Prediction of Anastomotic Leakage After Pancreatic Head Resections by Dynamic Magnetic Resonance Imaging (dMRI)

Abstract

dMRI with SI(ratio) calculation provided reliable information for the prediction of pancreatic texture. Patients with a SI(ratio) >or= 1.1 had a 7.9-fold increased risk of anastomotic leakage and a prolonged hospital stay. SIC with measurements of SI(ratio) in dMRI could therefore define patients at risk for anastomotic leakage.

Dual-Phase Computed Tomography for Assessment of Pancreatic Fibrosis and Anastomotic Failure Risk Following Pancreatoduodenectomy

“…3,4,10,13 On the other hand, pancreatic fibrosis is thought to decrease the softness of the gland. [18][19][20][21][22]27 Recently, it has been shown that CT or magnetic resonance (MR) perfusion imaging can detect microcirculatory changes caused by collagen deposits in the liver and pancreas. [18][19][20]22,28,29 Romero-Gomez et al 28 studied liver fibrosis in patients with chronic hepatitis C and concluded that optical digital analysis of conventional CT images is effective in determining the stage and distribution of liver fibrosis.…”

“…[18][19][20][21][22] In a recent study, we reported that patients with autoimmune pancreatitis show enhancement characteristics distinct from patients with adenocarcinoma on dualphase computed tomography (CT). 22 A delayed enhancement with a slow increase followed by a slow decline or a plateau was characteristic for a fibrotic pancreas in patients with autoimmune pancreatitis; a rapid increase followed by a rapid decrease indicated a "normal" pancreas with lower degrees of fibrosis.…”

“…22 A delayed enhancement with a slow increase followed by a slow decline or a plateau was characteristic for a fibrotic pancreas in patients with autoimmune pancreatitis; a rapid increase followed by a rapid decrease indicated a "normal" pancreas with lower degrees of fibrosis. [18][19][20][21][22] The aim of this study was to investigate the ability of dual-phase CT to assess the histological degree of pancreatic fibrosis and to predict the risk of developing a clinically relevant PAF after PD in a large single surgeon cohort of patients undergoing PD.…”

Preoperative imaging evaluation of pancreatic pathologies for the objective prediction of pancreatic fistula after pancreaticoduodenectomy

“…The most powerful and promising imaging modalities were ARFI elastography [35,36], which provides information about the elastic properties of the pancreas; contrast-enhanced CT, which reflects the enhancement characteristics of the pancreatic parenchyma; [37,38] MR images, which display the ratios of the signal intensity of the pancreas relative to hepatic, splenic, or muscular values on T1-weighted MRI [43,44], and time-signal intensity curves on dynamic contrast-enhanced MRI [18,46,47,49], in which the MR images reflect the histological degree of pancreatic fibrosis; and MDCT and/or MRI, which reflect the histological grade of pancreatic fatty infiltration [40,41,51]. US elastography, with either a transabdominal or an endoscopic approach, can be a useful, convenient, and inexpensive imaging tool in the diagnostic workup for various pancreatic pathologies.…”

“…Lastly, the pancreatic TIC can be used to detect early fibrotic changes induced in the pancreatic remnant after PD that precede the functional deterioration of the pancreatic remnant [48]. Using the axial T1-weighted imaging sequences obtained from dynamic contrast-enhanced MRI of the pancreas before and at 25 and 60 s after the intravenous administration of contrast media, Dinter et al [49] calculated the muscle-normalized signal intensity curve of the pancreas with an SI ratio (SI ratio ) at the estimated transection line for the pancreas in 72 patients undergoing PD. The SI ratio = SI ea /SI pv : SI ea was defined as the SI of the pancreas in the early arterial phase, and SI pv as the portalvenous phase, after the application of contrast.…”