Mech-Sense, Department of Radiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Søndre Skovvej 11, 9000 Aalborg, Denmark.
Department of Clinical Medicine, Aalborg University, Søndre Skovvej 11, 9000 Aalborg, Denmark; Centre for Pancreatic Diseases, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Mølleparkvej 4, 9000 Aalborg, Denmark.
Eur J Radiol. 2020 Apr;125:108868. doi: 10.1016/j.ejrad.2020.108868. Epub 2020 Feb 7.
Knowledge of the underlying mechanisms behind progression of chronic pancreatitis (CP) is needed to identify targets for new mechanism-based treatments. There is an urgent need for imaging biomarkers that can detect early morphological and functional pancreatic damage in order to initiate intervention and reduce the progression of CP at an early stage. The aim of our study was to assess and explore the potential role of structural magnetic resonance imaging (MRI) biomarkers for characterisation of disease progression in a CP patient cohort over a 4-year period.
This longitudinal MRI study included twenty-five patients with definitive CP. Assessments of morphological imaging parameters at baseline and after 4 years included pancreatic gland volume, apparent diffusion coefficient (ADC) values, fat signal fraction (FSF) and main pancreatic duct (MPD) diameter. Patients were classified according to the modified Cambridge classification.
CP patients developed significantly reduced pancreatic gland volume, which decreased from mean 50.3 ± 19.6 ml at baseline to 43.5 ± 20.8 ml at follow-up (P < 0.001), decreased ADC values, meaning a higher degree of fibrosis (P < 0.001), increased FSF, meaning more fat infiltration (P < 0.001) and higher Cambridge classification scores (P = 0.033). The MPD diameter in the pancreatic head, body and tail did not change significantly over time (all P > 0.05). Only few, but no clear and systematic, associations were found between the progressions of the individual MRI measures.
Morphological progression in patients with established CP seems to be primarily parenchymal-related. The different parenchymal changes were mostly unrelated and probably reflect diverse pathophysiological processes.
为了确定新的基于机制的治疗靶点，需要了解慢性胰腺炎（CP）进展背后的潜在机制。迫切需要成像生物标志物来检测早期的形态和功能胰腺损伤，以便在早期启动干预并减少 CP 的进展。我们的研究目的是评估和探索结构性磁共振成像（MRI）生物标志物在 CP 患者队列中 4 年内疾病进展特征中的潜在作用。
这项纵向 MRI 研究包括 25 名确诊为 CP 的患者。基线和 4 年后的形态学影像学参数评估包括胰腺腺体体积、表观扩散系数（ADC）值、脂肪信号分数（FSF）和主胰管（MPD）直径。患者根据改良剑桥分类进行分类。
CP 患者的胰腺腺体体积明显减少，从基线时的平均 50.3 ± 19.6ml 减少到随访时的 43.5 ± 20.8ml（P < 0.001），ADC 值降低，提示纤维化程度更高（P < 0.001），FSF 增加，提示脂肪浸润程度更高（P < 0.001），剑桥分类评分更高（P = 0.033）。胰头、体和尾部的 MPD 直径在随访期间没有明显变化（均 P > 0.05）。仅发现了少数但不明确和系统的关联，这些关联存在于个体 MRI 测量的进展之间。
已确诊 CP 患者的形态学进展似乎主要与实质有关。不同的实质变化大多无关，可能反映了不同的病理生理过程。
