Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
Eur Radiol. 2022 Mar;32(3):1770-1780. doi: 10.1007/s00330-021-08255-4. Epub 2021 Oct 12.
To investigate the diagnostic performance of the extracellular volume (ECV) fraction in multiphasic contrast-enhanced computed tomography (CE-CT) for estimating histologic pancreatic fibrosis and predicting postoperative pancreatic fistula (POPF).
Eighty-five patients (49 men; mean age, 69 years) who underwent multiphasic CE-CT followed by pancreaticoduodenectomy with pancreaticojejunal anastomosis between January 2012 and December 2018 were retrospectively included. The ECV fraction was calculated from absolute enhancements of the pancreas and aorta between the precontrast and equilibrium-phase images, followed by comparisons among histologic pancreatic fibrosis grades (F0‒F3). The diagnostic performance of the ECV fraction in advanced fibrosis (F2‒F3) was evaluated using receiver operating characteristic curve analysis. Multivariate logistic regression analysis was used to evaluate the associations of the risk of POPF development with patient characteristics, histologic findings, and CT imaging parameters.
The mean ECV fraction of the pancreas was 34.4% ± 9.5, with an excellent intrareader agreement of 0.811 and a moderate positive correlation with pancreatic fibrosis (r = 0.476; p < 0.001). The mean ECV fraction in advanced fibrosis was significantly higher than that in no/mild fibrosis (44.4% ± 10.8 vs. 31.7% ± 6.7; p < 0.001), and the area under the receiver operating characteristic curve for the diagnosis of advanced fibrosis was 0.837. Twenty-two patients (25.9%) developed clinically relevant POPF. Multivariate logistic regression analysis demonstrated that the ECV fraction was a significant predictor of POPF.
The ECV fraction can offer quantitative information for assessing pancreatic fibrosis and POPF after pancreaticojejunal anastomosis.
• There was a moderate positive correlation of the extracellular volume (ECV) fraction of the pancreas in contrast-enhanced CT with the histologic grade of pancreatic fibrosis (r = 0.476; p < 0.001). • The ECV fraction was higher in advanced fibrosis (F2‒F3) than in no/mild fibrosis (F0‒F1) (p < 0.001), with an AUC of 0.837 for detecting advanced fibrosis. • The ECV fraction was an independent risk factor for predicting subclinical (odds ratio, 0.81) and clinical (odds ratio, 0.80) postoperative pancreatic fistula.
研究多期对比增强 CT（CE-CT）中细胞外容积（ECV）分数对胰腺纤维化的组织学评估和预测术后胰瘘（POPF）的诊断性能。
回顾性纳入 2012 年 1 月至 2018 年 12 月间接受多期 CE-CT 检查并随后行胰十二指肠切除术和胰肠吻合术的 85 例患者（49 例男性；平均年龄，69 岁）。通过计算胰腺和主动脉在增强前和平衡期图像之间的绝对增强值来计算 ECV 分数，并对组织学胰腺纤维化程度（F0-F3）进行比较。采用受试者工作特征曲线分析评估 ECV 分数对晚期纤维化（F2-F3）的诊断性能。采用多变量逻辑回归分析评估 POPF 发生风险与患者特征、组织学发现和 CT 影像学参数之间的相关性。
胰腺的平均 ECV 分数为 34.4%±9.5，具有极好的内部读者一致性（0.811），与胰腺纤维化呈中度正相关（r=0.476；p<0.001）。晚期纤维化的平均 ECV 分数明显高于无/轻度纤维化（44.4%±10.8 比 31.7%±6.7；p<0.001），诊断晚期纤维化的受试者工作特征曲线下面积为 0.837。22 例患者（25.9%）发生临床相关的 POPF。多变量逻辑回归分析表明，ECV 分数是 POPF 的显著预测因子。
ECV 分数可为胰肠吻合术后评估胰腺纤维化和 POPF 提供定量信息。
• 胰腺增强 CT 的细胞外容积（ECV）分数与胰腺纤维化的组织学分级呈中度正相关（r=0.476；p<0.001）。• 晚期纤维化（F2-F3）的 ECV 分数高于无/轻度纤维化（F0-F1）（p<0.001），检测晚期纤维化的 AUC 为 0.837。• ECV 分数是预测亚临床（优势比，0.81）和临床（优势比，0.80）术后胰瘘的独立危险因素。
