Shimada R, Yamada Y, Okamoto K, Murakami K, Motomura M, Takaki H, Fukuzawa K, Asayama Y. Pancreatic volume change using three dimensional-computed tomography volumetry and its relationships with diabetes on long-term follow-up in autoimmune pancreatitis. World J Radiol 2024; 16(11): 644-656 [PMID: 39635311 DOI: 10.4329/wjr.v16.i11.644]
Corresponding Author of This Article
Ryuichi Shimada, MD, Assistant Professor, Department of Radiology, Oita University Faculty of Medicine, Yufu city, Hasamamachi, Idaigaoka1-1, Yufu 879-5593, Oita, Japan. rshimada@oita-u.ac.jp
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Radiol. Nov 28, 2024; 16(11): 644-656 Published online Nov 28, 2024. doi: 10.4329/wjr.v16.i11.644
Pancreatic volume change using three dimensional-computed tomography volumetry and its relationships with diabetes on long-term follow-up in autoimmune pancreatitis
Ryuichi Shimada, Yoshiki Asayama, Department of Radiology, Oita University Faculty of Medicine, Yufu 879-5593, Oita, Japan
Yasunari Yamada, Hajime Takaki, Department of Radiology, Oita Red Cross Hospital, Oita 870-0033, Oita, Japan
Kazuhisa Okamoto, Kazunari Murakami, Department of Gastroenterology, Oita University Faculty of Medicine, Yufu 879-5593, Oita, Japan
Mitsuteru Motomura, Department of Hepato-Biliary-Pancreatic Internal Medicine, Oita Red Cross Hospital, Oita 870-0033, Oita, Japan
Kengo Fukuzawa, Department of Surgery, Oita Red Cross Hospital, Oita 870-0033, Oita, Japan
Author contributions: Shimada R and Yamada Y designed and conducted the study; Shimada R wrote the paper; Yamada Y contributed to the analysis; Okamoto K and Motomura M provided clinical advice; Asayama Y, Murakami K, Fukuzawa K, and Takaki H supervised the study.
Institutional review board statement: The study was approved by the institutional review board in Oita University Faculty of Medicine and Oita Red Cross Hospital.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymized clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors report no relevant conflicts of interest for this article.
Data sharing statement: The data used to support the findings to this study are available from the corresponding author upon request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ryuichi Shimada, MD, Assistant Professor, Department of Radiology, Oita University Faculty of Medicine, Yufu city, Hasamamachi, Idaigaoka1-1, Yufu 879-5593, Oita, Japan. rshimada@oita-u.ac.jp
Received: July 25, 2024 Revised: September 7, 2024 Accepted: September 23, 2024 Published online: November 28, 2024 Processing time: 124 Days and 20.3 Hours
Abstract
BACKGROUND
Several studies found that early pancreatic atrophy detected by computed tomography (CT) within 6 months was associated with a high incidence of diabetes in patients with type-1 autoimmune pancreatitis (AIP) receiving steroid therapy; however, no long-term follow-up studies have been performed.
AIM
To investigate pancreatic volume (PV) changes using three dimensional (3D)-CT volumetry and their relationship with IgG4 and diabetes in patients with AIP.
METHODS
This retrospective study included 33 patients with type-1 AIP receiving steroid therapy. Patients were divided into diffuse (D-type) and mass-forming type (M-type) AIP. PV was determined by semi-automated 3D-CT volumetry, and changes between initial and follow-up values were calculated. The relationship between PV and serum IgG4 levels was analyzed by Spearman’s rank correlation. The PV atrophy ratio compared with the presumed normal PV at the time of last follow-up CT and its relationship with diabetes were investigated.
RESULTS
There were 16 D-type and 17 M-type patients with long-term follow-up (mean, 95.8 months). The regression curve of mean relative PV change reduced exponentially and rapidly during the first 25 months and then more slowly in both groups. The overall cumulative pancreas re-enlargement rates at 1, 3, 5, 7 and 10 years were 6.1%, 12.2%, 29.2%, 47.5% and 55.0%, respectively. There was a moderate-to-very strong positive correlation (ρ ≥ 0.4) between PV and serum IgG4 levels in nine (9/13, 69.2%) patients. All 33 patients showed pancreatic atrophy (mean 59.3%) after long-term follow-up. Patients with D-type AIP had a significantly higher atrophy rate and higher incidence of diabetes than M-type patients (P < 0.05).
CONCLUSION
PV change initially reduced exponentially and then more slowly and is considered an important factor associated with diabetes. Serum IgG4 levels were positively correlated with PV during follow-up.
Core Tip: To the best of our knowledge, no previous studies have reported on pancreatic volume (PV) changes during long-term follow-up in patients with autoimmune pancreatitis (AIP). In this study, we investigated PV changes using computed tomography volumetry and examined their relationships with IgG4 and diabetes in patients with AIP with long-term follow-up. PV reduced exponentially and rapidly during the first 25 months and then more slowly. IgG4 levels were positively correlated with PV during long-term follow-up in most patients. Pancreatic atrophy occurred during long-term follow-up in all patients, and is considered an important factor associated with diabetes.
