Novel Prediction of Pancreatic Anastomotic Failure After Pancreatoduodenectomy Using Preoperative CT Imaging With the Evaluation of Remnant Pancreatic Volume and Body Composition

Pancreatic Steatosis and Fibrosis: Quantitative Assessment with Preoperative Multiparametric MR Imaging

“…This retrospective study was approved by the Seoul National University institutional review board, and the requirement for informed consent was waived. pancreatic steatosis, absence of fibrosis, and small pancreatic duct size, have been reported to be associated with an increased rate of postoperative pancreatic fistula (11,12). Thus, if these factors could be identified at preoperative imaging assessment, it would provide value in the preoperative risk analysis (10,13).…”

“…Thus, if these factors could be identified at preoperative imaging assessment, it would provide value in the preoperative risk analysis (10,13). However, only a few studies on the preoperative prediction of postoperative pancreatic fistula have been performed (11,13,14) due to the limited capability of imaging modalities to depict pancreatic parenchymal changes, such as steatosis and fibrosis. Relatively recently, magnetic resonance (MR) imaging has been used with increasing frequency to evaluate various pancreatic diseases.…”

Preoperative imaging evaluation of pancreatic pathologies for the objective prediction of pancreatic fistula after pancreaticoduodenectomy

“…The most powerful and promising imaging modalities were ARFI elastography [35,36], which provides information about the elastic properties of the pancreas; contrast-enhanced CT, which reflects the enhancement characteristics of the pancreatic parenchyma; [37,38] MR images, which display the ratios of the signal intensity of the pancreas relative to hepatic, splenic, or muscular values on T1-weighted MRI [43,44], and time-signal intensity curves on dynamic contrast-enhanced MRI [18,46,47,49], in which the MR images reflect the histological degree of pancreatic fibrosis; and MDCT and/or MRI, which reflect the histological grade of pancreatic fatty infiltration [40,41,51]. US elastography, with either a transabdominal or an endoscopic approach, can be a useful, convenient, and inexpensive imaging tool in the diagnostic workup for various pancreatic pathologies.…”

“…The study revealed that among various possible risk factors, a visceral fat area greater than 84 cm [2] was the only independent factor associated with the presence of pancreatic fatty infiltration, and also the only independent predictor of clinically relevant POPF. Kirihara et al [41] reported that subcutaneous and visceral adipose tissue areas, skeletal muscle area, and remnant pancreatic volume, calculated from preoperative thin-section CT images in 173 patients undergoing PD, was able to predict the occurrence of clinically relevant POPF. They measured these adipose tissue areas and skeletal muscle area (cm 2 ) at the level of the third lumber vertebra, where the skeletal muscle area was used as a surrogate for sarcopenia [42], and confirmed that the subcutaneous and visceral adipose tissue areas were greater and the skeletal muscle area significantly less in the group with POPF than in the group without POPF.…”

Practical Application of Predictors for Pancreatic Anastomotic Failure After Pancreaticoduodenectomy, Especially in the Asian Context

“…1 Until now, no consensus has been reached regarding the best strategy to prevent pancreatic anastomotic failure (PAF) after pancreatoduodenectomy (PD). The goal of our study was to identify patients undergoing PD who may be at higher risk for PAF.…”