Density and enhancement of the pancreatic tail on computer tomography predicts acinar score and pancreatic fistula after pancreatoduodenectomy

Christopher B Nahm,Isaac Lui,Catherine S Naidoo,Lucian Roseverne,Saeed Alzaabi,Richard Maher,Georgina Mann,Steven Blome,Anthony J Gill,Jaswinder S Samra,Anubhav Mittal

doi:10.1016/j.hpb.2018.09.014

Christopher B Nahm, Isaac Lui + Show 9 more

Open Access

https://doi.org/10.1016/j.hpb.2018.09.014

Copy DOI

Journal: HPB	Publication Date: Oct 28, 2018
Citations: 23	License type: publisher-specific-oa

Affiliation: University of Sydney, Royal North Shore Hospital, Macquarie University

Abstract

BackgroundAcinar score calculated at the pancreatic resection margin is associated with postoperative pancreatic fistula (POPF) after pancreatoduodenectomy (PD). The present study evaluates the association between (i) computed tomography (CT) density of the pancreas and the acinar score of the pancreatic resection margin, and (ii) CT density of the pancreas and POPF after PD. MethodsConsecutive patients who underwent PD were included for analysis. CT densities of the pancreatic head, neck, body and tail were measured in non-contrast (NC), arterial (ART) and portal venous (PV) phases. Histologic slides of the pancreatic resection margin were scored for acinar cell density. ResultsNinety patients were included for analysis. Non-contrast density of the pancreatic tail was a good predictor of POPF (AUROC 0.704, p = 0.036), and a cut-off value of >40 Hounsfield units predicted POPF with 70.0% sensitivity and 73.4% specificity. The ratio of densities between PV and NC phases in the pancreatic tail was also a good predictor of POPF (AUROC 0.712, p = 0.030), and a cut-off value of <2.29 predicted POPF with 70.9% sensitivity and 80% specificity. ConclusionNon-contrast CT density of the pancreatic tail correlates with acinar cell density of the pancreatic resection margin and predicts the development of POPF after PD.

Full Text