From the Departments of Radiology (Y.S., Ying Liu, Yanqing Liu, Q.G.), Pancreato-thyroidic Surgery (F.G.), and Pathology (Yue Li), Shengjing Hospital, China Medical University, No. 36 Sanhao St, Heping District, Shenyang 110004, P.R. China; and Department of Radiology, Mayo Clinic, Rochester, Minn (S.T., K.J.G., R.L.E.).
Radiology. 2018 Aug;288(2):476-484. doi: 10.1148/radiol.2018170450. Epub 2018 Apr 17.
Purpose To describe the relationship between conventional magnetic resonance (MR) imaging parameters and MR elastography of the pancreas in association with pancreatic histologic features and occurrence of postoperative pancreatic fistula (POPF). Materials and Methods Patients who underwent preoperative MR imaging (MR elastography and diffusion-, T1-, and T2-weighted imaging) followed by pancreatectomy with pancreaticoenteric anastomosis were included. The relationships between preoperative MR imaging parameters, demographic data, and intraoperative factors with POPF risk were analyzed with logistic regression analyses. The correlation of MR imaging parameters with histologic characteristics was evaluated with multivariate regression analysis. Results A total of 112 patients (64 men, 48 women; median age, 58 years) were evaluated. Forty-two patients (37.5%) developed POPF and 20 (17.9%) developed high-grade POPF (grades B and C). Lower pancreatic stiffness (≤1.43 kPa; odds ratio [OR], 9.196; 95% confidence interval [CI]: 1.92, 43.98), nondilated main pancreatic duct (MPD) diameter (<3 mm; OR, 7.298; 95% CI: 1.51, 35.34), and larger stump area (≥211 mm; OR, 9.210; 95% CI: 1.53, 55.26) were risk factors for POPF. Lower pancreatic stiffness (≤1.27 kPa; OR, 8.389; 95% CI: 1.88, 37.41) was the only independent predictor of high-grade POPF. Log-transformed pancreatic stiffness was independently associated with fibrosis (β = 0.060; 95% CI: 0.052, 0.068), acinar atrophy (β = 0.015; 95% CI: 0.003, 0.028), and lipomatosis (β = -0.016; 95% CI: -0.026, -0.006). Conclusion Preoperative MR assessment of pancreatic stiffness, MPD diameter, and stump area are important predictors of POPF.
描述胰腺常规磁共振（MR）成像参数与 MR 弹性成像与胰腺组织学特征及术后胰瘘（POPF）发生之间的关系。
本研究纳入了接受术前 MR 成像（MR 弹性成像以及弥散加权、T1 加权和 T2 加权成像），随后接受胰肠吻合术的患者。采用逻辑回归分析评估术前 MR 成像参数、人口统计学数据和术中因素与 POPF 风险的相关性。采用多元回归分析评估 MR 成像参数与组织学特征的相关性。
共纳入 112 例患者（64 例男性，48 例女性；中位年龄 58 岁）。42 例（37.5%）患者发生 POPF，20 例（17.9%）发生高分级 POPF（分级 B 和 C）。较低的胰腺硬度（≤1.43 kPa；比值比 [OR]，9.196；95%置信区间 [CI]：1.92，43.98）、主胰管（MPD）不扩张直径（<3 mm；OR，7.298；95% CI：1.51，35.34）和较大的残端面积（≥211 mm；OR，9.210；95% CI：1.53，55.26）是 POPF 的危险因素。较低的胰腺硬度（≤1.27 kPa；OR，8.389；95% CI：1.88，37.41）是高分级 POPF 的唯一独立预测因子。胰腺硬度的对数值与纤维化（β=0.060；95% CI：0.052，0.068）、腺泡萎缩（β=0.015；95% CI：0.003，0.028）和脂肪化生（β=-0.016；95% CI：-0.026，-0.006）独立相关。
术前胰腺硬度、MPD 直径和残端面积的 MR 评估是 POPF 的重要预测因子。
