Association between insulin-like growth factor 1 and pancreatic volume in type 1 and type 2 diabetes: cross-sectional study of a Japanese population.

AIMS/HYPOTHESIS: Although IGF-1 is known to promote organ growth, including exocrine pancreas, the association between plasma IGF-1 levels and pancreatic size remains unclear in diabetic patients. METHODS: This cross-sectional study was designed to investigate the correlations among pancreatic volume (PV) based on computed tomography, IGF-1 levels, age- and sex-adjusted IGF-1 levels (IGF-1 Z-score), and C-peptide levels in patients with type 1 diabetes (T1D) (n = 51) and type 2 diabetes (T2D) (n = 104) in a Japanese population. RESULTS: PV was significantly correlated with body weight (BW) in both types of diabetes. PV adjusted for BW (PV/BW), IGF-1 Z-score and C-peptide levels were significantly lower in patients with T1D than T2D. There was a significant positive correlation between C-peptide levels and PV/BW in both subtypes of diabetes. IGF-1 Z-scores were significantly correlated with PV/BW in patients with T1D (r = 0.37, P = 0.007), but not T2D. Although IGF-1 Z-scores were not correlated with age, age of disease onset, disease duration, HbA1c, or C-peptide levels in both types of diabetes, a multivariable liner regression analysis revealed that IGF-1 Z-score and C-peptide levels were independent correlates of PV/BW in T1D patients, while C-peptide levels were a sole correlate in T2D. CONCLUSIONS/INTERPRETATION: Decreased IGF-1 levels might be one causal factor for smaller pancreas in patients with T1D.

Pancreatic fat accumulation evaluated by multidetector computed tomography in patients with type 2 diabetes.

AIMS: To clarify the clinical impact of pancreatic fat volume on beta cell function in type 2 diabetes patients. MATERIALS AND METHODS: One hundred thirty two consecutive type 2 diabetic patients (mean age, 63.7 years) were enrolled in this cross-sectional study. Total pancreatic volume (TPV), pancreatic fat volume (PFV), and pancreatic parenchymal volume (PPV), and visceral fat volume were examined quantitatively with multidetector computed tomography using SYNAPSE VINCENT image analysis system (Fujifilm Inc., Tokyo, Japan). Pancreatic fat was identified using Hounsfield Units of less than zero. The capacity of insulin secretion was assessed by C-peptide immunoreactivity (CPR) index (100 × fasting CPR/fasting plasma glucose). Insulin sensitivity was evaluated using CPR-insulin resistance (20/fasting CPR × fasting plasma glucose). RESULTS: TPV, PFV, PPV, and visceral fat volume were significantly correlated with body weight (BW). PPV/BW, but not PFV/BW, significantly decreased with increasing duration of diabetes and aging. PFV/BW was positively associated with body mass index and visceral fat volume/BW. PFV/BW was significantly correlated with CPR index, while inversely associated with insulin sensitivity. CPR index, but not CPRinsulin resistance was progressively decreased in patients with a longer duration of diabetes. When patients were divided into two groups according to a median PFV/BW value, CPR index in high PFV/BW group with diabetes duration >5 years was significantly lower than those ≤5 years. However, duration-dependent decrease in CPR index was not observed in low PFV/BW group. CONCLUSIONS: Our present study suggests that PFV might predict the progression of beta cell dysfunction in patients with type 2 diabetes.

Circulating anti-glutamic acid decarboxylase-65 antibody titers are positively associated with the capacity of insulin secretion in acute-onset type 1 diabetes with short duration in a Japanese population.

AIMS/INTRODUCTION: To elucidate the relationship between titers of islet autoantibodies, the C-X-C motif chemokine 10 - a circulating chemokine that activates T-helper 1 cells leading to ß-cell destruction - and ß-cell function in type 1 diabetes. MATERIALS AND METHODS: In total, 58 type 1 diabetes patients positive for glutamic decarboxylase-65 autoantibodies (GADA)-radioimmunoassay (mean age 54.1 years; 27 acute-onset cases and 31 slowly progressive cases) were enrolled; serum C-X-C motif chemokine 10 (n = 50), zinc transporter 8 autoantibodies (n = 50) and GADA (n = 58) by an enzyme-linked immunosorbent assay, and insulinoma-associated antigen-2 autoantibodies by radioimmunoassay (n = 50) were measured. The ratio of 100 × random C-peptide (ng/mL)-to-plasma glucose levels (mg/dL; C-peptide index [CPI]) was measured. RESULTS: The CPI significantly decreased in both groups with the progression of disease duration. GADA titers by radioimmunoassay and enzyme-linked immunosorbent assay were strongly correlated with the CPI in acute-onset type 1 diabetes patients with a shorter disease duration (≤10 years), but not in those with a longer duration or slowly progressive type 1 diabetes. Neither insulinoma-associated antigen-2 nor zinc transporter 8 autoantibodies titers were correlated with the CPI. Serum C-X-C motif chemokine 10 levels in both groups were significantly higher than in non-diabetic controls, and persisted at high levels even in those with chronic duration. CONCLUSIONS: Among islet autoantibodies, the intensity of the humoral immune response, as defined by GADA titers, reflected the degree of residual ß-cell function in acute-onset type 1 diabetes patients with short duration. Prolonged disease activity might accelerate ß-cell impairment in both subtypes of type 1 diabetes.

Usefulness of both PET/CT with F18-FDG and whole-body diffusion-weighted imaging in cancer screening: a preliminary report.

OBJECTIVE: Positron emission tomography/computed tomography (PET/CT) with fluorodeoxyglucose (F18-FDG) is useful for the detection of malignant lesions, including metastatic lesions, and this technique is widely used in cancer screening. However, this approach may occasionally yield false-positive and false-negative findings. At our PET center, to increase the accuracy of PET/CT, we use PET/CT and whole-body diffusion-weighted imaging (WB-DWI) together. This study aimed to assess the usefulness of this combination. METHODS: We examined 29 subjects with confirmed diagnosis. All of them had undergone PET/CT and WB-DWI on the same day. Twenty-seven of them also underwent ultrasonography, blood testing, and upper gastrointestinal series on the same day and two fecal occult blood tests on another day. WB-DWI was performed on a 1.5-T MRI unit with a b value of 0 and 800 or 1000 s/mm2. For all 29 cases, PET/CT and WB-DWI were classified to be positive or negative, and the diagnostic ability was calculated for each modality. RESULTS: Among the 29 subjects, 17 had malignant tumors and 12 had benign tumors or no abnormalities. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of PET/CT were 65%, 25%, 55%, 33%, and 48%, respectively; while the corresponding values for WB-DWI were 59%, 100%, 100%, 63%, and 76%, respectively. By considering the result to be negative when PET/CT findings were positive but WB-DWI findings were negative, specificity increased from 25 to 100%, and accuracy increased from 48 to 76%. On the other hand, by considering the result to be positive when the findings of either PET/CT or WB-DWI were positive, sensitivity increased from 65 to 76%, and accuracy increased from 48 to 55%. CONCLUSIONS: Our results suggest that using both PET/CT and WB-DWI together can increase accuracy in cancer screening. However, this approach was not able to detect malignant lesions in some cases, indicating that there were limitations with imaging certain organs. Therefore, it is important to further understand the features of PET/CT and WB-DWI and use them appropriately for each organ. Additionally, given that the study sample was relatively small, further research is needed to validate these findings.

Analysis of pancreatic volume in acute-onset, slowly-progressive and fulminant type 1 diabetes in a Japanese population.

AIMS/INTRODUCTION: A decrease in the size of the pancreas is observed in islet autoantibody-positive non-diabetic donors and acute-onset type 1 diabetes irrespective of the diabetes duration. Little is known, however, about the relationship between the size of the pancreas and type 1 diabetes subtypes, including fulminant type 1 diabetes. MATERIALS AND METHODS: We examined the pancreatic volume (PV) in 44 adult patients with type 1 diabetes (16 acute-onset type 1 diabetes, 18 slowly progressive type 1 diabetes and 10 fulminant type 1 diabetes) and 39 age- and body mass index-matched non-diabetic controls. PV was measured by computed tomography. The ability to secrete insulin was assessed by stimulated C-peptide after intravenous glucagon administration. RESULTS: PV was significantly correlated with bodyweight in both control participants and type 1 diabetes patients. The PV index (PVI; PV/bodyweight) was decreased by 39% in type 1 diabetes compared with that in controls. PVI was significantly decreased in acute-onset type 1 diabetes patients and slowly progressive type 1 diabetes patients (both P < 0.0001), but not in fulminant type 1 diabetes patients (P = 0.10), compared with control participants. In cases patients with recent-onset type 1 diabetes (0-7 days post-diagnosis), PVI was significantly decreased in acute-onset type 1 diabetes patients (n = 8, P = 0.0005), but not in fulminant type 1 diabetes patients (n = 7, P = 0.44), compared with controls. PVI showed no correlations with the diabetes duration, C-peptide levels, glycated hemoglobin, glutamic acid decarboxylase autoantibody levels, serum amylase or daily total insulin dose in type 1 diabetes subtypes. CONCLUSIONS: The present results show that patients with acute-onset type 1 diabetes and slowly progressive type 1 diabetes have small pancreases irrespective of the diabetes duration or C-peptide levels. In contrast to earlier findings on acute-onset type 1 diabetes, we found no reduction of PVI at the onset of fulminant type 1 diabetes.

Preoperative T staging of urinary bladder cancer: efficacy of stalk detection and diagnostic performance of diffusion-weighted imaging at 3T.

PURPOSE: We evaluated the ability of diffusion-weighted imaging (DWI) at 3 tesla for diagnosing T stage and detecting stalks in bladder cancer. METHODS: In total, 39 consecutive patients with bladder tumors underwent magnetic resonance (MR) imaging that included T2-weighted imaging (T2WI) and DWI using a 3T MR scanner. Two radiologists interpreted T2WI plus DWI and T2WI for diagnosis of T stage and for detection of stalks. We used McNemar's test to examine differences in diagnostic performance and Fisher's exact test to evaluate differences in stalk detection frequency. RESULTS: Specificity and accuracy in differentiating T1 tumors from T2 to T4 tumors were significantly better with T2WI plus DWI (83% [20/24] and 85% [33/39]) than T2WI (50% [12/24] and 67% [26/39]; P = 0.02), and accuracy for diagnosing tumor stage was significantly better with T2WI plus DWI (82% [32/39]) than T2WI alone (59% [23/39]; P = 0.03). The observers identified stalks in 11 tumors by T2WI (48% [11/23]) and 17 by DWI (74% [17/23]) (P < 0.03). CONCLUSION: DWI at 3T was superior to T2WI for evaluating the T stage of bladder cancer, particularly in differentiating T1 tumors from those T2 or higher, and in detecting stalks of papillary bladder tumors.

Utility of apparent diffusion coefficients in the evaluation of solid renal tumors at 3T.

PURPOSE: We assessed the usefulness of apparent diffusion coefficients (ADCs) for solid renal tumor imaging using diffusion-weighted magnetic resonance imaging (DWI) at 3T. METHODS: This retrospective study assessed ADCs of 31 patients with renal tumors that were imaged using preoperative DWI. DWI was performed with the b values of 50, 500, and 1000 s/mm(2), using a 3T magnetic resonance imaging (MRI) system (MAGNETOM Trio, 3T, Siemens Healthcare, Erlangen, Germany). The ADC map was calculated using the b values of 50 and 1000 s/mm(2). ADCs of the different tumors were compared according to the Tukey-Kramer test. RESULTS: The tumors were diagnosed as clear cell renal cell carcinoma (RCC; n = 20), papillary RCC (n = 1), infiltrating urothelial carcinoma (UC) of the kidney (n = 4), cystic RCC (n = 1), poorly differentiated carcinoma (n = 1), and angiomyolipoma (AML; n = 4). The mean ADC of clear cell RCC was significantly higher than that of infiltrating UC of the kidney (1.423 vs. 0.931 × 10(-3) mm(2)/s; P < 0.05), and the mean ADC of AML was significantly lower than that of clear cell RCC (0.674 vs. 1.423 × 10(-3) mm(2)/s; P < 0.01). CONCLUSION: ADCs used in DWI at 3T may be useful for differentiation of different types of solid renal tumors.