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

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Purpose

The texture of the pancreatic tissue is a main risk factor for leakage after pancreaticojejunostomy and can be differentiated using dynamic contrast enhanced magnetic resonance imaging (dMRI). In order to identify risk factors and to assess the role of pancreatic dMRI, a cohort of patients was retrospectively reviewed.

Patients and methods

One hundred seven consecutive patients were identified in the departmental database and examined by means of a standardized dMRI protocol using a 1.5-T MRI system. Signal intensity (SI) measurements (aorta, body of the pancreas, muscle tissue) were performed in the axial T1-weighted sequences before and after 25 and 60 s after i.v. application of gadolinium–diethylenetriaminepentaacetic acid. For all patients with a standardized contrast medium curve in the aorta (n = 72), a muscle-normalized signal intensity curve (SIC) with SIratio was calculated. SIratios were classified in two groups: rapid increase (SIratio ≥ 1.1, early arterial value > portal-venous value, “soft” pancreas) and delayed increase (SIratio <1.1, “firm” or “hard” pancreas). All patients received pancreatic head resection with a duct-to-mucosa pancreaticojejunostomy. The dMRI data was correlated with prospectively acquired clinical data.

Results

Leakage of the pancreaticojejunostomy occurred more frequently (12/37 vs. two of 35, 32% vs. 6%, p = 0.006) in patients with a rapid increase and an SIratio ≥ 1.1 (“soft” pancreas, n = 37) compared to those with delayed perfusion (SIratio <1.1, “hard” pancreas, n = 35). The more severe type B and C anastomotic leakages occurred only in the group of patients with SIratio ≥ 1.1. Patients with a rapid increase had significantly better preoperative American Society of Anesthesiologists staging, lower carbohydrate antigen 19-9 values, and smaller tumor sizes. Most of them had not only benign tumors but also longer postoperative hospital stay, in comparison to patients with delayed perfusion (SIratio <1.1). Multivariate analysis revealed SIratio of ≥1.1 to be the only preoperative parameter predicting leakage significantly with an odds ratio of 7.9.

Conclusion

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

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Authors and Affiliations

  1. Department of Clinical Radiology and Nuclear Medicine, University Hospital Mannheim, Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany

    Dietmar J. Dinter, Gerald Weisser & Stefan O. Schoenberg

  2. Department of Surgery, University Hospital Mannheim, Faculty of Medicine Mannheim, , University of Heidelberg, Theodor-Kutzer Ufer 1-3, 68167, Mannheim, Germany

    Niloufar Aramin, Christoph Singer, Stefan Post & Marco Niedergethmann

  3. Department of Medical Statistics, University Hospital Mannheim, Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany

    Christel Weiss

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  1. Dietmar J. Dinter
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Correspondence to Marco Niedergethmann.

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Dietmar J. Dinter and Niloufar Aramin contributed equally to this work.

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Dinter, D.J., Aramin, N., Weiss, C. et al. Prediction of Anastomotic Leakage After Pancreatic Head Resections by Dynamic Magnetic Resonance Imaging (dMRI). J Gastrointest Surg 13, 735–744 (2009). https://doi.org/10.1007/s11605-008-0765-7

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