Kalayarasan Raja, Himaja Mandalapu, Ramesh Ananthakrishnan, Kokila Kathirvel
Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India.
Department of Radiodiagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India.
World J Radiol. 2023 Jun 28;15(6):170-181. doi: 10.4329/wjr.v15.i6.170.
Preoperative prediction of the postoperative pancreatic fistula risk is critical in the current era of minimally invasive pancreatic surgeries to tailor perioperative management, thereby minimizing postoperative morbidity. Pancreatic duct diameter can be readily measured by any routine imaging used to diagnose pancreatic disease. However, radiological evaluation of pancreatic texture, an important determinant of pancreatic fistula, has not been widely used to predict the risk of postoperative pancreatic fistula. Qualitative and quantitative assessment of pancreatic fibrosis and fat fraction provides the basis for predicting pancreatic texture. Traditionally computed tomography has been utilized in identifying and characterizing pancreatic lesions and background parenchymal pathologies. With the increasing utilisation of endoscopic ultrasound and magnetic resonance imaging for evaluating pancreatic pathologies, elastography is emerging as a promising tool for predicting pancreatic texture. Also, recent studies have shown that early surgery for chronic pancreatitis is associated with better pain relief and preservation of pancreatic function. Pancreatic texture assessment can allow early diagnosis of chronic pancreatitis, facilitating early intervention. The present review outlines the current evidence in utilizing various imaging modalities for determining the pancreatic texture based on different parameters and image sequences. However, multidisciplinary investigations using strong radiologic-pathologic correlation are needed to standardize and establish the role of these non-invasive diagnostic tools in predicting pancreatic texture.
在当前微创胰腺手术时代，术前预测术后胰瘘风险对于制定围手术期管理方案至关重要，从而将术后发病率降至最低。胰管直径可通过用于诊断胰腺疾病的任何常规影像检查轻松测量。然而，作为胰瘘重要决定因素的胰腺质地的影像学评估尚未广泛用于预测术后胰瘘风险。胰腺纤维化和脂肪分数的定性和定量评估为预测胰腺质地提供了依据。传统上，计算机断层扫描已用于识别和表征胰腺病变及背景实质病变。随着内镜超声和磁共振成像在评估胰腺病变中的应用日益增加，弹性成像正成为预测胰腺质地的一种有前景的工具。此外，最近的研究表明，慢性胰腺炎的早期手术与更好的疼痛缓解和胰腺功能保留相关。胰腺质地评估可实现慢性胰腺炎的早期诊断，便于早期干预。本综述概述了目前利用各种成像方式基于不同参数和图像序列确定胰腺质地的证据。然而，需要使用强大的放射病理相关性进行多学科研究，以规范并确立这些非侵入性诊断工具在预测胰腺质地中的作用。
