Imaging Findings of Pancreatic Changes in Type 1 Diabetes

Type 1 diabetes (T1D) is caused by autoimmune destruction of the pancreatic beta cell. However, the pancreas, the site of T1D pathogenesis, is not routinely assessed in T1D. Rather, the disease is diagnosed and monitored by assaying the consequence of the destruction of beta cells: lack of insulin production and dysregulation of blood glucose levels. This assessment of disease symptoms, rather than the cause, has important implications for understanding the natural history and treatment of T1D. Dysregulated glucose is thought to occur only after beta cell mass is greatly reduced, putatively due to compensation for loss of beta cells via increased insulin secretion 1. The autoimmune process underlying T1D can occur years or decades prior to onset of dysglycemia 2, but current clinical practice is limited by a lack of early prediction and interventions intended to prevent beta cell loss. Cross-sectional imaging of the endocrine and exocrine pancreas may provide early predictors of T1D risk and progression. In this review, we summarize current imaging techniques capable of monitoring changes in the pancreas and their potential clinical utility in T1D.