Abstract
BACKGROUND: Pancreatic fibrosis is closely related to blood glucose levels in diabetes, and pancreatic extracellular volume fraction (fECV) can quantify pancreatic fibrosis. The aim of this study was to investigate the correlation between pancreatic fECV measured by dual-energy computed tomography (DECT) iodine maps and hemoglobin A1c (HbA1c), and the feasibility of fECV in evaluating the progression of diabetes. METHODS: This retrospective cross-sectional study included 213 patients who underwent abdominal contrast-enhanced DECT examinations; they were divided into two groups: non-diabetes (Group ND) and diabetes (Group D). Group ND included normal blood glucose (Group ND_N) and pre-diabetes (Group ND_PD). Group D included good blood glucose control (Group D_C) and poor blood glucose control (Group D_NC). HbA1c data were collected through electronic medical records. Pancreatic fECV was derived from DECT equilibrium phase iodine maps. Correlations between pancreatic fECV and HbA1c and comparisons of fECV among different groups were evaluated with Spearman's correlation and analysis of variance (ANOVA). Logistic regression analysis was conducted to investigate the association between pancreatic fECV and diabetes. Diagnostic value of fECV was assessed by receiver operating characteristic (ROC) curve. RESULTS: HbA1c was positively correlated with fECV (r(s)=0.457, P<0.001). Pancreatic fECV was the independent indicator to assess the progression of diabetes [odds ratio (OR) =1.449; 95% confidence interval (CI): 1.265-1.659; P<0.001]. Pancreatic fECV in Group D was significantly higher than that in Group ND. There were significant differences during pairwise comparisons, excluding Group ND_N and Group ND_PD. The area under the curve (AUC) of fECV was 0.732 (95% CI: 0.664-0.799, sensitivity 60.20%, specificity 79.20%) between Group ND and Group D. CONCLUSIONS: Pancreatic fECV is positively correlated with HbA1c, the independent indicator to assess the progression of diabetes, and could indirectly reflect pathophysiological changes of pancreas with diabetes and indicate progression of diabetes from imaging.