Quantitative MRI Markers Detect Postpancreatitis Changes and Diabetes: A Prospective Cohort Study

Area of Science:

• Medical Imaging
• Radiology
• Pediatric Gastroenterology

Background:

• Pediatric acute pancreatitis (AP) is rising, but early imaging markers for progression to acute recurrent pancreatitis (ARP) and endocrine dysfunction (DM/Pre-DM) remain unknown.
• Quantitative MRI metrics like T1 relaxation, T1 signal intensity ratio, proton density fat fraction (PDFF), and pancreatic volume may offer insights but require prospective evaluation post-AP.

Purpose of the Study:

• To prospectively evaluate quantitative MRI markers for identifying pediatric patients with single AP, ARP, or DM/Pre-DM.
• To determine if MRI-derived metrics can differentiate disease severity and predict endocrine dysfunction in young AP patients.

Main Methods:

• A prospective, single-center study involving 60 participants (aged 5-30 years) imaged ≥4 weeks after their most recent AP episode.
• 3T MRI utilized MOLLI-based T1 mapping, mDixon Quant PDFF, and volumetric assessments, alongside clinical, laboratory, and genetic data collection.
• Statistical analyses included group comparisons, correlation, ANOVA, and ROC analyses with cross-validation to assess marker performance.

Main Results:

• ARP patients exhibited higher T1 relaxation and pancreatic PDFF compared to single AP patients.
• DM/Pre-DM participants showed significantly higher liver PDFF than AP and ARP groups.
• Liver PDFF was the strongest predictor of DM/Pre-DM (AUC 0.77), with a combined model improving discrimination (AUC 0.82).

Conclusions:

• Quantitative MRI reveals distinct imaging features differentiating pediatric ARP and DM/Pre-DM.
• Increased T1 relaxation and pancreatic fat are characteristic of ARP, while hepatic fat strongly correlates with endocrine dysfunction.
• Multi-marker MRI models show promise for improved classification, warranting validation in larger cohorts.