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Prediction of pancreatic anastomotic failure after pancreatic head resection using preoperative diffusion-weighted MR imaging

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Japanese Journal of Radiology Aims and scope Submit manuscript

Abstract

Purpose

To determine whether the preoperative pancreatic apparent diffusion coefficient (ADC) can be used to predict the development of postoperative pancreatic anastomotic failure (PAF).

Materials and methods

We retrospectively examined the cases of 79 patients who underwent pancreatic head resection between January 2010 and October 2013. The patients underwent 1.5-T MR imaging including diffusion-weighted imaging before surgery. The main pancreatic duct diameter (MPD), the pancreatic parenchymal thickness (PT), and the ADC of the pancreatic remnant parenchyma were measured. Two radiologists blinded to the patients’ outcomes performed the measurements. The imaging parameters were compared between the patients who developed PAF and those who did not. The cut-off ADC for the development of PAF was calculated with a receiver operating characteristic analysis.

Results

The imaging parameters were highly correlated between the two observers. The MPD and PT did not differ significantly among the patients. The mean pancreatic ADCs were significantly higher in the patients with PAF than in those without PAF. An ADC higher than 1.50 × 10−3 mm2/s (Az = 0.719, observer-1) or 1.35 × 10−3 mm2/s (Az = 0.752, observer-2) was optimal for predicting the development of postoperative PAF.

Conclusion

Measuring the preoperative non-tumorous pancreatic ADC may be useful for the prediction of a postoperative PAF.

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References

  1. Wellner UF, Kayser G, Lapshyn H, Sick O, Makowiec F, Hoppner J, et al. A simple scoring system based on clinical factors related to pancreatic texture predicts postoperative pancreatic fistula preoperatively. HPB Off J Int Hepato Pancreato Biliary Assoc. 2010;12(10):696–702.

    Article  Google Scholar 

  2. Miyamoto N, Kodama Y, Endo H, Shimizu T, Miyasaka K. Hepatic artery embolization for postoperative hemorrhage in upper abdominal surgery. Abdom Imaging. 2003;28(3):347–53.

    Article  CAS  PubMed  Google Scholar 

  3. Sugimoto M, Takahashi S, Gotohda N, Kato Y, Kinoshita T, Shibasaki H, et al. Schematic pancreatic configuration: a risk assessment for postoperative pancreatic fistula after pancreaticoduodenectomy. J Gastrointest Surg Off J Soc Surg Aliment Tract. 2013;17(10):1744–51.

    Article  Google Scholar 

  4. Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005;138(1):8–13.

    Article  PubMed  Google Scholar 

  5. de Castro SM, Busch OR, van Gulik TM, Obertop H, Gouma DJ. Incidence and management of pancreatic leakage after pancreatoduodenectomy. Br J Surg. 2005;92(9):1117–23.

    Article  PubMed  Google Scholar 

  6. Hashimoto Y, Sclabas GM, Takahashi N, Kirihara Y, Smyrk TC, Huebner M, et al. Dual-phase computed tomography for assessment of pancreatic fibrosis and anastomotic failure risk following pancreatoduodenectomy. J Gastrointest Surg Off J Soc Surg Aliment Tract. 2011;15(12):2193–204.

    Article  Google Scholar 

  7. Lin JW, Cameron JL, Yeo CJ, Riall TS, Lillemoe KD. Risk factors and outcomes in postpancreaticoduodenectomy pancreaticocutaneous fistula. J Gastrointest Surg Off J Soc Surg Aliment Tract. 2004;8(8):951–9.

    Article  Google Scholar 

  8. Tajima Y, Kuroki T, Tsutsumi R, Fukuda K, Kitasato A, Adachi T, et al. Risk factors for pancreatic anastomotic leakage: the significance of preoperative dynamic magnetic resonance imaging of the pancreas as a predictor of leakage. J Am Coll Surg. 2006;202(5):723–31.

    Article  PubMed  Google Scholar 

  9. Watanabe H, Kanematsu M, Tanaka K, Osada S, Tomita H, Hara A, et al. Fibrosis and postoperative fistula of the pancreas: correlation with MR imaging findings—preliminary results. Radiology. 2014;270(3):791–9.

    Article  PubMed  Google Scholar 

  10. Cece H, Ercan A, Yildiz S, Karakas E, Karakas O, Boyaci FN, et al. The use of DWI to assess spleen and liver quantitative ADC changes in the detection of liver fibrosis stages in chronic viral hepatitis. Eur J Radiol. 2013;82(8):e307–12.

    Article  PubMed  Google Scholar 

  11. Akisik MF, Aisen AM, Sandrasegaran K, Jennings SG, Lin C, Sherman S, et al. Assessment of chronic pancreatitis: utility of diffusion-weighted MR imaging with secretin enhancement. Radiology. 2009;250(1):103–9.

    Article  PubMed  Google Scholar 

  12. Balci NC, Momtahen AJ, Akduman EI, Alkaade S, Bilgin M, Burton FR. Diffusion-weighted MRI of the pancreas: correlation with secretin endoscopic pancreatic function test (ePFT). Acad Radiol. 2008;15(10):1264–8.

    Article  PubMed  Google Scholar 

  13. Roberts KJ, Hodson J, Mehrzad H, Marudanayagam R, Sutcliffe RP, Muiesan P, et al. A preoperative predictive score of pancreatic fistula following pancreatoduodenectomy. HPB Off J Int Hepato Pancreato Biliary Assoc. 2014;16(7):620–8.

    Article  Google Scholar 

  14. Zink SI, Soloff EV, White RR, Clary BM, Tyler DS, Pappas TN, et al. Pancreaticoduodenectomy: frequency and outcome of post-operative imaging-guided percutaneous drainage. Abdom Imaging. 2009;34(6):767–71.

    Article  PubMed  Google Scholar 

  15. Schafer M, Heinrich S, Pfammatter T, Clavien PA. Management of delayed major visceral arterial bleeding after pancreatic surgery. HPB Off J Int Hepato Pancreato Biliary Assoc. 2011;13(2):132–8.

    Article  Google Scholar 

  16. Kim A, Lee CH, Kim BH, Lee J, Choi JW, Park YS, et al. Gadoxetic acid-enhanced 3.0T MRI for the evaluation of hepatic metastasis from colorectal cancer: metastasis is not always seen as a “defect” on the hepatobiliary phase. Eur J Radiol. 2012;81(12):3998–4004.

    Article  PubMed  Google Scholar 

  17. Adsay NV, Bagci P, Tajiri T, Oliva I, Ohike N, Balci S, et al. Pathologic staging of pancreatic, ampullary, biliary, and gallbladder cancers: pitfalls and practical limitations of the current AJCC/UICC TNM staging system and opportunities for improvement. Semin Diagn Pathol. 2012;29(3):127–41.

    Article  PubMed  Google Scholar 

  18. Desmet VJ, Gerber M, Hoofnagle JH, Manns M, Scheuer PJ. Classification of chronic hepatitis: diagnosis, grading and staging. Hepatology (Baltimore, Md). 1994;19(6):1513–20.

    Article  CAS  Google Scholar 

  19. Farnell MB, Pearson RK, Sarr MG, DiMagno EP, Burgart LJ, Dahl TR, et al. A prospective randomized trial comparing standard pancreatoduodenectomy with pancreatoduodenectomy with extended lymphadenectomy in resectable pancreatic head adenocarcinoma. Surgery. 2005;138(4):618–28; discussion 28–30.

    Article  PubMed  Google Scholar 

  20. Hashimoto Y, Traverso LW. Incidence of pancreatic anastomotic failure and delayed gastric emptying after pancreatoduodenectomy in 507 consecutive patients: use of a web-based calculator to improve homogeneity of definition. Surgery. 2010;147(4):503–15.

    Article  PubMed  Google Scholar 

  21. Dinter DJ, Aramin N, Weiss C, Singer C, Weisser G, Schoenberg SO, et al. Prediction of anastomotic leakage after pancreatic head resections by dynamic magnetic resonance imaging (dMRI). J Gastrointest Surg Off J Soc Surg Aliment Tract. 2009;13(4):735–44.

    Article  Google Scholar 

  22. Yeo CJ, Cameron JL, Lillemoe KD, Sauter PK, Coleman J, Sohn TA, et al. Does prophylactic octreotide decrease the rates of pancreatic fistula and other complications after pancreaticoduodenectomy? Results of a prospective randomized placebo-controlled trial. Ann Surg. 2000;232(3):419–29.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  23. Lee SE, Jang JY, Lim CS, Kang MJ, Kim SH, Kim MA, et al. Measurement of pancreatic fat by magnetic resonance imaging: predicting the occurrence of pancreatic fistula after pancreatoduodenectomy. Ann Surg. 2010;251(5):932–6.

    Article  PubMed  Google Scholar 

  24. Yeo CJ, Cameron JL, Sohn TA, Lillemoe KD, Pitt HA, Talamini MA, et al. Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes. Ann Surg. 1997;226(3):248–57.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  25. Ronot M, Asselah T, Paradis V, Michoux N, Dorvillius M, Baron G, et al. Liver fibrosis in chronic hepatitis C virus infection: differentiating minimal from intermediate fibrosis with perfusion CT. Radiology. 2010;256(1):135–42.

    Article  PubMed  Google Scholar 

  26. Tamada T, Ito K, Sone T, Yamamoto A, Yoshida K, Kakuba K, et al. Dynamic contrast-enhanced magnetic resonance imaging of abdominal solid organ and major vessel: comparison of enhancement effect between Gd-EOB-DTPA and Gd-DTPA. J Magn Reson Imaging JMRI. 2009;29(3):636–40.

    Article  Google Scholar 

  27. Mathur A, Pitt HA, Marine M, Saxena R, Schmidt CM, Howard TJ, et al. Fatty pancreas: a factor in postoperative pancreatic fistula. Ann Surg. 2007;246(6):1058–64.

    Article  PubMed  Google Scholar 

  28. Taouli B, Tolia AJ, Losada M, Babb JS, Chan ES, Bannan MA, et al. Diffusion-weighted MRI for quantification of liver fibrosis: preliminary experience. AJR Am J Roentgenol. 2007;189(4):799–806.

    Article  PubMed  Google Scholar 

  29. Balci C. MRI assessment of chronic pancreatitis. Diagn Interv Radiol. 2011;17(3):249–54.

    PubMed  Google Scholar 

  30. Morita S, Ueno E, Masukawa A, Suzuki K, Fujimura M, Hirabayashi N, et al. Prospective comparative study of negative oral contrast agents for magnetic resonance cholangiopancreatography. Jpn J Radiol. 2010;28(2):117–22.

    Article  CAS  PubMed  Google Scholar 

  31. Braithwaite AC, Dale BM, Boll DT, Merkle EM. Short- and midterm reproducibility of apparent diffusion coefficient measurements at 3.0-T diffusion-weighted imaging of the abdomen. Radiology. 2009;250(2):459–65.

    Article  PubMed  Google Scholar 

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Acknowledgments

We obtained valuable advice from Dr. Koji Oba (Translational Research and Clinical Trial Center, Hokkaido University Hospital).

Conflict of interest

We have no conflict of interest.

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, Hokkaido University Graduate School of Medicine, N15 W7 Kita-ku, Sapporo, Hokkaido, 060-8638, Japan

    Noriyuki Miyamoto, Satoshi Yabusaki, Keita Sakamoto, Yasuka Kikuchi, Rie Mimura, Fumi Kato, Noriko Oyama-Manabe, Bunya Takahashi, Takeshi Soyama, Daisuke Abo, Yusuke Sakuhara & Kohsuke Kudo

  2. Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan

    Hiroki Shirato

  3. Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Sapporo, Japan

    Toru Nakamura, Takahiro Tsuchikawa, Keisuke Okamura & Satoshi Hirano

Authors
  1. Noriyuki Miyamoto
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  2. Satoshi Yabusaki
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  3. Keita Sakamoto
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  11. Yusuke Sakuhara
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  13. Hiroki Shirato
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  14. Toru Nakamura
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  15. Takahiro Tsuchikawa
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  16. Keisuke Okamura
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  17. Satoshi Hirano
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Corresponding author

Correspondence to Noriyuki Miyamoto.

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Miyamoto, N., Yabusaki, S., Sakamoto, K. et al. Prediction of pancreatic anastomotic failure after pancreatic head resection using preoperative diffusion-weighted MR imaging. Jpn J Radiol 33, 59–66 (2015). https://doi.org/10.1007/s11604-014-0377-y

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  • DOI: https://doi.org/10.1007/s11604-014-0377-y

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