Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Aug 5;20(1):250.
doi: 10.1186/s12957-022-02718-8.

The pancreas-to-muscle signal intensity ratio on T1-weighted MRI as a predictive biomarker for postoperative pancreatic fistula after distal pancreatectomy: a single-center retrospective study

Masahiro Fukada  1 , Katsutoshi Murase  2 , Toshiya Higashi  2 , Seito Fujibayashi  2 , Masashi Kuno  2 , Itaru Yasufuku  2 , Yuta Sato  2 , Shigeru Kiyama  2 , Yoshihiro Tanaka  2 , Naoki Okumura  2 , Nobuhisa Matsuhashi  2 , Takao Takahashi  2
Affiliations

The pancreas-to-muscle signal intensity ratio on T1-weighted MRI as a predictive biomarker for postoperative pancreatic fistula after distal pancreatectomy: a single-center retrospective study

Masahiro Fukada et al. World J Surg Oncol. .

Abstract

Background: Postoperative pancreatic fistula (POPF) is one of the serious complications of pancreatic surgery. When POPF occurs and becomes severe, it causes secondary complications and a longer treatment period. We previously reported a correlation between pancreatic fibrosis and magnetic resonance imaging (MRI) findings, and MRI may have the potential to predict POPF. This study aimed to assess the predictive ability of the pancreas-to-muscle signal intensity ratio on T1-weighted MRI (SIR on T1-w MRI) for POPF after distal pancreatectomy (DP).

Methods: This single-institution retrospective study comprised 117 patients who underwent DP. It was conducted between 2010 and 2021 at the Gifu University Hospital. We statistically analyzed pre-, intra-, and postoperative factors to assess the correlation with POPF.

Results: According to the definition and grading of the International Study Group of Pancreatic Fistula (ISGPF), 29 (24.8%) of the 117 patients had POPF grades B and C. In the univariate analysis, POPF was significantly associated with the pancreas-to-muscle SIR on T1-w MRI, the drainage fluid amylase concentration (D-Amy) levels on postoperative day (POD) 1 and 3, white blood cell count on POD 1 and 3, C-reactive protein level on POD 3, and heart rate on POD 3. In multivariate analysis, only the pancreas-to-muscle SIR on T1-w MRI (>1.37; odds ratio [OR] 23.25; 95% confidence interval [CI] 3.93-454.03; p < 0.01) and D-Amy level on POD 3 (>737 U/l; OR 3.91; 95% CI 1.02-16.36; p = 0.046) were identified as independent predictive factors.

Conclusions: The pancreas-to-muscle SIR on T1-w MRI and postoperative D-Amy levels were able to predict the development of POPF after DP. The pancreas-to-muscle SIR on T1-w MRI may be a potential objective biomarker reflecting pancreatic status.

Keywords: Distal pancreatectomy; Postoperative pancreatic fistula; Signal intensity ratio on T1-weighted MRI.

PubMed Disclaimer

Conflict of interest statement

T. Takahashi received honoraria for lectures from Takeda Pharmaceutical Co., Ltd. The remaining authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Exclusion criteria
Fig. 2
Fig. 2
Analysis flow chart for identifying predictive factors for postoperative pancreatic fistula (POPF) after distal pancreatectomy (DP)
Fig. 3
Fig. 3
The pancreas-to-muscle signal intensity ratio on fat-suppressed axial T1-weighted MRI was calculated by [signal intensity of the pancreatic parenchyma] (arrow)/[signal intensity of the paraspinal muscle] (arrowhead)
Fig. 4
Fig. 4
Receiver operating characteristic (ROC) curve analysis of pancreas-to-muscle SIR on T1-weighted MRI and D-Amy level on POD 1 and 3 for discriminating to POPF
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Fujino Y. Perioperative management of distal pancreatectomy. World J Gastroenterol. 2015;21:3166–3169. doi: 10.3748/wjg.v21.i11.3166. - DOI - PMC - PubMed
    1. Sell NM, Pucci MJ, Gabale S, Leiby BE, Rosato EL, Winter JM, et al. The influence of transection site on the development of pancreatic fistula in patients undergoing distal pancreatectomy: a review of 294 consecutive cases. Surgery. 2015;157:1080–1087. doi: 10.1016/j.surg.2015.01.014. - DOI - PubMed
    1. Glowka TR, von Websky M, Pantelis D, Manekeller S, Standop J, Kalff JC, et al. Risk factors for delayed gastric emptying following distal pancreatectomy. Langenbecks Arch Surg. 2016;401:161–167. doi: 10.1007/s00423-016-1374-7. - DOI - PubMed
    1. Andrianello S, Marchegiani G, Malleo G, Masini G, Balduzzi A, Paiella S, et al. Pancreaticojejunostomy with externalized stent vs pancreaticogastrostomy with externalized stent for patients with high-risk pancreatic anastomosis: a single-center, phase 3, randomized clinical trial. JAMA Surg. 2020;155:313–321. doi: 10.1001/jamasurg.2019.6035. - DOI - PMC - PubMed
    1. Zhang H, Zhu F, Shen M, Tian R, Shi CJ, Wang X, et al. Systematic review and meta-analysis comparing three techniques for pancreatic remnant closure following distal pancreatectomy. Br J Surg. 2015;102:4–15. doi: 10.1002/bjs.9653. - DOI - PubMed