Xiaoyang Li , Kuinan Tong , Tianxin Cheng , Piao Yan , Hui Xu , Kun Liu , Rui Xu , Jun Lu , Zhenghan Yang , Hongwei Wu
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The related risk factors of pancreatic fistula, the correlation between imaging and pathological changes were analyzed, and the value of preoperative imaging in predicting pancreatic fistula was evaluated.</div></div><div><h3>Results</h3><div>Of the 122 patients, 23(18.9 %) developed POPF. Pathological score showed that there was a significant difference in pancreatic fat deposition between the two groups (P = 0.006), the fat deposition score was higher in the POPF group. Pancreatic fat deposition was the only independent risk factor for POPF(OR,1.933; P = 0.018). MRI showed that proton density fat fraction(PDFF) (P = 0.001), pancreas-to-aorta signal intensity ratio(P-A SI ratio) of equilibrium phase(P = 0.023) and delay phase(P = 0.020) had significant differences. PDFF was positively correlated with fat deposition(r = 0.404, P < 0.001), P-A SI ratio of equilibrium phase and delay phase were positively correlated with fibrosis(r = 0.313, P = 0.002; r = 0.315, P = 0.002, respectively). ROC analysis showed that PDFF had the best efficacy in predicting postoperative pancreatic fistula (AUROC = 0.810), better than P-A SI ratio of equilibrium phase(AUROC = 0.752) and delayed phase(AUROC = 0.766).</div></div><div><h3>Conclusions</h3><div>Pancreatic fat deposition is a high risk factor for POPF, PDFF can reflect fat deposition and predict POPF.</div></div>","PeriodicalId":12063,"journal":{"name":"European Journal of Radiology","volume":"186 ","pages":"Article 112067"},"PeriodicalIF":3.9000,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Prediction of postoperative pancreatic fistula based on multi-sequence MR imaging\",\"authors\":\"Xiaoyang Li , Kuinan Tong , Tianxin Cheng , Piao Yan , Hui Xu , Kun Liu , Rui Xu , Jun Lu , Zhenghan Yang , Hongwei Wu\",\"doi\":\"10.1016/j.ejrad.2025.112067\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objective</h3><div>To investigate the value of conventional MRI sequences in predicting the occurrence of postoperative pancreatic fistula (POPF) in patients undergoing pancreaticoduodenectomy (PD).</div></div><div><h3>Methods</h3><div>A total of 122 patients from August 2019 to April 2023 were enrolled. All patients underwent pancreatic histological evaluation, including fibrosis, fat deposition, and acinar cell atrophy. The preoperative image features of pancreas were obtained, including morphological features, pancreas-muscle signal intensity ratio, pancreatic fat fraction and multi-phase enhancement features. The patients were divided into two groups according to whether pancreatic fistula occurred after operation. The related risk factors of pancreatic fistula, the correlation between imaging and pathological changes were analyzed, and the value of preoperative imaging in predicting pancreatic fistula was evaluated.</div></div><div><h3>Results</h3><div>Of the 122 patients, 23(18.9 %) developed POPF. Pathological score showed that there was a significant difference in pancreatic fat deposition between the two groups (P = 0.006), the fat deposition score was higher in the POPF group. Pancreatic fat deposition was the only independent risk factor for POPF(OR,1.933; P = 0.018). MRI showed that proton density fat fraction(PDFF) (P = 0.001), pancreas-to-aorta signal intensity ratio(P-A SI ratio) of equilibrium phase(P = 0.023) and delay phase(P = 0.020) had significant differences. PDFF was positively correlated with fat deposition(r = 0.404, P < 0.001), P-A SI ratio of equilibrium phase and delay phase were positively correlated with fibrosis(r = 0.313, P = 0.002; r = 0.315, P = 0.002, respectively). 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引用次数: 0
摘要
目的探讨常规MRI序列对胰十二指肠切除术（PD）患者术后胰瘘（POPF）发生的预测价值。方法2019年8月至2023年4月共纳入122例患者。所有患者都进行了胰腺组织学评估，包括纤维化、脂肪沉积和腺泡细胞萎缩。获取胰腺术前图像特征，包括形态学特征、胰肌信号强度比、胰腺脂肪分数及多相增强特征。根据术后是否发生胰瘘将患者分为两组。分析胰瘘的相关危险因素、影像学与病理改变的相关性，评价术前影像学对胰瘘的预测价值。结果122例患者中有23例（18.9%）发生POPF。病理评分显示两组胰腺脂肪沉积差异有统计学意义（P = 0.006）， POPF组胰腺脂肪沉积评分较高。胰腺脂肪沉积是POPF的唯一独立危险因素(OR,1.933；p = 0.018)。MRI显示质子密度脂肪分数（PDFF） （P = 0.001）、平衡期（P = 0.023）和延迟期（P = 0.020）胰腺-主动脉信号强度比（P- a - SI）差异有统计学意义。PDFF与脂肪沉积呈正相关(r = 0.404, P <；P- a - SI比值与纤维化呈正相关(r = 0.313, P = 0.002；r = 0.315, P = 0.002)。ROC分析显示，PDFF预测术后胰瘘的效果最佳（AUROC = 0.810），优于平衡期（AUROC = 0.752）和延迟期（AUROC = 0.766）的P-A - SI比值。结论胰腺脂肪沉积是POPF的高危因素，PDFF可反映脂肪沉积，预测POPF。
Prediction of postoperative pancreatic fistula based on multi-sequence MR imaging
Objective
To investigate the value of conventional MRI sequences in predicting the occurrence of postoperative pancreatic fistula (POPF) in patients undergoing pancreaticoduodenectomy (PD).
Methods
A total of 122 patients from August 2019 to April 2023 were enrolled. All patients underwent pancreatic histological evaluation, including fibrosis, fat deposition, and acinar cell atrophy. The preoperative image features of pancreas were obtained, including morphological features, pancreas-muscle signal intensity ratio, pancreatic fat fraction and multi-phase enhancement features. The patients were divided into two groups according to whether pancreatic fistula occurred after operation. The related risk factors of pancreatic fistula, the correlation between imaging and pathological changes were analyzed, and the value of preoperative imaging in predicting pancreatic fistula was evaluated.
Results
Of the 122 patients, 23(18.9 %) developed POPF. Pathological score showed that there was a significant difference in pancreatic fat deposition between the two groups (P = 0.006), the fat deposition score was higher in the POPF group. Pancreatic fat deposition was the only independent risk factor for POPF(OR,1.933; P = 0.018). MRI showed that proton density fat fraction(PDFF) (P = 0.001), pancreas-to-aorta signal intensity ratio(P-A SI ratio) of equilibrium phase(P = 0.023) and delay phase(P = 0.020) had significant differences. PDFF was positively correlated with fat deposition(r = 0.404, P < 0.001), P-A SI ratio of equilibrium phase and delay phase were positively correlated with fibrosis(r = 0.313, P = 0.002; r = 0.315, P = 0.002, respectively). ROC analysis showed that PDFF had the best efficacy in predicting postoperative pancreatic fistula (AUROC = 0.810), better than P-A SI ratio of equilibrium phase(AUROC = 0.752) and delayed phase(AUROC = 0.766).
Conclusions
Pancreatic fat deposition is a high risk factor for POPF, PDFF can reflect fat deposition and predict POPF.
期刊介绍：
European Journal of Radiology is an international journal which aims to communicate to its readers, state-of-the-art information on imaging developments in the form of high quality original research articles and timely reviews on current developments in the field.
Its audience includes clinicians at all levels of training including radiology trainees, newly qualified imaging specialists and the experienced radiologist. Its aim is to inform efficient, appropriate and evidence-based imaging practice to the benefit of patients worldwide.
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