Contrast-enhanced ultrasonography of the pancreas shows impaired perfusion in pancreas insufficient cystic fibrosis patients

Engjom, Trond; Nylund, Kim; Erchinger, Friedemann; Stangeland, Marcus; Lærum, Birger Norderud; Mézl, Martin; Jiřík, Radovan; Gilja, Odd Helge

doi:10.1186/s12880-018-0259-3

Cited by 5 publications

(3 citation statements)

References 31 publications

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“…Thus, Yung et al (58) concluded that insulinopenia plays a prominent role in the pathogenesis of glucose intolerance and subsequent development of CF-associated diabetes. Engjom et al (17) measured perfusion of the pancreas in pancreas deficient patients with CF using contrast-enhanced ultrasonography. Pancreas insufficient patients with CF had longer mean transit times (P Յ 0.002), lower blood flow (P Ͻ 0.001), and lower blood volume (P Ͻ 0.05) compared with healthy controls and pancreas-sufficient patients with CF.…”

Section: Discussionmentioning

confidence: 99%

Oxygen dependence of glucose sensing: role in glucose homeostasis and related pathology

Wilson

Matschinsky

2019

Journal of Applied Physiology

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In glucose homeostasis, glucose concentration is sensed by its metabolism through glucokinase (GCK) and oxidative phosphorylation. Because oxidative phosphorylation is an integral part of the sensory system, glucose sensing is necessarily dependent on oxygen pressure. Much of the dependence on oxygen is suppressed by location of glucose sensing cells in tissues with well-regulated blood flow. In healthy individuals the oxygen dependence is primarily observed in response to transient global hypoxia events such as during birth or transition to high altitude. The GCK sensing system is, however, used to control release of both insulin and glucagon, the preeminant hormonal regulators of blood glucose, as well as glucose sensitive neuronal activity. Suppression of oxygen delivery to glucose-sensing cells or interference with regulation of tissue blood flow by either local or systemic causes, stresses the glucose regulatory system. This is true whether the stress is imposed locally, such as by altered oxygen delivery to the pancreas, or globally, as in pulmonary insufficiency or exposure to high altitude. It may be expected that chronic application of this stress predisposes individuals to developing diabetes. Type 2 diabetes is a broad class of diseases characterized by disturbance of glucose homeostasis, i.e., having either hyperglycemia and/or decreased sensitivity to insulin. Given the role of oxidative phosphorylation in glucose sensing, tissue oxygen deprivation may predispose individuals to developing diabetes as well as contributing to the disease itself. This is particularly true in age-related diabetes because the incidence of vascular insufficiency increases markedly with increasing age. NEW & NOTEWORTHY Glucose sensing requires glucose metabolism through glycolysis and oxidative phosphorylation. Dependence of the latter on oxygen concentration imposes an oxygen dependence on glucose sensing. We have used a validated computational model to quantify that dependence. Evidence is presented that tissue oxygenation plays an important role in predisposition of individuals to developing type 2 diabetes and in progression of the disease.

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Section: Discussionmentioning

confidence: 99%

Oxygen dependence of glucose sensing: role in glucose homeostasis and related pathology

Wilson

Matschinsky

2019

Journal of Applied Physiology

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“…The measurements using absolute perfusion estimation should be independent of patient-and equipmentrelated factors. Though not demonstrated in the bowel, studies suggest that the interobserver data for this method is promising (Engjom et al 2018) and that you can indeed compare perfusion parameters between different scanners (Stangeland et al 2017). Currently there are no commercial systems providing these data and since the post-processing is cumbersome, it is primarily a research tool.…”

Section: Blood Flowmentioning

confidence: 99%

Ultrasound imaging for assessing functions of the GI tract

et al. 2021

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Objective. In the following review we outline how ultrasound can be used to measure physiological processes in the gastrointestinal tract. Approach. We have investigated the potential of ultrasound in assessing gastrointestinal physiology including original research regarding both basic methodology and clinical applications. Main results. Our main findings show the use of ultrasound to study esophageal motility, measure volume and contractility of the stomach, assess motility, wall thickness, and perfusion of the small bowel, and evaluate wall vascularization and diameters of the large bowel. Significance. Ultrasound is a widely accessible technology that can be used for both scientific and clinical purposes. Being radiation-free and user friendly, the examination can be frequently repeated enabling longitudinal studies. Furthermore, it does not influence normal GI physiology, thus being useful to estimate motility and subtle changes in physiology. Accordingly, ultrasound scanning and physiological measurements may make a big difference for the scientist and the doctor; and for the patients who receive an efficient work-up.

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“…Others demonstrated that the CF pancreas in insufficient subjects was softer compared to sufficient subjects by using Acoustic-Radiation-Force-Impulse (ARFI)-Imaging, maybe suggesting that fat rather than fibrosis is the dominating feature [ 18 ]. We recently demonstrated reduced perfusion of the CF pancreas, indicating reduced vascularity of the affected pancreas [ 19 ]. In this study we did not perform complementary US modalities.…”

Section: Introductionmentioning

confidence: 99%

Sonographic pancreas echogenicity in cystic fibrosis compared to exocrine pancreatic function and pancreas fat content at Dixon-MRI

et al. 2018

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ObjectiveFatty infiltration of the pancreas is a dominating feature in cystic fibrosis (CF). We evaluate the association between pancreatic fat content assessed by Dixon magnetic resonance imaging (MRI), pancreatic echogenicity at ultrasonography (US) and exocrine function in CF patients and healthy controls (HC).Material and methodsTransabdominal US, pancreatic Dixon-MRI and diffusion-weighted imaging (DWI) were performed in 21 CF patients and 15 HCs. Exocrine function was assessed by endoscopic secretin test and fecal elastase.ResultsCF patients were grouped according to exocrine pancreatic function as subjects with normal (CFS: n = 11) or reduced (CFI: n = 10) function. Among CFI 90% (9/10) had visual hyperechogenicity. CFI also had increased echo-level values (p<0.05 vs others). All CFI (10/10) had markedly increased pancreatic fat content estimated by MRI compared to sufficient groups, p<0.001). Among CFS patients and HC, 27% (3/11) and 33% (5/15), respectively, had hyperechoic pancreas. However, all these had low pancreatic fat-content at MRI compared to CFI. In CFI, pancreatic fat content was correlated to ADC (r = -0.93, p<0.001).ConclusionPancreas insufficient CF patients exhibit severe pancreatic fatty-infiltration at MRI and hyperechoic pancreas at US. Pancreas hyperechogenicity in pancreatic sufficient subjects does not co-exist with fatty infiltration at MRI. MRI evaluates pancreatic fatty infiltration more accurately than US and fat infiltration estimated by MRI outperforms sonographic hyper-echogenicity as a marker for exocrine pancreatic failure in CF.

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Contrast-enhanced ultrasonography of the pancreas shows impaired perfusion in pancreas insufficient cystic fibrosis patients

Cited by 5 publications

References 31 publications

Oxygen dependence of glucose sensing: role in glucose homeostasis and related pathology

Oxygen dependence of glucose sensing: role in glucose homeostasis and related pathology

Ultrasound imaging for assessing functions of the GI tract

Sonographic pancreas echogenicity in cystic fibrosis compared to exocrine pancreatic function and pancreas fat content at Dixon-MRI

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