Pancreatic hardness: Correlation of surgeon’s palpation, durometer measurement and preoperative magnetic resonance imaging features

Abstract

AIMTo evaluate the correlation between subjective assessments of pancreatic hardness based on the palpation, objective measurements using a durometer, and magnetic resonance imaging (MRI) findings for assessing pancreatic hardness.METHODSEighty-three patients undergoing pancreatectomies were enrolled. An experienced surgeon subjectively evaluated the pancreatic hardness in the surgical field by palpation. The pancreatic hardness was also objectively evaluated using a durometer. Preoperative MRI findings were evaluated by a radiologist in terms of the apparent diffusion coefficient (ADC) values, the relative signal intensity decrease (RSID) of the pancreatic parenchyma, and the diameter of the pancreatic parenchyma and duct. Durometer measurement results, ADC values, RSID, pancreatic duct and parenchyma diameters, and the ratio of the diameters of the duct and parenchyma were compared between pancreases judged to be soft or hard pancreas on the palpation. A correlation analysis was also performed between the durometer and MRI measurements.RESULTSThe palpation assessment classified 44 patients as having a soft pancreas and 39 patients as having a hard pancreas. ADC values were significantly lower in the hard pancreas group. The ductal diameter and duct-to-pancreas ratio were significantly higher in the hard pancreas group. For durometer measurements, a correlation analysis showed a positive correlation with the ductal diameter and the duct-to-pancreas ratio and a negative correlation with ADC values.CONCLUSIONHard pancreases showed lower ADC values, a wider pancreatic duct diameter and a higher duct-to-pancreas ratio than soft pancreases. Additionally, the ADC values, diameter of the pancreatic duct and duct-to-pancreas ratio were closely correlated with the durometer results.

Glenohumeral joint capsular tissue tension loading correlates moderately with shear wave elastography: a cadaveric investigation

“…A durometer measures a material's hardness or resistance to deformation by applying an indentation load on the specimen, giving a measure of tissue hardness based on an arbitrary Shore unit (HA) [30,31]. Durometers have been used in various medical applications, such as in dermatology [32,33] and for measurements of organ [34][35][36], breast [37], and muscle [38] tissue. The intrarater and inter-rater reliability measures of durometer measurements of epidermal tissue were good to excellent [32,33].…”

Pancreatic attenuation on computed tomography predicts pancreatic fistula after pancreaticoduodenectomy

“…Although some studies have shown the predictive ability of MRI for pancreatic fibrosis, 11,25,26 the association between the pancreatic density on CT and pancreatic hardness or fibrosis has hardly ever been evaluated. Hashimoto et al showed the pancreatic late/early (L/E) attenuation ratio was positively correlated with pancreatic fibrosis and PF in their retrospective study.…”

“…Because pancreatic hardness can only be determined intraoperatively, several studies have evaluated novel parameters that can be measured using preoperative computed tomography (CT) or magnetic resonance imaging (MRI) to predict the texture of the pancreas and the risk of development of PF. [11][12][13] Although these parameters may enable us to make preoperative and objective assessments of the risk for PF, they are often troublesome and have not been generally used.…”

Preoperative Computed Tomography Imaging of the Pancreas Identifying Predictive Factors for the Progression of Grade A, or Biochemical Leak, to Grade B Postoperative Pancreatic Fistula Following Pancreaticoduodenectomy: A Retrospective Study

“…The reason may be that the dilated pancreatic duct is related to pancreatic fibrosis. The fibrosis hardens the pancreas and thickens the pancreatic duct, resulting in a low incidence of fistulas after pancreaticoduodenectomy [ 25 ]. The thin pancreatic duct is not conducive to anastomosis and drainage of pancreatic juice, which increases the risk of POPF.…”