1. Magnetic Resonance Imaging Planimetry As A Quantitative
Imaging Tool To Measure Pancreas Volume In
Type II Diabetes Mellitus
Nishigandha Burute, Errol Colak, David Jenkins,
Shalini Anthwal, Anish Kirpalani
St. Michael’s Hospital and University of Toronto
Toronto, Canada
4. Pancreatic atrophy in diabetes
• Pancreatic atrophy is present in diabetes
• Atrophy progresses with duration and severity of diabetes
• Atrophy can be measured by pancreas volume estimation with
routine imaging modalities
Background
5. Background
Previous studies have measured pancreatic volume with CT/US
• CT involves ionizing radiation, making it less feasible to measure
volumes temporally in the same individual
• US provides only a rough estimation and cannot provide accurate
volumes
It would be beneficial to have an imaging modality that could measure
volumes accurately and without ionizing radiation
6. Background
Only a few studies to date have measured pancreatic volume in diabetes
with MRI
However these have specifically focused on:
• Type 1 diabetes1 (type 1 diabetics form < 5% of the diabetic population)
• Cystic fibrosis related diabetes2 (which is even more rare)
1. Williams et al. J Clin Endocrinol Metab, 2012, 97(10):E2109–E2113
2. Sequeiros et al. BJR 2010; 83: 921 - 926
7. No study until now has measured pancreas volumes in Type 2 diabetes
with MRI though type 2 diabetics form > 95% of the diabetic population
Rationale
8. Purpose
To compare pancreas volume (PV) in patients with Type II diabetes
mellitus (DM) to PV in normoglycemic individuals, measured with MRI-
based planimetry.
9. Methods
Our institutional review board approved this retrospective study with a
waiver of informed consent.
Data collection
32 consecutive patients with Type II DM and 50 consecutive
normoglycemic patients were reviewed from consecutive
abdominal MRIs done for non-pancreas related
pathologies.
10. Inclusion criteria diabetes cohort
Documented evidence of diabetes within 6 months of the date of
MRI: FPG > 7 mmol/l / HBA1c > 6.5%
Methods
Inclusion criteria normoglycemic cohort
Documented normoglycemic status within 6 months of the date of
MRI: FPG < 5.6 mmol/l or HBA1c < 5.7%
12. Technique for volume estimation
Pancreatic contours in these 82 MRIs were traced manually on non-
gadolinium T1W 3D FS GRE images with post-processing software to
generate PVs
Volume = Cross sectional area x slice thickness
Methods
17. Results
Regression models showed that given the same age, weight and
gender, PV in a patient with Type II DM was
17.89 mL (19.9%)
lower compared to a normoglycemic individual.
19. Patients with Type II DM had
significantly lower PV compared to
normoglycemic individuals
(p < 0.001)
Type II DM: 72.66 ± 20.7 cm3
Normoglycemic: 89.58 ± 20.6 cm3
20. Correcting for age and gender, overall mean PV in 82 patients increased with
increasing weight. PV both in the Type II DM cohort (p=0.0399) and in the
normoglycemic cohort (p<0.0001) increased with increasing weight.
Results
21. Pancreatic volume index (PVI) was
calculated as PV/weight (kg)
Patients with Type II DM also had
significantly lower PVIs compared
to normoglycemic individuals
(p < 0.0001)
Type II DM: 1.02 ± 0.27 cm3/kg
Normoglycemic: 1.27 ± 0.26 cm3/kg
22. Comparison of our
study to other
published human
studies reporting
PV measurements
(in mL) using
planimetry derived
from cross-
sectional imaging
studies.
23. Results
This study demonstrates that pancreas volume in Type II diabetes is
significantly reduced as compared to volume in normoglycemic
individuals (19.9%)
24. Discussion
• To our knowledge, this is the first study measuring pancreas volume
in Type II diabetics with MRI
• We successfully used a routine T1W FS GRE sequence without
Gadolinium to measure pancreas volume
• Our volume measurements in normoglycemic individuals (89.58 +/-
22.71, n=50) compared well with volume measurements
in previous studies using CT and MRI
25. Discussion
• We show that MRI can be of use as an accurate and reliable method
to estimate pancreatic volume without radiation exposure
• Potential applications of this technique include use of MRI-derived PV
as an outcome measure in clinical trials evaluating nutritional or
pharmacologic interventions in DM
26. Conclusion
PV is reduced in Type II DM compared to normoglycemic individuals
and can be measured using MRI without contrast injection
27. • Statistical evaluation: Rosane Nisenbaum and Sidharth Saini
• Lab medicine: Dr. Hilde Vandenberghe
• MRI Technologists and the Research department at St. Michael’s
Hospital
Acknowledgements
