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

Lucia Gonzalez-Llanos1,2, Jonathan Dudley2,3,4, Amol Pednekar2,3,4

  • 1Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.

Clinical and Translational Gastroenterology
|June 3, 2026
PubMed

Insights

Quantitative MRI reveals key imaging markers for pediatric acute recurrent pancreatitis (ARP) and diabetes (DM/Pre-DM). Increased pancreatic fat and T1 relaxation indicate ARP, while liver fat predicts endocrine dysfunction in young patients.

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.
Abstract

Keywords:
magnetic resonance imagingpancreas parenchymapancreatitisproton density fat fraction

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