Yingpu Zhu1, Arnold Kayira2, Blessed Kondowe3, Patrick Manda3, Junyi Ren4, Jingping Zhang5*
1 Department of Endocrine, Xi’an Xidian Group Hospital, Xi’an, China
2 Department of Nutrition, Mzuzu Central hospital, Mzuzu, Malawi
3 Department of Radiology, Mzuzu Central hospital, Mzuzu, Malawi
4 Department of Anesthesiology, Baoji Central Hospital, Baoji, China
5 Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong Universtiy, Xi’an, China
Corresponding Author: Jingping Zhang; E-mail: zhangjp@xjtufh.edu.cn.
Abstract
Purpose
Type 5 diabetes mellitus (T5DM), recently proposed as a diabetes phenotype associated with chronic undernutrition, remains poorly characterized regarding pancreatic structural changes. This study aimed to describe pancreatic MRI morphological features in individuals with clinically suspected T5DM from a resource-limited African setting.
Methods
This retrospective case series included four individuals with clinically suspected T5DM from Mzuzu Central Hospital, Malawi. Clinical characteristics, nutritional history, and routine abdominal MRI findings were reviewed. Pancreatic morphology was assessed using manual segmentation of axial T2-weighted PROPELLER images, with segmentation-derived pancreatic area and volume obtained.
Results
Four individuals (two females and two males; age range, 10–35 years) were included. All patients had a lean body habitus (BMI range, 16.4-18.3 kg/m²), childhood nutritional deprivation history, and no documented diabetic ketoacidosis or recurrent ketosis. MRI demonstrated a consistent morphological pattern characterized by relative preservation of the pancreatic head and uncinate process with reduction of the distal pancreas. Three patients showed thinning of the pancreatic body and tail, while the youngest patient demonstrated a shortened pancreatic tail not reaching the splenic hilum. Pancreatic body diameter ranged from 7.6 to 11.6 mm, with segmentation-derived pancreatic volume ranging from 16.9 to 27.3 cm³.
Conclusion
Individuals with clinically suspected T5DM demonstrated a recurrent pancreatic MRI pattern of preserved head morphology with reduced body and tail structures. These preliminary findings suggest that MRI-based pancreatic morphological assessment may provide additional structural information for malnutrition-associated diabetes phenotyping, particularly in settings with limited metabolic characterization.