Key result
One increment of vessel score on whole-body MRI was strongly predictive of major adverse cardiac and cerebrovascular events in patients with diabetes (HR 13.2; 95% CI 4.5-40.1).
Why the study?
Does whole-body MR imaging predict the occurrence of major adverse cardiac and cerebrovascular events in patients with diabetes mellitus?
Cohort (n=61)
No
Does whole-body MR imaging predict the occurrence of major adverse cardiac and cerebrovascular events in patients with diabetes mellitus?
Whole-body MR imaging provides strong prognostic information for predicting major adverse cardiac and cerebrovascular events in patients with diabetes mellitus.
May support MRI vessel scoring for prognostication in diabetes; leaves open prospective validation against standard risk tools.
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.
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Bamberg et al. (2013) conducted a cohort in Diabetes mellitus (n=61). Detectable ischemic and/or atherosclerotic changes on whole-body MR imaging vs. Normal whole-body MR imaging was evaluated on Major adverse cardiac and cerebrovascular event (MACCE), defined as composite cardiac-cerebrovascular death, myocardial infarction, cerebrovascular event, or revascularization (HR 13.2, 95% CI 4.5-40.1). One increment of vessel score on whole-body MRI was strongly predictive of major adverse cardiac and cerebrovascular events in patients with diabetes (HR 13.2; 95% CI 4.5-40.1).
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