Sasaki Takahide, Takayama Yukihisa, Tanaka Shinji, Hamada Yoshihiro, Nakashima Ryo, Naito Shigetoshi, Kajiwara Masatoshi, Hasegawa Suguru
Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
Department of Radiology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
Pancreatology. 2025 Feb;25(1):153-159. doi: 10.1016/j.pan.2024.12.003. Epub 2024 Dec 6.
BACKGROUND/OBJECTIVES: Postoperative pancreatic fistula (POPF) is a critical complication of pancreatectomy, with a higher risk associated with the absence of pancreatic fibrosis. We investigated whether pancreatic extracellular volume fraction (ECV) calculated from preoperative contrast-enhanced computed tomography (CE-CT) images can be used to predict pancreatic fibrosis and POPF.
This retrospective study included patients who underwent CE-CT before pancreatectomy. ECV map was created by subtracting unenhanced from equilibrium-phase images. We assessed the relationship between pancreatic ECV, the histopathological grade of fibrosis at the pancreatic resection margin, and the occurrence of POPF.
Among the 107 patients included, 66 underwent pancreaticoduodenectomy (PD) and 41 underwent distal pancreatectomy (DP). The median ECV at the pancreatic resection margin was 22.5 %. Pancreatic ECV significantly correlated with the histopathological grade of pancreatic fibrosis (ρ = 0.689; p < 0.001). In PD cases, the ECV was an independent risk factor for all-grade POPF (odds ratio, 0.852; 95 % confidence interval, 0.755-0.934), with excellent predictive capability (area under the curve, 0.912; 95 % confidence interval, 0.842-0.983). In DP cases, pancreatic thickness was the only factor associated with all-grade POPF.
Pancreatic ECV obtained from routine CE-CT images accurately predicted the histopathological grade of pancreatic fibrosis and was an independent risk factor for POPF after PD.
背景/目的：术后胰瘘（POPF）是胰腺切除术的一种严重并发症，胰腺纤维化缺失时其风险更高。我们研究了根据术前对比增强计算机断层扫描（CE-CT）图像计算出的胰腺细胞外容积分数（ECV）是否可用于预测胰腺纤维化和POPF。
这项回顾性研究纳入了胰腺切除术前接受CE-CT检查的患者。通过从平衡期图像中减去未增强图像来创建ECV图。我们评估了胰腺ECV、胰腺切除边缘纤维化的组织病理学分级与POPF发生之间的关系。
在纳入的107例患者中，66例行胰十二指肠切除术（PD），41例行远端胰腺切除术（DP）。胰腺切除边缘的ECV中位数为22.5%。胰腺ECV与胰腺纤维化的组织病理学分级显著相关（ρ = 0.689；p < 0.001）。在PD病例中，ECV是所有级别POPF的独立危险因素（优势比，0.852；95%置信区间，0.755 - 0.934），具有出色的预测能力（曲线下面积，0.912；95%置信区间，0.842 - 0.983）。在DP病例中，胰腺厚度是与所有级别POPF相关的唯一因素。
从常规CE-CT图像获得的胰腺ECV准确预测了胰腺纤维化的组织病理学分级，并且是PD术后POPF的独立危险因素。
