Adil DOĞAN, Adnan ÖZDEMİR, Mehmet Hamdi ŞAHAN, Yasemin Mirace KARADENİZ BİLGİLİ, Neşe ASAL, Aşkın GÜNGÜNEŞ

Pancreas and kidney changes in type 2 diabetes patients: the role of diffusion-weighted imaging

Background/aim: The aim of this study was to compare renal and pancreatic apparent diffusion-coefficient (ADC) values of diabetic patients and control subjects and to examine their potential association with several diabetes-related clinical parameters. Materials and methods: A total of 80 sex- and age-matched patients were included in the study. Of them, 40 were patients with type 2 diabetes and 40 were nondiabetic participants. Abdominal diffusion-weighted MRIs of both groups were retrospectively reviewed. Diabetes-related clinical parameters were recorded. Results: The difference between the mean ADC values of the patient group and the control group was significant (p = 0.012). It was also found that the mean pancreatic ADC values of diabetic patients and the control group significantly differed (p = 0.02). Besides, there were positive correlations between the mean pancreatic ADC values and age, Hb1Ac level, treatment type, and disease duration (p < 0.05). While eGFR values positively correlated with the mean renal ADC values (p < 0.05), there were negative correlations between such values and age, serum creatinine level, and disease duration (p < 0.05). Conclusion: Renal and pancreatic ADC values of diabetic patients could potentially play a role, as markers of renal and pancreatic functions, in clinical decisions in the follow-up of such patients.Key words: Diabetes mellitus, pancreas, kidney, magnetic resonance imaging, diffusion-weighted imaging

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1. Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes care 2004; 27 (5): 1047-1053. doi: 10.2337/ diacare.27.5.1047
2. Yılmaz S, Yumusak E, Burulday V. Changes of normal appearing optic nerve head on diffusion-weighted imaging in patients with diabetic retinopathy. Clinical imaging 2017; 42: 60-63. doi: 10.1016/j.clinimag.2016.11.012
3. Cakmak P, Yagcı AB, Dursun B, Herek D, Fenkci SM. Renal diffusion-weighted imaging in diabetic nephropathy: correlation with clinical stages of disease. Diagnostic and Interventional Radiology 2014; 20 (5): 374-378. doi: 10.5152/ dir.2014.13513
4. Mrđanin T, Nikolić O, Molnar U, Mitrović M, Till V. Diffusionweighted imaging in the assessment of renal function in patients with diabetes mellitus type 2. Magnetic Resonance Materials in Physics, Biology and Medicine 2020: 1-11. doi: 10.1007/s10334-020-00869-x
5. Noda Y, Goshima S, Tanaka K, Osada S, Tomita H et al. Findings in pancreatic MRI associated with pancreatic fibrosis and HbA1c values. Journal of Magnetic Resonance Imaging 2016; 43 (3): 680-687. doi: 10.1002/jmri.25019
6. Opie EL. The relation Oe diabetes mellitus to lesions of the Pancreas. Hyaline degeneration of the Islands Oe Langerhans. The Journal of Experimental Medicine 1901; 5 (5): 527. doi: 10.1084/jem.5.5.527
7. Clark A, Saad M, Nezzer T, Uren C, Knowler W et al. Islet amyloid polypeptide in diabetic and non-diabetic Pima Indians. Diabetologia 1990; 33 (5): 285-289. doi: 10.1007/ BF00403322
8. Baysal T, Dogan M, Karlidag R, Ozisik HI, Baysal O et al. Diffusion-weighted imaging in chronic Behcet patients with and without neurological findings. Neuroradiology 2005; 47 (6): 431-437. doi: 10.1007/s00234-005-1370-z
9. Hajnal JV, Doran M, Hall AS, Collins AG, Oatridge A et al. MR imaging of anisotropically restricted diffusion of water in the nervous system: technical, anatomic, and pathologic considerations. Journal of Computer Assisted Tomography 1991; 15 (1): 1-18. doi: 10.1097/00004728-199101000-00001
10. Carbone SF, Gaggioli E, Ricci V, Mazzei F, Mazzei MA et al. Diffusion-weighted magnetic resonance imaging in the evaluation of renal function: a preliminary study. La Radiologia Medica 2007; 112 (8): 1201-1210. doi: 10.1007/s11547-007- 0217-6.
11. Hueper K, Hartung D, Gutberlet M, Gueler F, Sann H et al. Magnetic resonance diffusion tensor imaging for evaluation of histopathological changes in a rat model of diabetic nephropathy. Investigative Radiology 2012; 47 (7): 430-437. doi: 10.1097/RLI.0b013e31824f272d
12. Inoue T, Kozawa E, Okada H, Inukai K, Watanabe S et al. Noninvasive evaluation of kidney hypoxia and fibrosis using magnetic resonance imaging. Journal of the American Society of Nephrology 2011; 22 (8): 1429-1434. doi: 10.1681/ ASN.2010111143
13. Ries M, Basseau F, Tyndal B, Jones R, Deminière C et al. Renal diffusion and BOLD MRI in experimental diabetic nephropathy. Journal of Magnetic Resonance Imaging: An Official Journal of the International Society for Magnetic Resonance in Medicine 2003; 17 (1): 104-113. doi: 10.1002/ jmri.10224
14. Lu L, Sedor JR, Gulani V, Schelling JR, O’Brien A et al. Use of diffusion tensor MRI to identify early changes in diabetic nephropathy. American Journal of Nephrology 2011; 34 (5): 476-482. doi.org/10.1159/000333044
15. American Diabetes Association. American diabetes association standards of medical care in diabetes 2017. Diabetes Care 2017; 40 (1): S1-S135.
16. Feng YZ, Chen XQ, Yu J, Liu XL, Cheng ZY et al. Intravoxel incoherent motion (IVIM) at 3.0 T: evaluation of early renal function changes in type 2 diabetic patients. Abdominal Radiology 2018; 43 (10): 2764-2773. doi: 10.1007/s00261-018- 1555-7
17. Liu T, Han Y, Tang L, Wu J, Miao Y et al. Detection of chronic brain damage by diffusion-weighted imaging with multiple b values in patients with type 2 diabetes. Medicine 2016; 95 (35): e4726. doi: 10.1097/MD.0000000000004726
18. Inal M, Sahan MH, Ergun U, Karadeniz Bilgili MY. Vitreous humor diffusion changes in Behçet’s disease and multiple sclerosis. Current Medical Imaging 2018; 14 (6): 933-937. doi: 10.2174/1573405613666170619092555
19. Xu Y, Wang X, Jiang X. Relationship between the renal apparent diffusion coefficient and glomerular filtration rate: preliminary experience. Journal of Magnetic Resonance Imaging: An Official Journal of the International Society for Magnetic Resonance in Medicine 2007; 26 (3): 678-681. doi: 10.1002/ jmri.20979
20. Namimoto T, Yamashita Y, Mitsuzaki K, Nakayama Y, Tang Y et al. Measurement of the apparent diffusion coefficient in diffuse renal disease by diffusion‐weighted echo‐planar MR imaging. Journal of Magnetic Resonance Imaging: An Official Journal of the International Society for Magnetic Resonance in Medicine 1999; 9 (6): 832-837. doi: 10.1002/(sici)1522- 2586(199906)9:6<832::aid-jmri10>3.0.co;2-1
21. Clark A, Wells C, Buley I, Cruickshank J, Vanhegan R et al. Islet amyloid, increased A-cells, reduced B-cells and exocrine fibrosis: quantitative changes in the pancreas in type 2 diabetes. Diabetes research (Edinburgh, Scotland) 1988; 9 (4): 151.
22. Noda Y, Goshima S, Tsuji Y, Kajita K, Akamine Y et al. Pancreatic extracellular volume fraction using T1 mapping in patients with impaired glucose intolerance. Abdominal Radiology 2020; 45 (2): 449-456. doi: 10.1007/s00261-019- 02384-7