Computed Tomography Enhancement Pattern of the Pancreatic Parenchyma Predicts Postoperative Pancreatic Fistula After Pancreaticoduodenectomy
Computed Tomography Enhancement Pattern of the Pancreatic Parenchyma Predicts Postoperative Pancreatic Fistula After Pancreaticoduodenectomy
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DOI：
10.1097/mpa.0000000000001229
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发表时间：
2019-02-01
期刊：
影响因子：
2.9
通讯作者：
Tani, Masaji
中科院分区：
文献类型：
--
作者：
Maehira, Hiromitsu;Iida, Hiroya;Tani, Masaji
目的探讨胰腺实质CT值与术后胰瘘的关系。方法回顾性分析115例胰十二指肠切除术患者的术前动态CT资料。通过CT测量胰腺实质的平扫期（N）、动脉期（A）、门静脉期（P）和晚期（L）的CT值，并计算A/N、A/P和P/L比值。比较POPF组与非POPF组的CT值及比值。结果32例患者（28%）被归类为POPF组。单因素分析显示，POPF组A/P比值（P < 0.001）和P/L比值（P = 0.018）显著高于对照组。在受试者工作特征曲线分析中，预测POPF的A/P和P/L比值截止值分别为1.19和1.17。在术前可评估的因素中，A/P比值≥ 1.19（P < 0.001;比值比10.3）和P/L比值≥ 1.17（P = 0.049;比值比3.23）是POPF的独立预测因素，两个比值的组合有助于术前检测POPF。结论胰腺实质的强化模式与临床相关的POPF的发生有关。
Objective The aim of this study was to assess the relationship between the computed tomography (CT) pancreatic parenchyma attenuation value and clinically relevant postoperative pancreatic fistula (POPF). Methods The medical records of 115 patients who underwent pancreaticoduodenectomy and preoperative dynamic CT were retrospectively reviewed. The CT attenuation values of the nonenhanced (N), arterial (A), portal venous (P), and late (L) phase in the pancreatic parenchyma were determined via CT, and the A/N, A/P, and P/L ratios were calculated. The CT attenuation values and value ratios were compared between the POPF and non-POPF groups. Results Thirty-two patients (28%) were categorized in the POPF group. On univariate analysis, the A/P ratio (P < 0.001) and P/L ratio (P = 0.018) were significantly higher in the POPF group. On receiver operating characteristic curve analysis, the A/P and P/L ratio cutoff values for predicting POPF were 1.19 and 1.17, respectively. Of the preoperative evaluable factors, A/P ratio of 1.19 or greater (P < 0.001; odds ratio, 10.3) and P/L ratio of 1.17 or greater (P = 0.049; odds ratio, 3.23) were independent predictive factors for POPF, and the combination of the 2 ratios was useful in detecting POPF preoperatively. Conclusions The enhancement pattern of the pancreatic parenchyma is associated with the development of clinically relevant POPF.