaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Yumiko Kawabata
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Junji Kozawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Akira Shimada
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Kazuma Takahashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Shoichiro Tanaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. Daisuke Chujo
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. Tomoyasu Fukui
    View author publications

    You can also search for this author in PubMed Google Scholar

  21. Junnosuke Miura
    View author publications

    You can also search for this author in PubMed Google Scholar

  22. Kazuki Yasuda
    View author publications

    You can also search for this author in PubMed Google Scholar

  23. Hisafumi Yasuda
    View author publications

    You can also search for this author in PubMed Google Scholar

  24. Tetsuro Kobayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  25. Toshiaki Hanafusa
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

For the 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

Corresponding author

Correspondence to Akihisa Imagawa.

Ethics declarations

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.

Additional information

Members of the Japan Diabetes Society Committee on Fulminant Type 1 Diabetes Mellitus Research are listed in acknowledgements.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tokunaga, A., Imagawa, A., Nishio, H. et al. Diffusion-weighted magnetic resonance imaging in the pancreas of fulminant type 1 diabetes. Diabetol Int 9, 257–265 (2018). https://doi.org/10.1007/s13340-018-0355-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13340-018-0355-1

Keywords

Search

Navigation