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Extracellular volume fraction derived from dual-energy CT: a potential predictor for acute pancreatitis after pancreatoduodenectomy

  • Gastrointestinal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To investigate the value of extracellular volume (ECV) fraction and fat fraction (FF) derived from dual- energy CT (DECT) for predicting postpancreatectomy acute pancreatitis (PPAP) after pancreatoduodenectomy (PD).

Methods

This retrospective study included patients who underwent DECT and PD between April 2022 and September 2022. PPAP was determined according to the International Study Group for Pancreatic Surgery (ISGPS) definition. Iodine concentration (IC) and FF of the pancreatic parenchyma were measured on preoperative DECT. The ECV fraction was calculated from iodine map images of the equilibrium phase. The independent predictors for PPAP were assessed by univariate and multivariable logistic regression analysis and receiver operating characteristic (ROC) curve analysis.

Results

Sixty-nine patients were retrospectively enrolled (median age, 60 years; interquartile range, 55–70 years; 47 men). Of these, nine patients (13.0%) developed PPAP. These patients had lower portal venous phase IC, equilibrium phase IC, FF, and ECV fraction, and higher pancreatic parenchymal-to-portal venous phase IC ratio and pancreatic parenchymal-to-equilibrium phase IC ratio, compared with patients without PPAP. After multivariable analysis, ECV fraction was independently associated with PPAP (odd ratio [OR], 0.87; 95% confidence interval [CI]: 0.79, 0.96; p < 0.001), with an area under the curve (AUC) of 0.839 (sensitivity 100.0%, specificity 58.3%).

Conclusions

A lower ECV fraction is independently associated with the occurrence of PPAP after PD. ECV fraction may serve as a potential predictor for PPAP after PD.

Clinical relevance statement

DECT-derived ECV fraction of pancreatic parenchyma is a promising biomarker for surgeons to preoperatively identify patients with higher risk for postpancreatectomy acute pancreatitis after PD and offer selective perioperative management.

Key Points

  • PPAP is a complication of pancreatic surgery, early identification of higher-risk patients allows for risk mitigation.

  • Lower DECT-derived ECV fraction was independently associated with the occurrence of PPAP after PD.

  • DECT aids in preoperative PAPP risk stratification, allowing for appropriate treatment to minimize complications.

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Abbreviations

CECT:

Contrast-enhanced computed tomography

DECT:

Dual-energy CT

ECV:

Extracellular volume

FF:

Fat fraction

IC:

Iodine concentration

PD:

Pancreatoduodenectomy

POPF:

Postoperative pancreatic fistula

PPAP:

Postpancreatectomy acute pancreatitis

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Funding

The authors state that this work has not received any funding.

Author information

Author notes

  1. Xiao-Han Bai and Jie Yin contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, The First Affiliated Hospital with Nanjing Medical University, No 300, Guangzhou Road, Nanjing, 210029, Jiangsu Province, China

    Xiao-Han Bai, Si-Yao Yu, Yu-Ping Shu & Qing Xu

  2. Pancreas Center, The First Affiliated Hospital with Nanjing Medical University, No 300, Guangzhou Road, Nanjing, 210029, Jiangsu Province, China

    Jie Yin, Zi-Peng Lu & Kui-Rong Jiang

Authors
  1. Xiao-Han Bai
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Corresponding authors

Correspondence to Kui-Rong Jiang or Qing Xu.

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The scientific guarantor of this publication is Qing Xu.

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The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was waived by the Institutional Review Board.

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  • Retrospective

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  • Performed at one institution

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Bai, XH., Yin, J., Yu, SY. et al. Extracellular volume fraction derived from dual-energy CT: a potential predictor for acute pancreatitis after pancreatoduodenectomy. Eur Radiol (2024). https://doi.org/10.1007/s00330-024-10750-3

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  • DOI: https://doi.org/10.1007/s00330-024-10750-3

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