A pilot study to assess the value of magnetic resonance imaging in diabetic patients

Esmail, Z

Abstract

Purpose: To assess the feasibility of multiple-bolus dynamic contrast-enhanced (DCE)
magnetic resonance imaging (MRI) in the pancreas; to optimize the analysis; and to
investigate the application of the method to glucose challenge in type II diabetes. This has
the benefit of using MRI as a diagnostic tool for investigating diabetes Type II and
developing diabetes medications.
Materials and Method: The study was approved by the Local Research Ethics Committee
and all subjects gave written informed consent written informed consent was obtained.
Method 1: Three non-diabetic volunteers (two women aged 26 and 31 years respectively
and one man aged 41 years) underwent 3D RF-spoiled fast field echo-GRE, non enhanced
axial planes to optimize and develop high resolution pancreatic MR imaging protocol using
3.0T MR scanner. Qualitative and quantitative assessments were done to measure the image
quality of the resultant images, and statistical significances for the pancreas and the
surrounding organs using different MR imaging pulse sequences were calculated using an
analysis of variance.
Method 2: Imaging was carried out using a 1.5T MR imaging system. DCE MR with a 3D
RF-spoiled fast field echo (spoiled gradient echo (GRE)) axial planes was used to assess
pancreatic microcirculation in subjects with and those without type II diabetes (1 female, 4
male; mean age 56.4 years; range, 31-68 years) and (6 female , 5 male; mean age 24.7 years;
range 24-54 years) respectively. The perfusion studies were done in baseline and under
glucose challenge on both groups. Microcirculatory semi-quantitative parameter, the area
under the first 60s of the contrast agent concentration curve (lAUCeo) was calculated on avoxel-by-voxel basis within the defined 3D ROIs, were compared between the groups with
and without glucose challenge by using paired t-test.
Results: Method 1: The resulting images were rated to be of low quality (SNR, CNR) and
the images were degraded by image artefacts which negatively affected the visual
appearance of images (qualitative) and the TI relaxation values of the pancreas tissue
(quantitative). Reaching the upper SAR limits quickly and magnetic field inhomogeneity
also affected the quality of the pancreas image. Hence it was decided to transfer the study to
lower field 1.5T MR scanner.
Method 2: Significant differences in perfusion parameters (IAUC60) between the two
pancreatic regions were observed (P < .05) where the IAUC60 reading was higher at the tail
in non diabetic subjects (^=0.001). A significant increase in pancreatic perfusion IAUC60
was observed between the tail regions before and after glucose administration (P= 0.003).
Patients with diabetes had a significantly lower IAUC60 in the tail region compared with
patients without diabetes during glucose challenge (P= 0.01).
Conclusion: Multiple bolus DCE-MRI is feasible in the pancreas as it enables noninvasive
quantification of regional pancreatic perfusion in non-diabetic and diabetic type II under
glucose challenge. This could greatly aid the diagnosis, staging, and treatment efficiency of
this disease.

Citation

Esmail, Z. A pilot study to assess the value of magnetic resonance imaging in diabetic patients. (Thesis). Salford : University of Salford

• Thesis Type: Thesis
• Deposit Date: Oct 3, 2012
• Award Date: Jan 1, 2010