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Application of ultrasound shear wave elastography in pre-operative and quantitative prediction of clinically relevant post-operative pancreatic fistula after pancreatectomy: a prospective study for the investigation of risk evaluation model

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

Abstract

Objectives

The aim of this study was to modify recognized clinically relevant post-operative pancreatic fistula (CR-POPF) risk evaluation models with quantitative ultrasound shear wave elastography (SWE) values and identified clinical parameters to improve the objectivity and reliability of the prediction.

Methods

Two prospective, successive cohorts were initially designed for the establishment of CR-POPF risk evaluation model and the internal validation. Patients who scheduled to receive pancreatectomy were enrolled. Virtual touch tissue imaging and quantification (VTIQ)-SWE was used to quantify pancreatic stiffness. CR-POPF was diagnosed according to 2016 International Study Group of Pancreatic Fistula standard. Recognized peri-operative risk factors of CR-POPF were analyzed, and the independent variables selected from multivariate logistic regression were used to build the prediction model.

Results

Finally, the CR-POPF risk evaluation model was built in a group of 143 patients (cohort 1). CR-POPF occurred in 52/143 (36%) patients. Constructed from SWE values and other identified clinical parameters, the model achieved an area under the receiver operating characteristic curve of 0.866, with sensitivity, specificity, and likelihood ratio of 71.2%, 80.2%, and 3.597 in predicting CR-POPF. Decision curve of modified model revealed a better clinical benefit compared to the previous clinical prediction models. The models were then examined via internal validation in a separate collection of 72 patients (cohort 2).

Conclusions

Risk evaluation model based on SWE and clinical parameters is a potential non-invasive way to pre-operatively, objectively predict CR-POPF after pancreatectomy.

Clinical relevance statement

Our modified model based on ultrasound shear wave elastography may provide an easy access in pre-operative and quantitative evaluating the risk of CR-POPF following pancreatectomy and improve the objectivity and reliability of the prediction compared to previous clinical models.

Key Points

• Modified prediction model based on ultrasound shear wave elastography (SWE) provides an easy access for clinicians to pre-operatively, objectively evaluate the risk of clinically relevant post-operative pancreatic fistula (CR-POPF) following pancreatectomy.

• Prospective study with validation showed that the modified model provides better diagnostic efficacy and clinical benefits compared to previous clinical models in predicting CR-POPF.

• Peri-operative management of CR-POPF high-risk patients becomes more possible.

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Abbreviations

CR-POPF:

Clinically relevant post-operative pancreatic fistula

DP:

Distal pancreatectomy

FRS:

Fistula risk score

ISGPF:

International Study Group of Pancreatic Fistula

MPD:

Main pancreatic duct

PD:

Pancreaticoduodenectomy

SWE:

Shear wave elastography

VTIQ:

Virtual touch tissue imaging and quantification technology

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Acknowledgements

This study was supported and funded by the National Natural Science Foundation of China (Grant No. 82071942), Clinical Research Plan of Shanghai Hospital Development Center (Grant No. SHDC2020CR4060, SHDC2020CR1031B), and Shanghai Pujiang Program (Grant No. 2020PJD008).

Funding

This study has received funding by the National Natural Science Foundation of China (Grant No. 82071942), Clinical Research Plan of Shanghai Hospital Development Center (Grant No. SHDC2020CR4060, SHDC2020CR1031B), and Shanghai Pujiang Program (Grant No. 2020PJD008).

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Authors and Affiliations

  1. Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, 200032, China

    Xiao-Fan Tian, Yi-Jie Qiu, Dan Zuo & Wen-Ping Wang

  2. Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China

    Xiao-Fan Tian & Yi Dong

  3. Department of Pancreatic Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China

    Lei Zhang & Wen-Hui Lou

Authors
  1. Xiao-Fan Tian
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  2. Lei Zhang
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  4. Yi-Jie Qiu
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Corresponding author

Correspondence to Yi Dong.

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Guarantor

The scientific guarantor of this publication is Yi Dong (Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China).

Conflict of interest

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

Xiao-Fan Tian and Lei Zhang kindly provided statistical advice for this manuscript.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

This prospective study was approved by the institutional review board of Zhongshan Hospital (affiliated to Fudan University, Shanghai, China) (Approval No. B2020-309R). Informed consent was signed, and all the procedures was followed in accordance with the Declaration of Helsinki.

Study subjects or cohorts overlap

No study subjects or cohorts have been previously reported.

Methodology

• prospective

• diagnostic or prognostic study

• performed at one institution

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Tian, XF., Zhang, L., Lou, WH. et al. Application of ultrasound shear wave elastography in pre-operative and quantitative prediction of clinically relevant post-operative pancreatic fistula after pancreatectomy: a prospective study for the investigation of risk evaluation model. Eur Radiol 33, 7866–7876 (2023). https://doi.org/10.1007/s00330-023-09859-8

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  • DOI: https://doi.org/10.1007/s00330-023-09859-8

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