Previtali Clelia, Sartoris Riccardo, Rebours Vinciane, Couvelard Anne, Cros Jerome, Sauvanet Alain, Cauchy Francois, Paradis Valérie, Vilgrain Valérie, Dioguardi Burgio Marco, Ronot Maxime
Department of Radiology. APHP.Nord. Beaujon Hospital, 92118 Clichy, France.
Department of Radiology. APHP.Nord. Beaujon Hospital, 92118 Clichy, France; Universit éParis Cité, Centre de Recherche sur l'Inflammation, Inserm, U1149, 75006, Paris, France.
Diagn Interv Imaging. 2023 Jul-Aug;104(7-8):359-367. doi: 10.1016/j.diii.2023.03.004. Epub 2023 Apr 13.
The purpose of this study was to assess the performance of quantitative computed tomography (CT) imaging for detecting pancreatic fatty infiltration, using the results of histopathological analysis as reference.
Sixty patients who underwent pancreatic surgery for a pancreatic tumor between 2016 and 2019 were retrospectively included. There were 33 women and 27 men with a mean age of 56 ± 12 (SD) years (age range: 18-79 years). Patients with dilatation of the main pancreatic duct, chronic pancreatitis, or preoperative treatment were excluded to prevent any bias in the radiological-pathological correlation. Pancreatic fatty infiltration was recorded at pathology. Pancreatic surface lobularity, pancreatic attenuation, visceral fat area, and subcutaneous fat area were derived from preoperative CT images. The performance for the prediction of fatty infiltration was assessed using area under receiver operating characteristic curve (AUC) and backward binary logistic regression analysis. Results were validated in a separate cohort of 34 patients (17 women; mean age, 50 ± 14 [SD] years; age range: 18-73).
A total of 28/60 (47%) and 17/34 (50%) patients had pancreatic fatty infiltration in the derivation and validation cohorts, respectively. In the derivation cohort, patients with pancreatic fatty infiltration had a significantly higher PSL (P < 0.001) and a lower pancreatic attenuation on both precontrast and portal venous phase images (P = 0.011 and 0.003, respectively), and higher subcutaneous fat area and visceral fat area (P = 0.010 and 0.007, respectively). Multivariable analysis identified pancreatic surface lobularity > 7.6 and pancreatic attenuation on portal venous phase images < 83.5 Hounsfield units as independently associated with fatty infiltration. The combination of these variables resulted in an AUC of 0.85 (95% CI: 0.74-0.95) and 0.83 (95% CI: 0.67-0.99) in the derivation and validation cohorts, respectively.
CT-based quantitative imaging accurately predicts pancreatic fatty infiltration.
本研究旨在以组织病理学分析结果为参照，评估定量计算机断层扫描（CT）成像检测胰腺脂肪浸润的性能。
回顾性纳入2016年至2019年间因胰腺肿瘤接受胰腺手术的60例患者。其中女性33例，男性27例，平均年龄56±12（标准差）岁（年龄范围：18 - 79岁）。排除主胰管扩张、慢性胰腺炎或术前接受治疗的患者，以防止在放射学 - 病理学相关性方面产生任何偏差。在病理学检查中记录胰腺脂肪浸润情况。从术前CT图像中获取胰腺表面分叶、胰腺衰减、内脏脂肪面积和皮下脂肪面积。使用受试者操作特征曲线下面积（AUC）和向后二元逻辑回归分析评估预测脂肪浸润的性能。结果在另一组34例患者（17例女性；平均年龄50±14（标准差）岁；年龄范围：18 - 73岁）中进行验证。
在推导队列和验证队列中，分别有28/60（47%）和17/34（50%）的患者存在胰腺脂肪浸润。在推导队列中，存在胰腺脂肪浸润的患者在胰腺表面分叶（PSL）方面显著更高（P < 0.001），在平扫和门静脉期图像上的胰腺衰减均更低（分别为P = 0.011和0.003），皮下脂肪面积和内脏脂肪面积更高（分别为P = 0.010和0.007）。多变量分析确定胰腺表面分叶> 7.6且门静脉期图像上的胰腺衰减< 83.5亨氏单位与脂肪浸润独立相关。这些变量的组合在推导队列和验证队列中的AUC分别为0.85（95% CI：0.74 - 0.95）和0.83（95% CI：0.67 - 0.99）。
基于CT的定量成像能够准确预测胰腺脂肪浸润。
