PREOPERATIVE ASSESSMENT OF THE DEGREE OF PANCREATIC FIBROSIS USING COMPUTED TOMOGRAPHY
DOI:
https://doi.org/10.11603/2414-4533.2024.1.14638Keywords:
pancreatic fibrosis, computed tomography, postoperative complications, fistula, histologyAbstract
The aim of the work: to establish the correlation between pancreatic density on CT images and degree of pancreatic fibrosis determined by histological examination.
Materials and Methods. A retrospective analysis of 121 patients who underwent pancreaticoduodenectomy (PD) for biliopancreatoduodenal diseases at a single institution and confirmed pancreatic fibrosis by histology was performed. Pancreatic parenchymal density was measured by two blinded radiologists in Hounsfield units on preoperative non-contrast CT images, with avoidance of vessels and ducts. Collagen staining with Masson’s trichrome on histological slides provided by a blinded pathologist was used to determine percentage of fibrosis relative to total tissue area. Correlations were analyzed using Spearman’s rank test between CT density, histological fibrosis percentage, pancreatic duct diameter, intraoperative texture, and postoperative pancreatic fistula grade based on ISGPF criteria.
Results. Median pancreatic density was 45.38 HU (interquartile range 27 to 80 HU). A strong positive correlation was found between CT density and percent histological fibrosis (Spearman’s r=0.983, p<0.01). Receiver operating characteristic analysis determined an optimal cutoff of 36.06 HU to differentiate “soft” vs “firm” pancreas, with 95.1 % sensitivity, 86.7% specificity and 0.93 area under the curve. CT density decreased with increasing grade of postoperative pancreatic fistula (Spearman’s r=-0.449, p<0.01). Patients with “firm” pancreas intraoperatively had significantly higher CT density (49.97 vs 31.29 HU, p<0.01) and percent fibrosis (43.93 % vs 6.83 %, p<0.01) compared to “soft” pancreas. Quantitative CT density measurement correlates strongly with histological fibrosis and postoperative complication risk. A Hounsfield unit cutoff of 36 effectively differentiates firm fibrotic pancreas from soft pancreas. CT density aligns well with surgeon’s subjective intraoperative assessment of texture. Preoperative CT assessment of pancreatic density and fibrosis can therefore aid surgical planning and risk stratification for PD.
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