Preoperative Computerized Tomography and Magnetic Resonance Imaging of the Pancreas Predicts Pancreatic Mass and Functional Outcomes After Total Pancreatectomy and Islet Autotransplant.
Preoperative Computerized Tomography and Magnetic Resonance Imaging of the Pancreas Predicts Pancreatic Mass and Functional Outcomes After Total Pancreatectomy and Islet Autotransplant.
复制标题
术前胰腺计算机断层扫描和磁共振成像可预测全胰腺切除术和胰岛自体移植后的胰腺质量和功能结果。
作者：
Young,MichaelC;Theis,JakeR;Hodges,JamesS;Dunn,TyB;Pruett,TimothyL;Chinnakotla,Srinath;Walker,SidneyP;Freeman,MartinL;Trikudanathan,Guru;Arain,Mustafa;Robertson,PaulR;Wilhelm,JoshuaJ;Schwarzenberg,SarahJ;Bland,Barbara;
目的：慢性胰腺炎行全胰切除联合胰岛自体移植（TPIAT）后，约三分之二的患者仍需胰岛素治疗。我们调查了测量胰腺体积的计算机断层扫描或磁共振成像和慢性胰腺炎的成像功能之间的关系，随后的胰岛隔离和糖尿病outcomes.MethodsComputerized断层扫描或磁共振成像胰腺体积（Vitrea软件）和存在或不存在的钙化，萎缩和扩张的胰管97例接受TPIAT。这些功能之间的关系和（1）孤立的胰岛质量和（2）糖尿病状态在1年后TPIAT evaluated.ResultsPancreas胰腺体积与胰岛质量测量总胰岛当量（r= 0.50，P< 0.0001）。如果观察到钙化、萎缩或导管扩张中的任何一种，则平均胰岛当量减少一半以上。胰腺钙化使胰岛素依赖的几率增加4.0倍（1.1，15）。总的来说，胰腺体积和3个影像学特征与1年胰岛素使用密切相关（P= 0.07），胰岛移植失败（P= 0.003），血红蛋白A1c（P= 0.0004），空腹血糖（P= 0.027），空腹C肽水平结论胰腺实质破坏的影像学表现包括胰腺体积缩小和钙化，与受损的胰岛质量和1年糖尿病结局密切相关。
ObjectivesApproximately two thirds of patients will remain on insulin therapy after total pancreatectomy with islet autotransplant (TPIAT) for chronic pancreatitis. We investigated the relationship between measured pancreas volume on computerized tomography or magnetic resonance imaging and features of chronic pancreatitis on imaging, with subsequent islet isolation and diabetes outcomes.MethodsComputerized tomography or magnetic resonance imaging was reviewed for pancreas volume (Vitrea software) and presence or absence of calcifications, atrophy, and dilated pancreatic duct in 97 patients undergoing TPIAT. Relationship between these features and (1) islet mass isolated and (2) diabetes status at 1-year post-TPIAT were evaluated.ResultsPancreas volume correlated with islet mass measured as total islet equivalents (r= 0.50, P< 0.0001). Mean islet equivalents were reduced by more than half if any one of calcifications, atrophy, or ductal dilatation were observed. Pancreatic calcifications increased the odds of insulin dependence 4.0 fold (1.1, 15). Collectively, the pancreas volume and 3 imaging features strongly associated with 1-year insulin use (P= 0.07), islet graft failure (P= 0.003), hemoglobin A1c (P= 0.0004), fasting glucose (P= 0.027), and fasting C-peptide level (P= 0.008).ConclusionsMeasures of pancreatic parenchymal destruction on imaging, including smaller pancreas volume and calcifications, associate strongly with impaired islet mass and 1-year diabetes outcomes.