Tokunaga Ayumi, Imagawa Akihisa, Nishio Hiroshi, Hayata Satoshi, Shimomura Iichiro, Abiru Norio, Awata Takuya, Ikegami Hiroshi, Uchigata Yasuko, Oikawa Yoichi, Osawa Haruhiko, Kajio Hiroshi, Kawasaki Eiji, Kawabata Yumiko, Kozawa Junji, Shimada Akira, Takahashi Kazuma, Tanaka Shoichiro, Chujo Daisuke, Fukui Tomoyasu, Miura Junnosuke, Yasuda Kazuki, Yasuda Hisafumi, Kobayashi Tetsuro, Hanafusa Toshiaki
1Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Suita, Japan.
19Department of Internal Medicine (I), Osaka Medical College, Takatsuki, Japan.
Diabetol Int. 2018 Apr 12;9(4):257-265. doi: 10.1007/s13340-018-0355-1. eCollection 2018 Oct.
Abrupt disease onset and severe metabolic disorders are main characteristics of fulminant type 1 diabetes. Diffusion-weighted magnetic resonance imaging (DWI) is an imaging technique that reflects restricted diffusion in organs and can detect mononuclear cell infiltration into the pancreas at the onset of the disease. Fourteen patients with fulminant type 1 diabetes who underwent abdominal magnetic resonance imaging were recruited for the measurement of apparent diffusion coefficient (ADC) values of the pancreas that were compared with those of 21 non-diabetic controls. The ADC values of all parts of the pancreas were significantly lower in fulminant type 1 diabetes than in controls (head, 1.424 ± 0.382 × 10 vs. 1.675 ± 0.227 × 10 mm/s; body, 1.399 ± 0.317 × 10 vs. 1.667 ± 0.170 × 10 mm/s; tail, 1.336 ± 0.247 × 10 vs. 1.561 ± 0.191 × 10 mm/s; mean, 1.386 ± 0.309 × 10 vs. 1.634 ± 0.175 × 10 mm/s) ( < 0.01). The best cut-off value indicated that the sensitivity was 86% and the specificity was 71% when using DWI, which was also efficient in two atypical patients with fulminant type 1 diabetes without elevated levels of exocrine pancreatic enzymes or with high HbA1c levels due to the preexistence of type 2 diabetes. The ADC values were significantly correlated to plasma glucose levels and arterial pH, and tended to increase with the lapse of time. DWI may be an additional tool for making an efficient diagnosis of fulminant type 1 diabetes.
暴发性1型糖尿病的主要特征是疾病突然发作和严重的代谢紊乱。扩散加权磁共振成像（DWI）是一种反映器官内扩散受限的成像技术，能够在疾病发作时检测到单核细胞浸润胰腺。招募了14例接受腹部磁共振成像的暴发性1型糖尿病患者，测量其胰腺的表观扩散系数（ADC）值，并与21名非糖尿病对照者的ADC值进行比较。暴发性1型糖尿病患者胰腺各部位的ADC值均显著低于对照组（头部：1.424±0.382×10 vs. 1.675±0.227×10 mm²/s；体部：1.399±0.317×10 vs. 1.667±0.170×10 mm²/s；尾部：1.336±0.247×10 vs. 1.561±0.191×10 mm²/s；平均值：1.386±0.309×10 vs. 1.634±0.175×10 mm²/s）（P＜0.01）。最佳截断值显示，使用DWI时灵敏度为86%，特异性为71%，对于两名非典型暴发性1型糖尿病患者（胰腺外分泌酶水平未升高或因先前存在2型糖尿病而HbA1c水平较高）同样有效。ADC值与血糖水平和动脉pH值显著相关，并随时间推移有升高趋势。DWI可能是高效诊断暴发性1型糖尿病的一种辅助手段。
