Abstract
Objective
Transition from the first attack of acute pancreatitis (AP) to chronic pancreatitis (CP) via recurrent AP is common. Total pancreas volume (TPV) and pancreas diameters are often reduced in advanced CP but have never been studied after AP. The objective of this study was to investigate pancreas size after clinical resolution of AP and its association with the number of AP attacks.
Methods
Individuals with a history of AP were grouped based on the number of attacks (1, 2, ≥ 3 attacks). Healthy individuals were also recruited. All participants underwent magnetic resonance imaging, from which TPV and pancreas diameters (across the head, body, and tail) were measured independently by two raters in a blinded fashion. Generalised additive models (including age, sex, body mass index, and glycated haemoglobin levels) were used.
Results
A total of 123 participants were studied. Total pancreas volume and tail diameter were significantly reduced in both unadjusted (TPV (p = 0.036), tail diameter (p = 0.009)) and adjusted (TPV (p = 0.026), tail diameter (p = 0.034)) models in individuals with ≥ 3 attacks, but not with 1 or 2 attacks, compared with healthy individuals. Head and body diameters did not differ significantly.
Conclusions
Reduced TPV and tail diameter characterise individuals after ≥ 3 attacks of AP and may represent one of the earliest irreversible morphological changes in individuals after AP. A high-risk population for transition to CP might include individuals with at least 3 attacks of AP whereas those with less than 3 attacks might be at a low risk.
Key Points
• A significant reduction in total pancreas volume was demonstrated in individuals after 3 or more attacks of acute pancreatitis (without conventional signs of chronic pancreatitis).
• Pancreas tail diameter, but not head or body diameter, was reduced in individuals after 3 or more attacks of acute pancreatitis (without conventional signs of chronic pancreatitis).
• The above findings were independent of age, sex, body mass index, and glycated haemoglobin levels.
Similar content being viewed by others
Abbreviations
- AP:
-
Acute pancreatitis
- AUC:
-
Area under the curve
- BMI:
-
Body mass index
- CI:
-
Confidence interval
- CP:
-
Chronic pancreatitis
- CRP:
-
C-reactive protein
- GAM:
-
Generalised additive model
- HbA1c:
-
Glycated haemoglobin
- ICC:
-
Intra-class correlation coefficient
- IQR:
-
Interquartile range
- MR:
-
Magnetic resonance
- TPV:
-
Total pancreas volume
References
Xiao AY, Tan ML, Wu LM et al (2016) Global incidence and mortality of pancreatic diseases: a systematic review, meta-analysis, and meta-regression of population-based cohort studies. Lancet Gastroenterol Hepatol 1:45–55
Sankaran SJ, Xiao AY, Wu LM, Windsor JA, Forsmark CE, Petrov MS (2015) Frequency of progression from acute to chronic pancreatitis and risk factors: a meta-analysis. Gastroenterology 149:1490–1500 e1491
Petrov MS, Yadav D (2019) Global epidemiology and holistic prevention of pancreatitis. Nat Rev Gastroenterol Hepatol 16:175–184
Petrov MS (2018) Harnessing analytic morphomics for early detection of pancreatic cancer. Pancreas 47:1051–1054
Schrader H, Menge BA, Schneider S et al (2009) Reduced pancreatic volume and beta-cell area in patients with chronic pancreatitis. Gastroenterology 136:513–522
Bilgin M, Balci NC, Momtahen AJ, Bilgin Y, Klör HU, Rau WS (2009) MRI and MRCP findings of the pancreas in patients with diabetes mellitus: compared analysis with pancreatic exocrine function determined by fecal elastase 1. J Clin Gastroenterol 43:165–170
Sun J, Ni Q, Xie J et al (2019) Beta-cell dedifferentiation in patients with T2D with adequate glucose control and nondiabetic chronic pancreatitis. J Clin Endocrinol Metab 104:83–94
Mitnala S, Pondugala PK, Guduru VR et al (2010) Reduced expression of PDX-1 is associated with decreased beta cell function in chronic pancreatitis. Pancreas 39:856–862
Arger PH, Mulhern CB, Bonavita JA, Stauffer DM, Hale J (1979) An analysis of pancreatic sonography in suspected pancreatic disease. J Clin Ultrasound 7:91–97
Coleman BG, Arger PH, Rosenberg HK, Mulhern CB, Ortega W, Stauffer D (1983) Gray-scale sonographic assessment of pancreatitis in children. Radiology 146:145–150
Fleischer AC, Parker P, Kirchner SG, James AE Jr (1983) Sonographic findings of pancreatitis in children. Radiology 146:151–155
Siegel MJ, Martin KW, Worthington JL (1987) Normal and abnormal pancreas in children: US studies. Radiology 165:15–18
Maraví Poma E, Laplaza Santos C, Gorraiz López B et al (2012) Clinical pathways in acute pancreatitis: recommendations for early multidisciplinary management. Scientific Committee of the SEMICYUC. Working Group on Infectious Diseases (GTEI-SEMICYUC). Med Intensiva 36:351–357
Singh RG, Nguyen NN, DeSouza SV, Pendharkar SA, Petrov MS (2019) Comprehensive analysis of body composition and insulin traits associated with intra-pancreatic fat deposition in healthy individuals and people with new-onset prediabetes/diabetes after acute pancreatitis. Diabetes Obes Metab 21:417–423
Guda NM, Muddana V, Whitcomb DC et al (2018) Recurrent acute pancreatitis: international state-of-the-science conference with recommendations. Pancreas 47:653–666
Macauley M, Percival K, Thelwall PE, Hollingsworth KG, Taylor R (2015) Altered volume, morphology and composition of the pancreas in type 2 diabetes. PLoS One 10:e0126825
DeSouza SV, Yoon HD, Singh RG, Petrov MS (2018) Quantitative determination of pancreas size using anatomical landmarks and its clinical relevance: a systematic literature review. Clin Anat 31:913–926
DeSouza SV, Singh RG, Yoon HD, Murphy R, Plank LD, Petrov MS (2018) Pancreas volume in health and disease: a systematic review and meta-analysis. Expert Rev Gastroenterol Hepatol 12:757–766
Otsuki K, Akutsu N, Maruyama M et al (2014) Three-dimensional computed tomographic volumetric changes in pancreas before and after living donor surgery for pancreas transplantation: effect of volume on glucose metabolism. Transplant Proc 46:963–966
Bharmal SH, Pendharkar SA, Singh RG, Goodarzi MO, Pandol SJ, Petrov MS (2017) Relationship between circulating levels of pancreatic proteolytic enzymes and pancreatic hormones. Pancreatology 17:876–883
Foulis AK, Stewart JA (1984) The pancreas in recent-onset type 1 (insulin-dependent) diabetes mellitus: insulin content of islets, insulitis and associated changes in the exocrine acinar tissue. Diabetologia 26:456–461
Gilbeau JP, Poncelet V, Libon E, Derue G, Heller FR (1992) The density, contour, and thickness of the pancreas in diabetics: CT findings in 57 patients. AJR Am J Roentgenol 159:527–531
Pendharkar SA, Asrani VM, Xiao AY et al (2016) Relationship between pancreatic hormones and glucose metabolism: a cross-sectional study in patients after acute pancreatitis. Am J Physiol Gastrointest Liver Physiol 311:G50–G58
Gillies NA, Pendharkar SA, Singh RG, Windsor JA, Bhatia M, Petrov MS (2017) Fasting levels of insulin and amylin after acute pancreatitis are associated with pro-inflammatory cytokines. Arch Physiol Biochem 123:238–248
Pendharkar SA, Singh RG, Chand SK, Cervantes A, Petrov MS (2018) Pro-inflammatory cytokines after an episode of acute pancreatitis: associations with fasting gut hormone profile. Inflamm Res 67:339–350
Singh RG, Pendharkar SA, Cervantes A, Cho J, Miranda-Soberanis V, Petrov MS (2018) Abdominal obesity and insulin resistance after an episode of acute pancreatitis. Dig Liver Dis 50:1081–1087
Pendharkar SA, Singh RG, Bharmal SH, Drury M, Petrov MS (2018) Pancreatic hormone responses to mixed meal test in new-onset prediabetes/diabetes after non-necrotizing acute pancreatitis. J Clin Gastroenterol. https://doi.org/10.1097/MCG.0000000000001145
Pendharkar SA, Singh RG, Cervantes A, DeSouza SV, Bharmal SH, Petrov MS (2019) Gut hormone responses to mixed meal test in new-onset prediabetes/diabetes after acute pancreatitis. Horm Metab Res. 51:191–199
Rahier J, Loozen S, Goebbels RM, Abrahem M (1987) The haemochromatotic human pancreas: a quantitative immunohistochemical and ultrastructural study. Diabetologia 30:5–12
Wang X, Misawa R, Zielinski MC et al (2013) Regional differences in islet distribution in the human pancreas--preferential beta-cell loss in the head region in patients with type 2 diabetes. PLoS One 8:e67454
Conwell DL, Lee LS, Yadav D et al (2014) American Pancreatic Association practice guidelines in chronic pancreatitis: evidence-based report on diagnostic guidelines. Pancreas 43:1143–1162
Ohno Y, Kumagi T, Yokota T et al (2016) Early pancreatic volume reduction on CT predicts relapse in patients with type 1 autoimmune pancreatitis treated with steroids. Orphanet J Rare Dis 11:103–110
Burute N, Nisenbaum R, Jenkins DJ et al (2014) Pancreas volume measurement in patients with type 2 diabetes using magnetic resonance imaging-based planimetry. Pancreatology 14:268–274
Xiao AY, Tan ML, Plana MN, Yadav D, Zamora J, Petrov MS (2018) The use of international classification of diseases codes to identify patients with pancreatitis: a systematic review and meta-analysis of diagnostic accuracy studies. Clin Transl Gastroenterol 9:191
Acknowledgements
This study was part of the Clinical and epidemiOlogical inveStigations in Metabolism, nutritiOn, and pancreatic diseaseS (COSMOS) program.
Funding
COSMOS is supported, in part, by the Royal Society of New Zealand (Rutherford Discovery Fellowship to Associate Professor Max Petrov).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Guarantor
The scientific guarantor of this publication is Associate Professor Max Petrov, MD, MPH, PhD.
Conflict of interest
The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.
Statistics and biometry
Two of the authors have significant statistical expertise.
Informed consent
Written informed consent was obtained from all participants in this study.
Ethical approval
Health and Disability Ethics Committee approval was obtained.
Methodology
• prospective
• cross-sectional study
• performed at one institution
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
ESM 1
(DOCX 16 kb)
Rights and permissions
About this article
Cite this article
DeSouza, S.V., Priya, S., Cho, J. et al. Pancreas shrinkage following recurrent acute pancreatitis: an MRI study. Eur Radiol 29, 3746–3756 (2019). https://doi.org/10.1007/s00330-019-06126-7
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00330-019-06126-7