title: Diabetes mellitus: long-term prognostic value of whole-body MR imaging for the occurrence of cardiac and cerebrovascular events.
abstract: OBJECTIVE
  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).
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: 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.).
authors.forename: Fabian
authors.initials: F
authors.lastname: Bamberg
authors.forename: Klaus G
authors.initials: KG
authors.lastname: Parhofer
authors.forename: Elena
authors.initials: E
authors.lastname: Lochner
authors.forename: Roy P
authors.initials: RP
authors.lastname: Marcus
authors.forename: Daniel
authors.initials: D
authors.lastname: Theisen
authors.forename: Hannes M
authors.initials: HM
authors.lastname: Findeisen
authors.forename: Udo
authors.initials: U
authors.lastname: Hoffmann
authors.forename: Stefan O
authors.initials: SO
authors.lastname: Schönberg
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Schlett
authors.forename: Maximilian F
authors.initials: MF
authors.lastname: Reiser
authors.forename: Sabine
authors.initials: S
authors.lastname: Weckbach
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000175:diagnosis*; D002561:Cerebrovascular Disorders / Q000175:diagnosis*; D003287:Contrast Media; D048909:Diabetes Complications / Q000175:diagnosis*; D023381:Endpoint Determination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007407:Interviews as Topic; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012306:Risk; D051598:Whole Body Imaging
chemical_list: D003287:Contrast Media