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Image or scope: Magnetic resonance imaging and endoscopic testing for exocrine and endocrine pancreatic insufficiency
Michelle Saad1, David S Vitale1, Tom K Lin1
1Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
Insights
Magnetic Resonance Imaging (MRI) can identify pancreatic exocrine and endocrine insufficiency in children. Reduced pancreas volume on MRI is linked to dysfunction, aiding diagnosis.
Area of Science:
- Pediatric Gastroenterology
- Radiology
- Endocrinology
Background:
- Pancreatic insufficiency in children can lead to significant health issues.
- Non-invasive imaging markers for pancreatic dysfunction are needed.
- Magnetic Resonance Imaging (MRI) offers potential for evaluating pancreatic structure and function.
Purpose of the Study:
- To assess the association between MRI findings and pancreatic exocrine and endocrine insufficiency in pediatric patients.
- To identify specific MRI parameters that correlate with exocrine pancreatic insufficiency (EPI) and endocrine insufficiency (prediabetes or diabetes).
Main Methods:
- Retrospective study of patients under 21 years old.
- Patients underwent MRI and endoscopic pancreatic function testing (ePFT) within 3 months.
- MRI variables included pancreas parenchymal volume, secretin-stimulated fluid volume, and T1 relaxation time.
Main Results:
- Decreased pancreas parenchymal volume correlated with increased odds of exocrine pancreatic dysfunction.
- Pancreas parenchymal volume, sex, and acute pancreatitis status predicted exocrine dysfunction with an AUC of 0.82.
- T1 relaxation time on MRI was a predictor of endocrine insufficiency, with an AUC of 0.78 for glycemic outcomes.
Conclusions:
- Pancreas parenchymal volume on MRI is a valuable marker for both exocrine and endocrine pancreatic dysfunction in children.
- A predictive model incorporating sex, acute pancreatitis, and pancreas volume demonstrated strong performance for exocrine status.
- T1 relaxation time emerges as a significant MRI marker for identifying endocrine pancreatic insufficiency.
Objectives:
We sought to evaluate associations between Magnetic Resonance Imaging (MRI) findings, exocrine pancreatic insufficiency (EPI) and endocrine insufficiency (prediabetes or diabetes) in children.
Methods:
This was a retrospective study that included patients<21 years of age who underwent MRI and endoscopic pancreatic function testing (ePFT; reference standard for pancreatic exocrine function) within 3 months. MRI variables included pancreas parenchymal volume, secreted fluid volume in response to secretin, and T1 relaxation time. Data were analyzed for the full sample as well as the subset without acute pancreatitis (AP) at the time of imaging.
Results:
Of 72 patients, 56% (40/72) were female with median age 11.4 years. A 5 mL decrease in pancreas parenchymal volume was associated with increased odds of exocrine pancreatic dysfunction by both ePFT (OR = 1.16, p = 0.02 full sample; OR = 1.29, p = 0.01 no-AP subset), and fecal elastase (OR = 1.16, p = 0.04 full sample; OR = 1.23, p = 0.02 no-AP subset). Pancreas parenchymal volume had an AUC 0.71 (95% CI: 0.59, 0.83) for predicting exocrine pancreatic dysfunction by ePFT and when combined with sex and presence of AP had an AUC of 0.82 (95% CI: 0.72, 0.92). Regarding endocrine function, decreased pancreas parenchymal volume was associated with increased odds of diabetes (OR = 1.16, p = 0.03), and T1 relaxation time predicted glycemic outcomes with an AUC 0.78 (95% CI: 0.55-1), 91% specificity and 73% sensitivity.
Conclusions:
Pancreas parenchymal volume is an MRI marker of exocrine and endocrine pancreatic dysfunction in children. A model including sex, AP, and pancreas volume best predicted exocrine status. T1 relaxation time is also an MRI marker of endocrine insufficiency.
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