Imaging of the Pancreas (IMAP) in the New-Onset Diabetes (NOD) Study: A Prospective Pilot

ABSTRACT

Background: New-onset hyperglycemia may suggest presence of occult pancreatic cancer. The aim of this pilot study was to assess feasibility of pancreatic imaging in patients enrolled in the prospective NOD cohort study. Methods:We conducted a prospective pilot study November 2018-April 2020 within Kaiser Permanente Southern California. Patients 50-85 years enrolled in the NOD study (newly elevated glycemic parameter, no history of diabetes) were invited to complete a three-phase contrast-enhanced computed tomography pancreas-protocol scan. Time to imaging, abnormal pancreatic findings, incidental extra-pancreatic findings, including those prompting additional clinical evaluation were identified. Variability in clinical reporting (descriptors of pancreatic duct and parenchyma) between medical centers was assessed. Results: The majority (88.4%, N = 130) of 147 patients invited consented to undergo imaging;91 scans were completed (prior to COVID-19 stay-at-home orders). Median time from radiology order to imaging was 19.7 days (IQR, 15.4-27.6). Median age was 60.8 years (IQR, 56.3-68.8), 37.8% female;race/ethnicity was Hispanic (41.1%), followed by non-Hispanic white (27.8%), blacks (13.3%), and Asians (13.3%). One (1.1%) case of pancreatic cancer was detected between enrollment and study imaging;12/91 (13.1%) of patients had other pancreatic findings: 2 atrophy, 5 fatty infiltration, 1 divisum, 3 cysts, 1 calcification. Among those with findings, 2 (16.7%) underwent further diagnostic evaluation. Therewere 57 extra-pancreatic findings among 52 (57.1%) unique patients, of which 21.1% (12/57) prompted clinical evaluation. Reports from one of the 8 participating medical centers more frequently described both normal pancreatic parenchyma and normal ducts (39/42 (92.9%) compared to 9/49 (18.4%), P < 0.0001). Conclusions: Among participants in this pilot NOD study, pancreatic imaging was found to be acceptable and feasible to be completed in a timely fashion. There was a high rate of incidental findings as well as significant variability in clinical reports. These challenges will need to be addressed in future studies evaluating early detection of pancreatic cancer.