| Objectives:To investigate the correlation between pancreatic extracellular volume fraction(fECV)measured by dual-energy CT(DECT)iodine maps and hemoglobin A1c(HbA1c),and the feasibility of pancreatic fECV in evaluating the progression of diabetes mellitus.Materials and Methods:A total of 213 patients who underwent abdominal contrast-enhanced DECT examinations due to confirmed or suspected abdominal disease were retrospectively enrolled.Subjects were divided into two groups according to the 2020 Chinese Diabetes Society(CDS)or 2021 American Diabetes Association(ADA)standards:non-diabetes group(Group ND,n=120)and diabetes group(Group D,n=93).Group ND included normal blood glucose group(Group ND＿N,HbA1c<5.7%,n=56)and pre-diabetes group(Group ND＿PD,5.7%≤HbA1c<6.5%,n=64).Group D could be further subdivided into the good blood glucose control group(Group D＿C,HbA1c<7.0%,n=37)and poor blood glucose control group(Group D＿NC,HbA1c≥7.0%,n=56)according to the HbA1c level after hypoglycemic treatment.DECT equilibrium phase iodine maps-derived pancreatic fECV were calculated.Inter-observer consistency was assessed by intraclass correlation coefficient(ICC).The differences in general clinical data and pancreatic fECV among groups were compared by independent sample T test or one-way analysis of variance.The correlation between pancreatic fECV and HbA1c(non-normally distribution)was analyzed by Spearman rank correlation analysis.The diagnostic value of pancreatic fECV was assessed by receiver operating characteristic curve(ROC).Results:1.There were no significant differences in age,sex,hematocrit(Hct)and body mass index(BMI)between Group ND and Group D(all P>0.05).Similarly,there were no statistically significant differences in age,sex,Hct and BMI among Group ND＿N,Group ND＿PD,Group D＿C and Group D＿NC(all P>0.05).2.Pancreatic fECV in Group D was significantly higher than that in Group ND(P<0.001).Among four subgroups,Group D＿NC generated the highest fECV(34.95%±2.20)followed by Group D＿C(33.33%±2.66),ND＿PD(32.25%±2.60)and ND＿N(31.79%±2.73).There were significant differences while pairwise comparisons,except for Group ND＿N and ND＿PD(all P<0.05).3.For all patients,HbA1c was positively correlated with pancreatic fECV(r_s=0.457,P<0.001).Further analysis showed that:In Group D and its two subgroups(Group D＿C and Group D＿NC),there was a significant positive correlation between HbA1c and pancreatic fECV(r_s=0.449,0.327,0.336,respectively;all P<0.05).However,in Group ND and its two subgroups(Group ND＿N and Group ND＿PD),there was no significant correlation between HbA1c and pancreatic fECV(r_s=0.111,0.081,0.057,respectively;all P>0.05).4.With pancreatic fECV=34.00%as the optimal cut-off value,the sensitivity,specificity and area under the curve(AUC)of Group ND and Group D were 60.2%,79.2%and 0.723(P<0.001),respectively.Among the subgroups,the AUCs of Group ND＿N and Group D＿NC,Group ND＿PD and Group D＿NC in pancreatic fECV region were higher,which achieved 0.831(sensitivity 75.0%,specificity 83.9%,P<0.001)and 0.782(sensitivity 71.4%,specificity 79.7%,P<0.001),respectively;the AUCs of Group ND＿N and Group D＿C,Group D＿C and Group D＿NC in pancreatic fECV region were 0.651(sensitivity 67.6%,specificity 60.7%,P<0.05)and 0.687(sensitivity71.4%,specificity 70.3%,P<0.05),respectively;the AUC of Group ND＿PD and Group D＿C in pancreatic fECV region was 0.594(sensitivity 62.2%,specificity 54.7%,P>0.05).5.The inter-observer consistency of pancreatic fECV was good(ICC>0.75,P<0.001).Conclusions:1.Pancreatic fECV was positively correlated with HbA1c.This relationship existed in subjects including diabetes and disappeared in non-diabetes alone,which was closely related to the degree of pancreatic fibrosis.2.Pancreatic fECV in diabetic patients with good blood glucose control was lower than that in diabetic patients with poor blood glucose control,but its value was still higher than that in pre-diabetic patients.Hypoglycemic treatment in advanced diabetes can delay the progression of pancreatic fibrosis,but it is difficult to reverse.3.Pancreatic fECV is valuable in the identification of diabetic and non-diabetic patients.4.Pancreatic fECV could indirectly and non-invasively reflect the pathophysiological changes of pancreas in patients with diabetes,which may be used as a new imaging biomarker to evaluate the progression of diabetes. |
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