Enhancement pattern of the pancreatic parenchyma predicts postpancreatectomy acute pancreatitis after pancreaticoduodenectomy

• Published in: European radiology Vol. 34; no. 1; pp. 6 - 15
• Main Authors: Chen, Haoda, Fu, Ningzhen, Zhong, Jingyu, Wang, Chao, Xu, Zhiwei, Wang, Weishen, Cheng, Dongfeng, Weng, Yuanchi, Deng, Xiaxing, Shen, Baiyong
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.01.2024; Springer Nature B.V
• Subjects: Acute Disease; Attenuation; Complications; Computed Tomography; Diagnostic Radiology; Humans; Imaging; Internal Medicine; Interventional Radiology; Medicine; Medicine & Public Health; Morbidity; Multivariate analysis; Neuroradiology; Pancreas; Pancreatic Fistula - etiology; Pancreaticoduodenectomy; Pancreaticoduodenectomy - adverse effects; Pancreatitis; Pancreatitis - diagnostic imaging; Pancreatitis - etiology; Parenchyma; Performance prediction; Postoperative; Postoperative Complications - diagnostic imaging; Postoperative Complications - etiology; Propylamines; Radiology; Regression analysis; Retrospective Studies; Risk Factors; Risk groups; Ultrasound; Pancreaticoduodenectomy; Computed tomography; Image enhancement; Pancreatitis
• ISSN: 1432-1084; 0938-7994; 1432-1084
• DOI: 10.1007/s00330-023-09927-z

Objectives To assess the association between the enhancement pattern of the pancreatic parenchyma on preoperative multiphasic contrast-enhanced computed tomography (CECT) and the occurrence of postpancreatectomy acute pancreatitis (PPAP) after pancreaticoduodenectomy (PD). Methods A total of 513 patients who underwent PD were retrospective enrolled. The CT attenuation values of the nonenhanced (N), arterial (A), portal venous (P), and late (L) phases in the pancreatic parenchyma were measured on preoperative multiphasic CECT. The enhancement pattern was quantized by the CT attenuation value ratios in each phase. Receiver operating characteristic (ROC) curve analyses were computed to evaluate predictive performance. Regression analyses were used to identify independent risk factors for PPAP. Results PPAP developed in 102 patients (19.9%) and was associated with increased morbidity and a worse postoperative course. The A/P ratio, P/L ratio, and A/L ratio were significantly higher in the PPAP group. On the ROC analysis, the A/L ratio and A/P ratio both performed well in predicting PPAP (A/L: AUC = 0.7579; A/P: AUC = 0.7497). On multivariate analyses, the A/L ratio > 1.29 (OR 4.30 95% CI: 2.62–7.06, p < 0.001) and A/P ratio > 1.13 (OR 5.02 95% CI: 2.98–8.45, p < 0.001) were both independent risk factors of PPAP in each model. Conclusions The enhancement pattern of the pancreatic parenchyma on multiphasic preoperative CECT is a good predictor of the occurrence of PPAP after PD, which could help clinicians identify high-risk patients or enable selective enhance recovery protocols. Clinical relevance statement Preoperative identification of patients at high risk for postpancreatectomy acute pancreatitis by enhancement patterns of the pancreatic parenchyma allows surgeons to tailor their perioperative management and take precautions. Key Points PPAP is associated with increased risk of postoperative complications and a worse postoperative course. A rapid-decrease enhancement pattern of the pancreatic parenchyma is related to the occurrence of PPAP. The A/L and A/P ratios were both independent risk factors of PPAP in each multivariate model.