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02-09-2023 | Computed Tomography | Hepatobiliary-Pancreas

Quantitative edge analysis of pancreatic margins in patients with head pancreatic tumors: correlations between pancreatic margins and the onset of postoperative pancreatic fistula

Authors: Maria-Chiara Ambrosetti, Alberto Ambrosetti, Giampaolo Perri, Clizia Gasparini, Giovanni Marchegiani, Roberto Salvia, Stefania Montemezzi, Giancarlo Mansueto, Giulia A. Zamboni

Published in: European Radiology | Issue 3/2024

Abstract

Objective

To assess the correlation between pancreatic quantitative edge analysis as a surrogate of parenchymal stiffness and the incidence of postoperative pancreatic fistula (POPF), in patients undergoing pancreaticoduodenectomy (PD).

Methods

All consecutive patients who underwent PD at our Institution between March 2018 and November 2019 with an available preoperative CT were included. Pancreatic margin score (PMS) was calculated through computer-assisted quantitative edge analysis on the margins of the pancreatic body and tail (the expected pancreatic remnant) on non-contrast scans with in-house software. Intraoperative assessment of pancreatic stiffness by manual palpation was also performed, classifying pancreatic texture into soft and non-soft. PMS values were compared between groups using an unpaired T-test and correlated with the intraoperative evaluation of stiffness and with the grading of postoperative pancreatic fistula according to the International Study Group on Pancreatic Surgery (ISGPS).

Results

Patient population included 200 patients (mean age 64.6 years), 146 without onset of POPF (73%, non-POPF group), and 54 with POPF (27%, POPF group).

A significant difference in PMS values was observed between POPF and non-POPF (respectively 1.88 ± 0.05 vs 0.69 ± 0.01; p < 0.0001). PMS values of pancreatic parenchymas intraoperatively considered “soft” were significantly higher than those evaluated as “non-soft” (1.21 ± 0.04 vs 0.73 ± 0.02; p < 0.0001). A significant correlation between PMS values and POPF grade was observed (r = 0.8316), even in subgroups of patients with soft (r = 0.8016) and non-soft (r = 0.7602) pancreas (all p < 0.0001).

Conclusions

Quantitative edge analysis with dedicated software may stratify patients with different pancreatic stiffness, thus potentially improving preoperative risk assessment and strategies for POPF mitigation.

Clinical relevance statement

This study proposes quantitative pancreas edge analysis as a predictor for postoperative pancreatic fistula. The test has high accuracy and correlation with fistula grade according to the International Study Group on Pancreatic Surgery.

Key Points

• Prediction of postoperative pancreatic fistula (POPF) onset risk after pancreaticoduodenectomy is based only on intraoperative evaluation.

• Quantitative edge analysis may preoperatively identify patients with higher risk of POPF.

• Quantification of pancreatic stiffness through the analysis of pancreatic margins could be done on preoperative CT.

Bassi C, Marchegiani G, Giuliani T et al (2022) Pancreatoduodenectomy at the Verona Pancreas Institute: the evolution of indications, surgical techniques, and outcomes. Ann Surg. https://doi.org/10.1097/sla.0000000000004753CrossRefPubMed

Marchegiani G, Perri G, Burelli A et al (2022) High-risk pancreatic anastomosis versus total pancreatectomy after pancreatoduodenectomy. Ann Surg. https://doi.org/10.1097/sla.0000000000004840CrossRefPubMed

Callery MP, Pratt WB, Kent TS et al (2013) A prospectively validated clinical risk score accurately predicts pancreatic fistula after pancreatoduodenectomy. J Am Coll Surg. https://doi.org/10.1016/j.jamcollsurg.2012.09.002CrossRefPubMed

Perri G, Marchegiani G, Partelli S et al (2021) Preoperative risk stratification of postoperative pancreatic fistula: a risk-tree predictive model for pancreatoduodenectomy. Surgery. https://doi.org/10.1016/j.surg.2021.06.046CrossRefPubMed

Nahm CB, Lui I, Naidoo CS et al (2019) Density and enhancement of the pancreatic tail on computer tomography predicts acinar score and pancreatic fistula after pancreatoduodenectomy. HPB (Oxford). https://doi.org/10.1016/j.hpb.2018.09.014

Gnanasekaran S, Durgesh S, Gurram R et al (2022) Do preoperative pancreatic computed tomography attenuation index and enhancement ratio predict pancreatic fistula after pancreaticoduodenectomy? World J Radiol 14:165–176. https://doi.org/10.4329/wjr.v14.i6.165CrossRefPubMedPubMedCentral

Hatano M, Watanabe J, Kushihata F et al (2015) Quantification of pancreatic stiffness on intraoperative ultrasound elastography and evaluation of its relationship with postoperative pancreatic fistula. Int Surg. https://doi.org/10.9738/INTSURG-D-14-00040.1CrossRefPubMedPubMedCentral

Pickhardt PJ, Malecki K, Kloke J, Lubner MG (2016) Accuracy of liver surface nodularity quantifcation on MDCT as a noninvasive biomarker for staging hepatic fibrosis. AJR Am J Roentgenol. https://doi.org/10.2214/AJR.16.16514CrossRefPubMedPubMedCentral

Smith AD, Zand KA, Florez E et al (2017) Liver surface nodularity score allows prediction of cirrhosis decompensation and death. Radiology. https://doi.org/10.1148/radiol.2016160799CrossRefPubMed

10.

Smith AD, Branch CR, Zand K et al (2016) Liver surface nodularity quantification from routine ct images as a biomarker for detection and evaluation of cirrhosis. Radiology. https://doi.org/10.1148/radiol.2016151542CrossRefPubMed

11.

Bassi C, Marchegiani G, Dervenis C et al (2017) The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery. https://doi.org/10.1016/j.surg.2016.11.014CrossRefPubMed

12.

Miller BC, Christein JD, Behrman SW et al (2013) Assessing the impact of a fistula after a pancreaticoduodenectomy using the Post-operative Morbidity Index. HPB (Oxford). https://doi.org/10.1111/hpb.12131CrossRefPubMed

13.

Finks JF, Osborne NH, Birkmeyer JD (2011) Trends in hospital volume and operative mortality for high-risk surgery. N Engl J Med. https://doi.org/10.1056/nejmsa1010705CrossRefPubMedPubMedCentral

14.

Mungroop TH, Van Rijssen LB, Van Klaveren D et al (2019) Alternative fistula risk score for pancreatoduodenectomy (a-FRS): design and international external validation. Ann Surg. https://doi.org/10.1097/SLA.0000000000002620CrossRefPubMed

15.

Partelli S, Andreasi V, Schiavo Lena M et al (2021) The role of acinar content at pancreatic resection margin in the development of postoperative pancreatic fistula and acute pancreatitis after pancreaticoduodenectomy. Surgery. https://doi.org/10.1016/j.surg.2021.03.047CrossRefPubMed

16.

Maeda K, Kuriyama N, Yuge T et al (2022) Risk factor analysis of postoperative pancreatic fistula after distal pancreatectomy, with a focus on pancreas-visceral fat CT value ratio and serrated pancreatic contour. BMC Surg 22:240. https://doi.org/10.1186/s12893-022-01650-8CrossRefPubMedPubMedCentral

17.

Goshima S, Bae KT (2017) Liver surface nodularity as a biomarker for detection and evaluation of cirrhosis. Radiology. https://doi.org/10.1148/radiol.2017170112CrossRefPubMed

18.

Previtali C, Sartoris R, DioguardiBurgio M et al (2022) Quantitative imaging analysis predicts pancreatic fatty infltration on routine CT. Insights Imaging 13(suppl 2):24

19.

Ambrosetti MC, Grecchi A, Ambrosetti A, Amodio A, Mansueto G, Montemezzi S, Zamboni GA (2023) Quantitative edge analysis of pancreatic margins in patients with chronic pancreatitis: a correlation with exocrine function. Diagnostics 13: https://doi.org/10.3390/diagnostics13132272

Title: Quantitative edge analysis of pancreatic margins in patients with head pancreatic tumors: correlations between pancreatic margins and the onset of postoperative pancreatic fistula
Authors: Maria-Chiara Ambrosetti
Alberto Ambrosetti
Giampaolo Perri
Clizia Gasparini
Giovanni Marchegiani
Roberto Salvia
Stefania Montemezzi
Giancarlo Mansueto
Giulia A. Zamboni
Publication date: 02-09-2023
Publisher: Springer Berlin Heidelberg
Keywords: Computed Tomography
Computed Tomography
Published in: European Radiology / Issue 3/2024
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-023-10200-6

2024 ASCO Annual Meeting

Springer Medicine

Quantitative edge analysis of pancreatic margins in patients with head pancreatic tumors: correlations between pancreatic margins and the onset of postoperative pancreatic fistula

Abstract

Objective

Methods

Results

Conclusions

Clinical relevance statement

Key Points

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Objective

Methods

Results

Conclusions

Clinical relevance statement

Key Points

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