Future imaging modalities for the assessment of pancreas allografts a scan of the horizon

• Published in: Transplantation reviews (Philadelphia, Pa.) Pa.), 2022-04, Vol.36 (2), p.100692-100692, Article 100692
• Main Authors: Doherty, D.T., Khambalia, H.A., Summers, A., Moinuddin, Z., Yiannoullou, P., Krishnan, A., Augustine, T., Naish, J.H., van Dellen, D.
• Format: Article
• Language: English
• Subjects: Allografts - diagnostic imaging; Functional imaging; Humans; Imaging techniques; Kidney Transplantation - methods; Pancreas - pathology; Pancreas transplant; Positron Emission Tomography Computed Tomography; Ultrasonography - methods
• ISSN: 0955-470X; 1557-9816
• DOI: 10.1016/j.trre.2022.100692

Pancreas transplantation (PT) allows improved glycaemic control for patients with complicated type 1 diabetes mellitus and is most commonly performed simultaneously with a renal transplant. Imaging modalities are critical for the assessment of pancreatic graft dysfunction, as clinical assessment and hyperglycaemia lack robust sensitivity for the transplant clinician. Biopsy represents the most conclusive standard of PT graft assessment but is challenging due to its invasive nature and the potential morbidity associated with the procedure. Innovative imaging technologies offer the opportunity to apply these modalities to improve PT outcomes while using non-invasive technologies to provide a diagnostic sensitivity that traditionally only biopsies can provide. Early graft dysfunction has traditionally been investigated with Computed tomography (CT) and ultrasound (US) scans. We explore adjuncts to these modalities including the application of contrast enhanced ultrasound (CEUS) for routine post-operative graft assessment to inform post-operative treatment strategies. There is currently a dearth of imaging modalities to reliably monitor long term graft function, but the use of innovative functional imaging techniques and how they can be applied to PT is discussed. Perfusion CT and glucose stimulated magnetic resonance imaging (MRI) to detect whole organ function are examined. In addition, early phase developments in beta-cell specific imaging methods to quantify beta-cell mass longitudinally are described. The clinical applications of such tools including Mn2+-enhanced MR and GLP-1R targeted PET/CT are reviewed and may demonstrate opportunities to provide the transplant clinician with greater information to support improved patient care. •Overview of current imaging techniques in pancreas transplantation.•Perioperative assessment with novel US and CT modes.•Functional imaging to measure beta-cell mass.