Measurement of Pancreatic Fat Fraction by CT Histogram Analysis to Predict Pancreatic Fistula after Pancreaticoduodenectomy

Abstract

ObjectiveTo evaluate the effectiveness of computed tomography (CT) Hounsfield unit histogram analysis (HUHA) in postoperative pancreatic fistula (PF) prediction.Materials and MethodsFifty-four patients (33 males and 21 females; mean age, 65.6 years; age range, 37–89 years) who had undergone preoperative CT and pancreaticoduodenectomy were included in this retrospective study. Two radiologists measured mean CT Hounsfield unit (CTHU) values by drawing regions of interest (ROIs) at the level of the pancreaticojejunostomy site on preoperative pre-contrast images. The HUHA values were arbitrarily divided into three categories, comprising HUHA-A ≤ 0 HU, 0 HU < HUHA-B < 30 HU, and HUHA-C ≥ 30 HU. Each HUHA value within the ROI was calculated as a percentage of the entire area using commercial 3-dimensional analysis software. Pancreas texture was evaluated as soft or hard by manual palpation.ResultsFifteen patients (27.8%) had clinically relevant PFs. The PF group had significantly higher HUHA-A (p < 0.01) and significantly lower mean CTHU (p < 0.01) values than those of the non-PF group. The HUHA-A value had a moderately strong correlation with PF occurrence (r = 0.60, p < 0.01), whereas the mean CTHU had a weak negative correlation with PF occurrence (r = −0.27, p < 0.01). The HUHA-A and mean CTHU areas under the curve (AUCs) for predicting PF occurrence were 0.86 and 0.65, respectively, with significant difference (p < 0.01). The HUHA-A and mean CTHU AUCs for predicting pancreatic softness were 0.86 and 0.64, respectively, with significant difference (p < 0.01).ConclusionThe HUHA-A values on preoperative pre-contrast CT images demonstrate a strong correlation with PF occurrence.

Prediction of clinically relevant Pancreatico-enteric Anastomotic Fistulas after Pancreatoduodenectomy using deep learning of Preoperative Computed Tomography

“…The reported risk factors for CR-POPFs are broadly classifiable as local factors at pancreatic remnant 9 , systemic factors ( e.g ., high body mass index [BMI]), and operative factors (eg, blood loss) 10 - 13 . Local risk factors at pancreatic remnant, which strongly linked to underlying local histopathologic changes, such as rich viable gland, absence of fibrosis 14 , and fatty pancreas 15 , 16 , represent the most likely determinants directly related to anatomic failure. The Fistula Risk Score (FRS), which incorporated four of the aforementioned parameters: small-sized main pancreatic duct (MPD), soft glandular texture (by surgeon's palpation), high-risk pathology (chronic pancreatitis [CP] or pancreatic adenocarcinoma [PDAC]), and undue intraoperative blood loss, is a well-developed and validated 10-point scale used to intraoperatively predict CR-POPF development after PD 17 - 19 .…”

The effect of atrophied pancreas as shown in the preoperative imaging on the leakage rate after pancreaticoduodenectomy

“…There are other studies that have evaluated the relationship between pancreas as shown on pre-operative imaging leakage and rate [ 11 - 13 ]. Kim et al [ 11 ] compared preoperative MRI of the pancreas with the leakage rate and showed that the signal intensity ratio between the pancreas and different intrabdominal organs such as the liver and spleen may predict the leakage rate.…”

Larger Volume and Higher Fat Content of the Pancreatic Head Are Predictive Factors for Postendoscopic Retrograde Cholangiopancreatography Pancreatitis

“…Histograms were automatically constructed by using precontrast CT images. The region of interest was set as a 1-cm-diameter circle at 2 sites in the pancreas: the right edge of the superior mesenteric-portal vein confluence (pancreatic head) and the center of the pancreatic body and tail (pancreatic body/tail) 14 (Fig. 3).…”