Diabetes mellitus: long-term prognostic value of whole-body MR imaging for the occurrence of cardiac and cerebrovascular events

Fabian Bamberg; Klaus G Parhofer; Elena Lochner; Roy P Marcus; Daniel Theisen; Hannes M Findeisen; Udo Hoffmann; Stefan O Schönberg; Christopher L Schlett; Maximilian F Reiser; Sabine Weckbach

doi:10.1148/radiol.13130371

Diabetes mellitus: long-term prognostic value of whole-body MR imaging for the occurrence of cardiac and cerebrovascular events

Radiology. 2013 Dec;269(3):730-7. doi: 10.1148/radiol.13130371. Epub 2013 Oct 28.

Authors

Fabian Bamberg¹, Klaus G Parhofer, Elena Lochner, Roy P Marcus, Daniel Theisen, Hannes M Findeisen, Udo Hoffmann, Stefan O Schönberg, Christopher L Schlett, Maximilian F Reiser, Sabine Weckbach

Affiliation

¹ From the Department of Clinical Radiology (F.B., E.L., R.P.M., D.T., M.F.R., S.W.) and Department of Internal Medicine II (K.G.P.), Ludwig Maximilians University, Klinikum Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany; Department of Cardiology, University Hospital RWTH Aachen, Aachen, Germany (F.B., H.M.F.); Cardiac MR PET CT Program, Division of Cardiology and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (U.H., C.L.S.); Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Mannheim, Germany (S.O.S.); and Department of Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany (S.W., C.L.S.).

PMID: 24023074
DOI: 10.1148/radiol.13130371

Abstract

Purpose: To study the predictive value of whole-body magnetic resonance (MR) imaging for the occurrence of cardiac and cerebrovascular events in a cohort of patients with diabetes mellitus (DM).

Materials and methods: This HIPAA-compliant study was approved by the institutional review board. Informed consent was obtained from all patients before enrollment into the study. The authors followed up 65 patients with DM (types 1 and 2) who underwent a comprehensive, contrast material-enhanced whole-body MR imaging protocol, including brain, cardiac, and vascular sequences at baseline. Follow-up was performed by phone interview. The primary endpoint was a major adverse cardiac and cerebrovascular event (MACCE), which was defined as composite cardiac-cerebrovascular death, myocardial infarction, cerebrovascular event, or revascularization. MR images were assessed for the presence of systemic atherosclerotic vessel changes, white matter lesions, and myocardial changes. Kaplan-Meier survival and Cox regression analyses were performed to determine associations.

Results: Follow-up was completed in 61 patients (94%; median age, 67.5 years; 30 women [49%]; median follow-up, 70 months); 14 of the 61 patients (23%) experienced MACCE. Although normal whole-body MR imaging excluded MACCE during the follow-up period (0%; 95% confidence interval [CI]: 0%, 17%), any detectable ischemic and/or atherosclerotic changes at whole-body MR imaging (prevalence, 66%) conferred a cumulative event rate of 20% at 3 years and 35% at 6 years. Whole-body MR imaging summary estimate of disease was strongly predictive for MACCE (one increment of vessel score and each territory with atherosclerotic changes: hazard ratio, 13.2 [95% CI: 4.5, 40.1] and 3.9 [95% CI: 2.2, 7.5], respectively), also beyond clinical characteristics as well as individual cardiac or cerebrovascular MR findings.

Conclusion: These initial data indicate that disease burden as assessed with whole-body MR imaging confers strong prognostic information in patients with DM. Online supplemental material is available for this article.

MeSH terms

Aged
Cardiovascular Diseases / diagnosis*
Cerebrovascular Disorders / diagnosis*
Contrast Media
Diabetes Complications / diagnosis*
Endpoint Determination
Female
Follow-Up Studies
Humans
Interviews as Topic
Magnetic Resonance Imaging / methods*
Male
Predictive Value of Tests
Prognosis
Prospective Studies
Risk
Whole Body Imaging*

Substances

Contrast Media