title: Early pancreatic volume reduction on CT predicts relapse in patients with type 1 autoimmune pancreatitis treated with steroids.
abstract: Type 1 autoimmune pancreatitis (AIP) is clinically characterized by a response to steroid therapy. Despite having a favorable prognosis, AIP has a high relapse rate and factors predicting relapse in AIP patients treated with steroids have not yet been established.
  
  
  
  A retrospective chart review was conducted of 32 newly diagnosed type 1 AIP patients who had undergone enhanced computed tomography (CT) pre- and post-steroid therapy.
  
  
  
  Ten patients experienced relapse. Pancreatic volume was reduced significantly in all patients (pre-treatment volume, 88.5 ± 32.9 cm(3) vs. post-treatment volume, 45.4 ± 21.1 cm(3); P < 0.001), although the pre-treatment pancreatic volume did not differ between the relapse and non-relapse groups (92.6 ± 10.5 cm(3) vs. 86.6 ± 7.1 cm(3), P = 0.401). However, the post-treatment pancreatic volume was significantly greater in the relapse group than that in the non-relapse group (56.9 ± 6.3 cm(3) vs. 40.2 ± 4.2 cm(3), P = 0.008). Similarly, the percent reduction in pancreatic volume was significantly smaller in the relapse group than that in the non-relapse group (36.6 ± 4.7 % vs. 52.1 ± 3.2 %, P = 0.002). Multivariate analysis identified post-treatment pancreatic volume (HR, 1.04, 95 % CI: 1.01-1.08, P = 0.010) and percent reduction in pancreatic volume (HR, 0.87, 95 % CI: 0.79-0.94, P < 0.001) as predictive factors for relapse of type 1 AIP. A post-treatment pancreatic volume of 50 cm(3) < (P = 0.009) and a percent reduction in the pancreatic volume of <35 % (P = 0.004) had a significantly high relapse rate. These data suggest that early pancreatic volume changes after steroid therapy may be a useful prognostic value, because type 1 AIP patients with a high post-treatment pancreatic volume or low pancreatic volume reduction showed significant relapse.
  
  
  
  Early pancreatic volume reduction on CT after steroid therapy indicates the therapeutic effects of steroids, and a low decrease in the pancreatic volume may be associated with a limited response that predicts future relapse in patients with type 1 AIP. Reduction of steroids in these cases must be observed carefully with consideration of immunomodulator use.
authors.affiliation: Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan.
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Ohno
authors.affiliation: Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan. terukuma@m.ehime-u.ac.jp.
authors.forename: Teru
authors.initials: T
authors.lastname: Kumagi
authors.affiliation: Center for Liver-Biliary-Pancreatic Diseases, Matsuyama Red Cross Hospital, Matsuyama, 790-8524, Ehime, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Yokota
authors.affiliation: Gastroenterology, Ehime Prefectural Central Hospital, Matsuyama, 790-0024, Ehime, Japan.
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Azemoto
authors.affiliation: Gastroenterology, Matsuyama Municipal Hospital, Matsuyama, 790-0067, Ehime, Japan.
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Tanaka
authors.affiliation: Internal Medicine, Saiseikai Imabari Hospital, Imabari, 799-1502, Ehime, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Tange
authors.affiliation: Internal Medicine, Saiseikai Matsuyama Hospital, Matsuyama, 791-8026, Ehime, Japan.
authors.forename: Nobu
authors.initials: N
authors.lastname: Inada
authors.affiliation: Gastroenterology, Ehime Prefectural Central Hospital, Matsuyama, 790-0024, Ehime, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Miyata
authors.affiliation: Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan.
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Imamura
authors.affiliation: Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan.
authors.forename: Mitsuhito
authors.initials: M
authors.lastname: Koizumi
authors.affiliation: Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan.
authors.forename: Taira
authors.initials: T
authors.lastname: Kuroda
authors.affiliation: Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan.
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Hiasa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001327:Autoimmune Diseases / Q000188:drug therapy* / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000187:drug effects / Q000473:pathology; D010195:Pancreatitis / Q000188:drug therapy / Q000473:pathology; D012008:Recurrence; D012189:Retrospective Studies; D013256:Steroids / Q000627:therapeutic use*; D014057:Tomography, X-Ray Computed
chemical_list: D013256:Steroids
keywords: Autoimmune pancreatitis; CT; Pancreatic volume; Relapse factor; Steroid therapy