Department of Surgery, University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN 55455.
Department of Radiology, University of Colorado School of Medicine, Aurora, CO.
AJR Am J Roentgenol. 2021 Jul;217(1):100-106. doi: 10.2214/AJR.20.23303. Epub 2021 Apr 28.
The purpose of this retrospective study was to investigate the prevalence and patterns of hepatic steatosis after total pancreatectomy with islet autotransplant (TPIAT) and to determine if the unique patterns of steatosis seen in this study correlated with islet graft function. Fifty-two subjects who had undergone MRI after TPIAT were reviewed for the presence of hepatic steatosis. Patterns of steatosis were categorized into three groups: normal (no steatosis), homogeneous, and atypical. Demographics and outcomes were compared between the groups. Islet graft function 1 year after surgery was classified as full graft function, partial graft function, and graft failure. Statistical analysis was performed using ANOVA, Kruskal-Wallis, and Fisher exact tests. Sixty-three percent of patients had steatosis present on MRI after TPIAT (33 subjects of 52 total), and 48% (25/52) exhibited an atypical pattern. Twenty-four percent of the 37 patients who had MRI examinations before TPIAT showed steatosis preoperatively, yet none of these showed an atypical steatosis pattern. Islet graft function was not statistically different between the groups. The only statistically significant variable difference between the groups was body mass index ( = .02). Steatosis is a common finding after TPIAT, and atypical steatosis patterns frequently develop after the procedure, implying that the procedure itself is the causal factor. There was no correlation between islet graft function and the presence or pattern of steatosis. An atypical pattern of hepatic steatosis can therefore be considered an incidental finding after TPIAT and does not require additional workup or treatment.
本回顾性研究旨在调查全胰切除伴胰岛自体移植（TPIAT）后肝脂肪变性的发生率和模式，并确定本研究中观察到的独特脂肪变性模式是否与胰岛移植物功能相关。 对 52 例行 TPIAT 后行 MRI 检查的患者进行了肝脂肪变性的存在情况评估。 将脂肪变性模式分为三组：正常（无脂肪变性）、均匀和非典型。 比较各组间的人口统计学和结局。 术后 1 年胰岛移植物功能分为全移植物功能、部分移植物功能和移植物衰竭。 使用方差分析、Kruskal-Wallis 和 Fisher 精确检验进行统计学分析。 63%的患者 TPIAT 后 MRI 显示有脂肪变性（52 例中 33 例），48%（25/52）表现为非典型模式。 24%的 37 例术前行 MRI 检查的患者术前有脂肪变性，但均无非典型脂肪变性模式。 各组间胰岛移植物功能无统计学差异。 组间唯一有统计学差异的变量是体重指数（=.02）。 脂肪变性是 TPIAT 后的常见发现，且术后常出现非典型脂肪变性模式，这表明该手术本身是致病因素。 胰岛移植物功能与脂肪变性的存在或模式之间无相关性。 因此，TPIAT 后肝脂肪变性的非典型模式可视为偶发发现，不需要进一步检查或治疗。
