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European Radiology
Published in: European Radiology 5/2019

01-05-2019 | Pancreaticojejunostomy | Hepatobiliary-Pancreas

Multidetector CT findings differ between surgical grades of pancreatic fistula after pancreaticoduodenectomy

Authors: Hyo-jae Lee, Jin Woong Kim, Young Hoe Hur, Byung Kook Lee, Sung Bum Cho, Eu Chang Hwang, Seung Jin Lee, Eun Ju Yoon, Hyun Ju Seon

Published in: European Radiology | Issue 5/2019

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Abstract

Objectives

To define and correlate multidetector CT (MDCT) findings of pancreatic fistula after pancreaticoduodenectomy with surgical grading based on the 2016 Revised International Study Group of Pancreatic Fistula (ISGPF) classification.

Methods

Between May 2011 and December 2016, 235 patients with periampullary tumor underwent pancreaticoduodenectomy and postoperative MDCT. Patients were classified into three groups (clinically no pancreatic fistula (cNo-PF), grade B, and grade C) according to the ISGPF classification. MDCT images were retrospectively evaluated by two radiologists in consensus for the presence of pancreaticojejunostomy (PJ) dehiscence, PJ dehiscence diameter, PJ defect, acute necrotic collection (ANC), peripancreatic fluid collection, and imaging findings of complications. Categorical MDCT findings were compared among the three groups using Pearson’s chi-square test, and PJ dehiscence diameter was compared using the Kruskal–Wallis test.

Results

There was no significant difference in patient demographics among the groups (cNo-PF = 133, grade B = 68, and grade C = 34), but the MDCT findings were significantly different regarding the presence of PJ dehiscence (p < 0.001), PJ defect (p < 0.001), ANC (p = 0.002), and imaging findings of total complications (p < 0.001). The diameters of PJ dehiscence were significantly different among the groups (cNo-PF [0.42 ± 1.54 mm], grade B [1.47 ± 2.33 mm], and grade C [5.38 ± 6.45 mm]) (p < 0.001).

Conclusion

With respect to the presence of PF, postoperative MDCT findings may differ between surgical grading based on the ISGPF classification.

Key Points

• Regarding the presence of pancreatic fistula, the postoperative multidetector CT findings correlate well with surgical grading based on the International Study Group of Pancreatic Fistula classification.
• Multidetector CT may provide reliable information to suggest pancreatic fistula after pancreaticoduodenectomy.
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Metadata
Title
Multidetector CT findings differ between surgical grades of pancreatic fistula after pancreaticoduodenectomy
Authors
Hyo-jae Lee
Jin Woong Kim
Young Hoe Hur
Byung Kook Lee
Sung Bum Cho
Eu Chang Hwang
Seung Jin Lee
Eun Ju Yoon
Hyun Ju Seon
Publication date
01-05-2019
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 5/2019
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-018-5916-y

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