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Correlation between pathology and quantitative ultrasonographic evaluation of pancreatic fat with ultrasonographic classification

  • Original Article–Gastroenterology
  • Published:
Journal of Medical Ultrasonics Aims and scope Submit manuscript

Abstract

Purpose

No studies of the relationship between grayscale sonographic findings and pancreatic fat content have been reported to date. This study aimed to investigate the correlation between echogenicity and fat content of resected specimens using quantitative analysis.

Methods

Forty-two consecutive patients who underwent pancreatoduodenectomy or distal pancreatectomy for pancreatic tumors were enrolled in this study. Ultrasonographic images were compared with quantitative pathological analysis. Subjective evaluation of echogenicity was classified as hypoechoic, isoechoic, hyperechoic, and super hyperechoic. The total and intralobular fat areas were measured.

Results

The mean, median, modal, minimum, and maximum ultrasound gray values correlated with the proportion of total fat area (r = 0.349; 0.357, 0.486, 0.466, and 0.347; p = 0.024, 0.020, 0.014, 0.019, and 0.089, respectively), but did not correlate with the proportion of intralobular fat area. Subjective classification was correlated with median gray value (p < 0.001), intralobular fat area (p = 0.118), and total fat area (p = 0.011). Cases were classified as hypoechoic (n = 3), isoechoic (n = 7), hyperechoic (n = 30), and super hyperechoic (n = 2). The subjective classification was correlated with the median gray value (p < 0.001) and total fat area (p = 0.005), and not correlated with the intralobular fat area (p = 0.118). Hyperechoic or super hyperechoic pancreatic parenchyma contains over 19.7% fat. Computed tomography values correlated with the proportion of intralobular fat area (r = − 0.479, p = 0.004) and total fat area (r = − 0.541, p < 0.001).

Conclusion

Echogenicity classified based on subjective evaluation and image analysis were correlated with the proportion of fat in the pancreas.

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Data availability

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Mathiesen UL, Franzén LE, Aselius H, et al. Increased liver echogenicity at ultrasound examination reflects degree of steatosis but not of fibrosis in asymptomatic patients with mild/moderate abnormalities of liver transaminases. Dig Liver Dis. 2002;34:516–22.

    Article  CAS  PubMed  Google Scholar 

  2. Choi CW, Kim GH, Kang DH, et al. Associated factors for a hyperechogenic pancreas on endoscopic ultrasound. World J Gastroenterol. 2010;16:4329–34.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Lesmana CR, Pakasi LS, Inggriani S, et al. Prevalence of non-alcoholic fatty pancreas disease (NAFPD) and its risk factors among adult medical check-up patients in a private hospital: a large cross sectional study. BMC Gastroenterol. 2015;15:174.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Li S, Su L, Lv G, et al. Transabdominal ultrasonography of the pancreas is superior to that of the liver for detection of ectopic fat deposits resulting from metabolic syndrome. Medicine (Baltimore). 2017;96: e8060.

    Article  PubMed  Google Scholar 

  5. Wang D, Yu XP, Xiao WM, et al. Prevalence and clinical characteristics of fatty pancreas in Yangzhou, China: a cross-sectional study. Pancreatology. 2018;18:263–8.

    Article  CAS  PubMed  Google Scholar 

  6. Yang W, Xie Y, Song B, et al. Effects of aging and menopause on pancreatic fat fraction in healthy women population: a strobe-compliant article. Medicine (Baltimore). 2019;98:14451.

    Article  Google Scholar 

  7. Sepe PS, Ohri A, Sanaka S, et al. A prospective evaluation of fatty pancreas by using EUS. Gastrointest Endosc. 2011;73:987–93.

    Article  PubMed  Google Scholar 

  8. Wang CY, Ou HY, Chen MF, et al. Enigmatic ectopic fat: prevalence of nonalcoholic fatty pancreas disease and its associated factors in a Chinese population. J Am Heart Assoc. 2014;3: e000297.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Wong VW, Wong GL, Yeung DK, et al. Fatty pancreas, insulin resistance, and β-cell function: a population study using fat-water magnetic resonance imaging. Am J Gastroenterol. 2014;109:589–97.

    Article  ADS  CAS  PubMed  Google Scholar 

  10. Weng S, Zhou J, Chen X, et al. Prevalence and factors associated with nonalcoholic fatty pancreas disease and its severity in China. Medicine (Baltimore). 2018;97: e11293.

    Article  PubMed  Google Scholar 

  11. Della Corte C, Mosca A, Majo F, et al. Nonalcoholic fatty pancreas disease and nonalcoholic fatty liver disease: more than ectopic fat. Clin Endocrinol (Oxf). 2015;83:656–62.

    Article  CAS  PubMed  Google Scholar 

  12. Ou HY, Wang CY, Yang YC, et al. The association between nonalcoholic fatty pancreas disease and diabetes. PLoS ONE. 2013;8: e62561.

    Article  ADS  CAS  PubMed  PubMed Central  Google Scholar 

  13. Lee JS, Kim SH, Jun DW, et al. Clinical implications of fatty pancreas: correlations between fatty pancreas and metabolic syndrome. World J Gastroenterol. 2009;15:1869–75.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Heber SD, Hetterich H, Lorbeer R, et al. Pancreatic fat content by magnetic resonance imaging in subjects with prediabetes, diabetes, and controls from a general population without cardiovascular disease. PLoS ONE. 2017;12: e0177154.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Wu WC, Wang CY. Association between non-alcoholic fatty pancreatic disease (NAFPD) and the metabolic syndrome: case-control retrospective study. Cardiovasc Diabetol. 2013;12:77.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Fujii M, Ohno Y, Yamada M, et al. Impact of fatty pancreas and lifestyle on the development of subclinical chronic pancreatitis in healthy people undergoing a medical checkup. Environ Health Prev Med. 2019;24:10.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Kim SY, Kim H, Cho JY, et al. Quantitative assessment of pancreatic fat by using unenhanced CT: pathologic correlation and clinical implications. Radiology. 2014;271:104–12.

    Article  PubMed  Google Scholar 

  18. Fukui H, Hori M, Fukuda Y, et al. Evaluation of fatty pancreas by proton density fat fraction using 3-T magnetic resonance imaging and its association with pancreatic cancer. Eur J Radiol. 2019;118:25–31.

    Article  PubMed  Google Scholar 

  19. Kloppel G, Maillet B. Pseudocysts in chronic pancreatitis: a morphological analysis of 57 resection specimens and 9 autopsy pancreata. Pancreas. 1991;6:266–74.

    Article  CAS  PubMed  Google Scholar 

  20. Kanda Y. Investigation of the freely-available easy-to-use software “EZR” (Easy R) for medical statistics. Bone Marrow Transplant. 2013;48:452–8.

    Article  CAS  PubMed  Google Scholar 

  21. Rosenblatt R, Mehta A, Snell D, et al. Ultrasonographic nonalcoholic fatty pancreas is associated with advanced fibrosis in NAFLD: a retrospective analysis. Dig Dis Sci. 2019;64:262–8.

    Article  CAS  PubMed  Google Scholar 

  22. Milovanovic T, Dragasevic S, Stojkovic Lalosevic M, et al. Ultrasonographic evaluation of fatty pancreas in serbian patients with non alcoholic fatty liver disease-a cross sectional study. Medicina (Kaunas). 2019;55:697.

    Article  PubMed  Google Scholar 

  23. Buturović-Ponikvar J, Visnar-Perovic A. Ultrasonography in chronic renal failure. Eur J Radiol. 2003;46:115–22.

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors thank Editage (https://www.editage.jp/) for the English language review.

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, 30-1 Oyaguchi Kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan

    Naoki Matsumoto, Mariko Kumagawa, Kei Saito, Hiroo Imazu, Masahiro Ogawa & Hirofumi Kogure

  2. Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan

    Yukiyasu Okamura

  3. Division of Oncologic Pathology, Department of Pathology and Microbiology, Nihon University School of Medicine, Tokyo, Japan

    Yoko Nakanishi & Shinobu Masuda

  4. Department of Pathology, Nihon University School of Medicine, Tokyo, Japan

    Masahiko Sugitani

Authors
  1. Naoki Matsumoto
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  2. Mariko Kumagawa
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  3. Kei Saito
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  4. Hiroo Imazu
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  5. Masahiro Ogawa
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  6. Hirofumi Kogure
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  7. Yukiyasu Okamura
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  8. Yoko Nakanishi
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  9. Shinobu Masuda
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  10. Masahiko Sugitani
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Corresponding author

Correspondence to Naoki Matsumoto.

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The authors declare that there are no conflicts of interest.

Ethical approval

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Owing to the retrospective nature of this study, informed consent was waived.

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Cite this article

Matsumoto, N., Kumagawa, M., Saito, K. et al. Correlation between pathology and quantitative ultrasonographic evaluation of pancreatic fat with ultrasonographic classification. J Med Ultrasonics (2024). https://doi.org/10.1007/s10396-024-01408-0

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  • DOI: https://doi.org/10.1007/s10396-024-01408-0

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