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Open Access 01-07-2021 | Magnetic Resonance Imaging | Pancreas

Postoperative single-sequence (PoSSe) MRI: imaging work-up for CT-guided or endoscopic drainage indication of collections after hepatopancreaticobiliary surgery

Authors: Uli Fehrenbach, Timo A. Auer, Wenzel Schöning, Moritz Schmelzle, Christian Jürgensen, Thomas Malinka, Marcus Bahra, Dominik Geisel, Timm Denecke

Published in: Abdominal Radiology | Issue 7/2021

Abstract

Purpose

Fluid collections due to anastomotic leakage are a common complication after hepatopancreaticobiliary (HPB) surgery and are usually treated with drainage. We conducted a study to evaluate imaging work-up with a postoperative single-sequence (PoSSe) MRI for the detection of collections and indication of drainage.

Material and methods

Forty-six patients who developed signs of leakage (fever, pain, laboratory findings) after HPB surgery were prospectively enrolled. Each patient was examined by abdominal sonography and our PoSSe MRI protocol (axial T2-weighted HASTE only). PoSSe MRI examination time (from entering to leaving the MR scanner room) was measured. Sonography and MRI were evaluated regarding the detection and localization of fluid collections. Each examination was classified for diagnostic sufficiency and an imaging-based recommendation if CT-guided or endoscopic drainage is reasonable or not was proposed. Imaging work-up was evaluated in terms of feasibility and the possibility of drainage indication.

Results

Sonography, as first-line modality, detected 21 focal fluid collections and allowed to decide about the need for drainage in 41% of patients. The average time in the scanning room for PoSSe MRI was 9:23 min [7:50–13:32 min]. PoSSe MRI detected 46 focal collections and allowed therapeutic decisions in all patients. Drainage was suggested based on PoSSe MRI in 25 patients (54%) and subsequently indicated and performed in 21 patients (100% sensitivity and 84% specificity). No patient needed further imaging to optimize the treatment.

Conclusions

The PoSSe MRI approach is feasible in the early and intermediate postoperative setting after HPB surgery and shows a higher detection rate than sonography. Imaging work-up regarding drainage of collections was successful in all patients and our proposed PoSSe MRI algorithm provides an alternative to the standard work-up.

Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J et al. (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138 (1):8-13. https://doi.org/10.1016/j.surg.2005.05.001CrossRefPubMed

Guillaud A, Pery C, Campillo B, Lourdais A, Sulpice L, Boudjema K (2013) Incidence and predictive factors of clinically relevant bile leakage in the modern era of liver resections. HPB : the official journal of the International Hepato Pancreato Biliary Association 15 (3):224-229. https://doi.org/10.1111/j.1477-2574.2012.00580.xCrossRef

Hackert T, Werner J, Buchler MW (2011) Postoperative pancreatic fistula. Surgeon 9 (4):211-217. https://doi.org/10.1016/j.surge.2010.10.011CrossRefPubMed

Sakamoto K, Tamesa T, Yukio T, Tokuhisa Y, Maeda Y, Oka M (2016) Risk Factors and Managements of Bile Leakage After Hepatectomy. World J Surg 40 (1):182-189. https://doi.org/10.1007/s00268-015-3156-8CrossRefPubMed

Braghetto I, Bastias J, Csendes A, Debandi A (2000) Intraperitoneal bile collections after laparoscopic cholecystectomy: causes, clinical presentation, diagnosis, and treatment. Surg Endosc 14 (11):1037-1041. https://doi.org/10.1007/s004649900029CrossRefPubMed

Scialpi M, Scaglione M, Volterrani L, Lupattelli L, Ragozzino A, Romano S et al. (2005) Imaging evaluation of post pancreatic surgery. European journal of radiology 53 (3):417-424. https://doi.org/10.1016/j.ejrad.2004.12.013CrossRefPubMed

Robert B, Yzet T, Regimbeau JM (2013) Radiologic drainage of post-operative collections and abscesses. J Visc Surg 150 (3 Suppl):S11-18. https://doi.org/10.1016/j.jviscsurg.2013.05.005CrossRefPubMed

Bowyer AJ, Royse CF (2016) Postoperative recovery and outcomes--what are we measuring and for whom? Anaesthesia 71 Suppl 1:72-77. https://doi.org/10.1111/anae.13312CrossRefPubMed

Tsai LL, Grant AK, Mortele KJ, Kung JW, Smith MP (2015) A Practical Guide to MR Imaging Safety: What Radiologists Need to Know. Radiographics : a review publication of the Radiological Society of North America, Inc 35 (6):1722–1737. https://doi.org/10.1148/rg.2015150108

10.

Tonolini M, Ierardi AM, Patella F, Carrafiello G (2018) Early cross-sectional imaging following open and laparoscopic cholecystectomy: a primer for radiologists. Insights into imaging 9 (6):925-941. https://doi.org/10.1007/s13244-018-0663-9CrossRefPubMedPubMedCentral

11.

Jin HY, Xue FS, Yang GZ, Sun C (2017) Assessing postoperative acute kidney injury in high-risk patients undergoing major abdominal surgery. J Crit Care 37:255-256. https://doi.org/10.1016/j.jcrc.2016.08.008CrossRefPubMed

12.

Hakansson K, Leander P, Ekberg O, Hakansson HO (2001) MR imaging of upper abdomen following cholecystectomy. Normal and abnormal findings. Acta radiologica (Stockholm, Sweden : 1987) 42 (2):181–186

13.

Lee MH, Eutsler EP, Sheybani EF, Khanna G (2017) Rapid non-contrast magnetic resonance imaging for post appendectomy intra-abdominal abscess in children. Pediatric radiology 47 (8):935-941. https://doi.org/10.1007/s00247-017-3860-7CrossRefPubMed

14.

Gnannt R, Fischer MA, Baechler T, Clavien PA, Karlo C, Seifert B et al. (2015) Distinguishing infected from noninfected abdominal fluid collections after surgery: an imaging, clinical, and laboratory-based scoring system. Investigative radiology 50 (1):17-23. https://doi.org/10.1097/rli.0000000000000090CrossRefPubMed

15.

Jurgensen C, Distler M, Arlt A, Bruckner S, Ellrichmann M, Matthes K et al. (2019) EUS-guided drainage in the management of postoperative pancreatic leaks and fistulas (with video). Gastrointest Endosc 89 (2):311-319.e311. https://doi.org/10.1016/j.gie.2018.08.046CrossRefPubMed

16.

McAllister JD, D'Altorio RA, Rao V (1993) CT findings after uncomplicated and complicated laparoscopic cholecystectomy. Seminars in ultrasound, CT, and MR 14 (5):356-367CrossRef

17.

McAllister JD, D'Altorio RA, Snyder A (1991) CT findings after uncomplicated percutaneous laparoscopic cholecystectomy. Journal of computer assisted tomography 15 (5):770-772CrossRef

18.

Malinka T, Timmermann L, Klein F, Geisel D, Pratschke J, Bahra M (2020) Is there a Role for the Appleby Procedure in 2020? Results from a Matched-Pair-Analysis. Anticancer research 40 (1):387-392. https://doi.org/10.21873/anticanres.13964CrossRefPubMed

19.

Zureikat AH, Beane JD, Zenati MS, Al Abbas AI, Boone BA, Moser AJ et al. (2019) 500 Minimally Invasive Robotic Pancreatoduodenectomies: One Decade of Optimizing Performance. Ann Surg. https://doi.org/10.1097/sla.0000000000003550CrossRefPubMed

20.

Cerullo M, Gani F, Chen SY, Canner JK, Dillhoff M, Cloyd J et al. (2019) Routine intensive care unit admission among patients undergoing major pancreatic surgery for cancer: No effect on failure to rescue. Surgery 165 (4):741-746. https://doi.org/10.1016/j.surg.2018.11.005CrossRefPubMed

21.

Varley PR, Geller DA, Tsung A (2017) Factors influencing failure to rescue after pancreaticoduodenectomy: a National Surgical Quality Improvement Project Perspective. J Surg Res 214:131-139. https://doi.org/10.1016/j.jss.2016.09.005CrossRefPubMed

22.

Patel BN, Boltyenkov AT, Martinez MG, Mastrodicasa D, Marin D, Jeffrey RB et al. (2020) Cost-effectiveness of dual-energy CT versus multiphasic single-energy CT and MRI for characterization of incidental indeterminate renal lesions. Abdominal radiology (New York). https://doi.org/10.1007/s00261-019-02380-xCrossRef

23.

Jennings R, Guo H, Goldin A, Wright DR (2020) Cost-effectiveness of Imaging Protocols for Suspected Appendicitis. Pediatrics. https://doi.org/10.1542/peds.2019-1352CrossRefPubMed

24.

Zens TJ, Rogers AP, Riedesel EL, Leys CM, Ostlie DJ, Woods MA et al. (2018) The cost effectiveness and utility of a “quick MRI” for the evaluation of intra-abdominal abscess after acute appendicitis in the pediatric patient population. J Pediatr Surg 53 (6):1168-1174. https://doi.org/10.1016/j.jpedsurg.2018.02.078CrossRefPubMed

Title: Postoperative single-sequence (PoSSe) MRI: imaging work-up for CT-guided or endoscopic drainage indication of collections after hepatopancreaticobiliary surgery
Authors: Uli Fehrenbach
Timo A. Auer
Wenzel Schöning
Moritz Schmelzle
Christian Jürgensen
Thomas Malinka
Marcus Bahra
Dominik Geisel
Timm Denecke
Publication date: 01-07-2021
Publisher: Springer US
Keywords: Magnetic Resonance Imaging
Magnetic Resonance Imaging
Published in: Abdominal Radiology / Issue 7/2021
Print ISSN: 2366-004X
Electronic ISSN: 2366-0058
DOI: https://doi.org/10.1007/s00261-021-02955-7

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