Diabetes Mellitus: Long-term Prognostic Value of Whole-Body MR Imaging for the Occurrence of Cardiac and Cerebrovascular Events
- Fabian Bamberg, MD, MPH,
- Klaus G. Parhofer, MD,
- Elena Lochner, BS,
- Roy P. Marcus, BS,
- Daniel Theisen, MD,
- Hannes M. Findeisen, MD,
- Udo Hoffmann, MD, MPH,
- Stefan O. Schönberg, MD,
- Christopher L. Schlett, MD, MPH,
- Maximilian F. Reiser, MD and
- Sabine Weckbach, MD
- 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.).
- Address correspondence to
F.B. (e-mail: fbamberg@med.lmu.de).
- Author contributions: Guarantors of integrity of entire study, F.B., S.W.; study concepts/study design or data acquisition or data analysis/interpretation, all authors; manuscript drafting or manuscript revision for important intellectual content, all authors; manuscript final version approval, all authors; literature research, F.B., E.L., D.T., U.H., S.O.S., M.F.R., S.W.; clinical studies, F.B., K.G.P., E.L., R.P.M., D.T., H.M.F., S.O.S., M.F.R., S.W.; statistical analysis, F.B., D.T., U.H., C.L.S.; and manuscript editing, F.B., K.G.P., E.L., R.P.M., D.T., U.H., S.O.S., C.L.S., M.F.R., S.W.
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-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.
© RSNA, 2013
Supplemental material:http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.13130371/-/DC1