An Observational Study of Pancreatic Elasticity on the Basis of Shear Wave Velocity by Elastography in Patients of Type 2 Diabetes Mellitus and Its Relation with Diabetic Microangiopathies at SMS Medical College, Jaipur

Abstract

 Background: Diabetic microangiopathy is a major cause of morbidity in type 2 diabetes mellitus (T2DM), yet the exocrine pancreas is rarely evaluated as a target of the same fibrotic and microvascular processes. Shear Wave Elastography (SWE) enables non-invasive quantification of pancreatic stiffness through Shear Wave Velocity (SWV), a validated surrogate of tissue fibrosis. Objective: To assess pancreatic elasticity on the basis of SWV in patients with T2DM and to determine its relationship with the presence and burden of diabetic microangiopathy. Methods: In this hospital-based cross-sectional study, 150 patients with T2DM were enrolled and divided into two groups of 75 each: those with microangiopathy (retinopathy, nephropathy and/or neuropathy) and those without. All patients underwent conventional B-mode ultrasonography and pancreatic SWE using a 2–5 MHz convex transducer. SWV (m/s) and elasticity modulus (kPa) were measured at the head, body and tail. Group comparisons, correlation analysis, logistic regression and receiver operating characteristic (ROC) analysis were performed; p<0.05 was considered significant. Results: Mean pancreatic SWV (1.9±0.3 vs. 1.3±0.2 m/s) and elasticity modulus (10.9±3.2 vs. 5.2±1.7 kPa) were significantly higher in the microangiopathy group (p<0.001). Patients with microangiopathy were older, had longer disease duration, poorer glycaemic control, shorter pancreatic length, wider main pancreatic duct and more coarse echotexture (all p<0.001). Pancreatic body SWV correlated most strongly with the number of microangiopathic complications (r = 0.72) and inversely with fasting C-peptide (r = −0.46). Age, duration of T2DM and HbA1c were independent predictors of microangiopathy. ROC analysis showed excellent discrimination, with AUCs of 0.947 (head), 0.941 (body) and 0.934 (tail) at cut-offs of ≥1.63–1.66 m/s. Conclusion: Pancreatic stiffness measured by SWE is significantly increased in T2DM patients with microangiopathy and tracks with complication burden, disease duration and glycaemic control. Pancreatic SWV is a promising non-invasive imaging biomarker for identifying diabetic microvascular disease.