Pancreatic Shear Wave Elastography in Pediatrics with Type I DM

Abstract Background Type I diabetes milletus (DM) is one of the most prevalent autoimmune diseases in the pediatric age group. It is characterized by pancreatic inflammation in the early stages due to autoimmune destruction of the insulin producing beta cells with subsequent fibrosis in the late stages. Conventional gray-scale ultrasonography can provide detailed information about the bio- mechanical structure of tissues when used with the new method of elastography. As tissues affected by a variety of pathologic processes display different mechanical features, stiffness differences may be used to differentiate diffuse diseases or focal lesions. Objective To assess the role of pancreatic shear wave elastography (SWE) in children with type I diabetes in comparison to control subjects. Methods A cross-sectional study over the course of 6 months from March 2023 till September 2023. It included 41 cases with laboratory proven type I DM on insulin therapy and 41 age and gender matched non-diabetic controls referred to our department from the outpatient pediatric clinics for and abdominal ultra-sonography. C-peptide and HbA1C of the cases were measured. Conventional B-mode ultrasonography and pancreatic SWE were performed using the General Electric Logiq P9 ultrasound system. Results Conventional B-mode abdominal ultra-sonography together with pancreatic shear wave elastography were done to the entire study group. There was no significant difference by B-mode noted between the study subjects regarding echogenicity and homogeneity. Shear wave elastography (SWE) values of the diabetic cases and non-diabetic controls were compared and revealed a significant difference between both groups being faster in the cases than in the control group with p-value <0.05. Shear wave elastography values of the cases were compared to each other in respect to their disease duration, age, C-peptide levels and HBA1C levels and there was a statistically significant positive correlation between SWE, disease duration and age with p-value <0.001, while there was statistically significant negative correlation between mean of SWE and level of C-peptide with p-value <0.001. There was no significant correlation with HbA1c with p-value 0.116. Conclusion Type I DM affects pancreatic tissue stiffness as evident by the difference in the mean SWE values of the diabetic cases and the non-diabetic controls. Pancreatic SWE changes significantly in correlation to disease duration, age and C-peptide. Hence, SWE might serve as a new promising non-invasive imaging modality for monitoring and following up type 1 diabetes in children.