Pancreatic Morphological Patterns on MRI in Individuals With Suspected Type 5 Diabetes: An Exploratory Case Series From Mzuzu Central hospital, Malawi.

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.