Zhong Yu-Qing, Zhu Xiao-Xu, Huang Xi-Tai, Luo Yan-Ji, Huang Chen-Song, Xu Qiong-Cong, Yin Xiao-Yu
Department of Pancreatobiliary Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
Department of Pancreatobiliary Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China; Department of Burn and Plastic Surgery, Guangzhou Red Cross Hospital, Jinan University, Guangdong, China.
J Gastrointest Surg. 2025 Feb;29(2):101886. doi: 10.1016/j.gassur.2024.101886. Epub 2024 Nov 13.
Clinically relevant postoperative pancreatic fistula (CR-POPF) is the major complication of pancreatoduodenectomy, and the pancreatic texture is one of the potential affecting factors. Multifrequency magnetic resonance elastography (MRE) is a novel technique for measuring tissue stiffness, but its value in predicting CR-POPF preoperatively has not been well documented.
A total of 70 patients who underwent multifrequency MRE before pancreatoduodenectomy between July 2021 and April 2024 were retrospectively recruited into the study. The parameters of MRE, shear wave speed (c) and phase angle (φ), and clinical data were collected. Logistic regression and the receiver operating characteristic curve analyses were used to assess the performance of multifrequency MRE in predicting CR-POPF.
CR-POPF was developed in 14 of 70 patients (20%), all categorized as grade B. The CR-POPF group had significantly lower c (1.339 ± 0.210 m/s) and longer hospital stays (21 [IQR, 15.50-37.75] days) than the no-CR-POPF group. The MRE parameters, c and φ, were moderately correlated with pancreas stiffness (eta for φ = 0.189 and eta for c = 0.106). Dilated major pancreatic duct (MPD ≥ 3 mm) and higher c were independently associated with a lower risk of CR-POPF in univariant and multivariant analyses (odds ratio [OR] for c, 0.041 [95% CI, 0.002-0.879]; OR for dilated MPD, 0.129 [95% CI, 0.022-0.768]). The area under the curve (AUC) of the predictive model based on c and MPD diameter was 0.786, which was better than the fistula risk score (FRS) (AUC = 0.587) and alternative FRS (AUC = 0.556) in our center, with the DeLong test P = .028 and P = .002, respectively.
The MRE parameters were associated with pancreatic stiffness, and c was an independent predictor of CR-POPF after pancreatoduodenectomy.
临床相关的术后胰瘘（CR-POPF）是胰十二指肠切除术的主要并发症，胰腺质地是潜在的影响因素之一。多频磁共振弹性成像（MRE）是一种测量组织硬度的新技术，但其术前预测CR-POPF的价值尚未得到充分证实。
回顾性纳入2021年7月至2024年4月期间在胰十二指肠切除术前接受多频MRE检查的70例患者。收集MRE参数、剪切波速度（c）和相位角（φ）以及临床数据。采用逻辑回归和受试者工作特征曲线分析来评估多频MRE预测CR-POPF的性能。
70例患者中有14例（20%）发生CR-POPF，均为B级。CR-POPF组的c值（1.339±0.210 m/s）显著低于非CR-POPF组，住院时间更长（21天[四分位数间距，15.50 - 37.75天]）。MRE参数c和φ与胰腺硬度呈中度相关（φ的eta值 = 0.189，c的eta值 = 0.106）。在单因素和多因素分析中，主胰管扩张（MPD≥3 mm）和较高的c与CR-POPF风险较低独立相关（c的比值比[OR]为0.041[95%置信区间，0.002 - 0.879]；扩张的MPD的OR为0.129[95%置信区间，0.022 - 0.768]）。基于c和MPD直径的预测模型的曲线下面积（AUC）为0.786，优于本中心的胰瘘风险评分（FRS）（AUC = 0.587）和替代FRS（AUC = 0.556），DeLong检验P值分别为0.028和0.002。
MRE参数与胰腺硬度相关联，c是胰十二指肠切除术后CR-POPF的独立预测因素。
