Dingxia Liu, Jiejun Chen, Yunfei Zhang, Yajia Gu, Xiuzhong Yao
{"title":"Magnetic Resonance Elastography Derived Stiffness to Predict Postoperative Pancreatic Fistula After Partial Pancreatectomy.","authors":"Dingxia Liu, Jiejun Chen, Yunfei Zhang, Yajia Gu, Xiuzhong Yao","doi":"10.1016/j.acra.2025.03.028","DOIUrl":null,"url":null,"abstract":"<p><strong>Rationale and objectives: </strong>To investigate the magnetic resonance elastography (MRE)-derived pancreatic stiffness for predicting the occurrence of clinically relative postoperative pancreatic fistula (CR-POPF) in patients with partial pancreatectomy, and establish a predictive model for POPF before surgery.</p><p><strong>Background: </strong>Pancreatic stiffness reflects fibrosis and fat infiltration, which are associated with CR-POPF. But preoperative prediction remains a challenge. MRE was proven to evaluate pancreatic stiffness accurately, potentially being a predictive imaging biomarker of POPF.</p><p><strong>Methods: </strong>This prospective study included adult patients who underwent magnetic resonance imaging with MRE sequence and subsequent partial pancreatectomy between August 2021 and December 2023. The relationships of MRE stiffness and main pancreatic duct diameter (MPD) with the risk of POPF were analyzed using logistic regression. Independent risk factors were identified to construct the nomogram prediction model. The predictive performance of each parameter and the model was conducted by calculating the area under the ROC curve (AUC).</p><p><strong>Results: </strong>A total of 73 patients (age 58.99±12.55 years; 30 pancreatoduodenectomy and 43 distal pancreatectomy) were enrolled, among whom 15 developed CR-POPF and 58 did not. After conducting uni- and multivariate logistic regression analyses, high BMI was found to be an independent risk factor for the occurrence of POPF (OR=2.916, 95% CI: 1.472-9.394, P=0.02), while high pancreatic MRE stiffness (OR=0.0633, 95% CI: 0.0022-0.5273, P=0.04) and large MPD (OR=0.0728, 95% CI: 0.003-0.5165, P=0.04) were independent protective factors. A preoperative prediction model for POPF was constructed by combining the three indicators, which has excellent predictive performance with an AUC of 0.97.</p><p><strong>Conclusion: </strong>MRE can quantitatively evaluate the mechanical property of pancreas, which is a reliable indicator for predicting the risk of POPF. The POPF prediction model established by combining BMI, pancreatic stiffness value, and MPD has promising clinical application prospects.</p>","PeriodicalId":50928,"journal":{"name":"Academic Radiology","volume":" ","pages":""},"PeriodicalIF":3.8000,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Academic Radiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.acra.2025.03.028","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING","Score":null,"Total":0}
引用次数: 0
Abstract
Rationale and objectives: To investigate the magnetic resonance elastography (MRE)-derived pancreatic stiffness for predicting the occurrence of clinically relative postoperative pancreatic fistula (CR-POPF) in patients with partial pancreatectomy, and establish a predictive model for POPF before surgery.
Background: Pancreatic stiffness reflects fibrosis and fat infiltration, which are associated with CR-POPF. But preoperative prediction remains a challenge. MRE was proven to evaluate pancreatic stiffness accurately, potentially being a predictive imaging biomarker of POPF.
Methods: This prospective study included adult patients who underwent magnetic resonance imaging with MRE sequence and subsequent partial pancreatectomy between August 2021 and December 2023. The relationships of MRE stiffness and main pancreatic duct diameter (MPD) with the risk of POPF were analyzed using logistic regression. Independent risk factors were identified to construct the nomogram prediction model. The predictive performance of each parameter and the model was conducted by calculating the area under the ROC curve (AUC).
Results: A total of 73 patients (age 58.99±12.55 years; 30 pancreatoduodenectomy and 43 distal pancreatectomy) were enrolled, among whom 15 developed CR-POPF and 58 did not. After conducting uni- and multivariate logistic regression analyses, high BMI was found to be an independent risk factor for the occurrence of POPF (OR=2.916, 95% CI: 1.472-9.394, P=0.02), while high pancreatic MRE stiffness (OR=0.0633, 95% CI: 0.0022-0.5273, P=0.04) and large MPD (OR=0.0728, 95% CI: 0.003-0.5165, P=0.04) were independent protective factors. A preoperative prediction model for POPF was constructed by combining the three indicators, which has excellent predictive performance with an AUC of 0.97.
Conclusion: MRE can quantitatively evaluate the mechanical property of pancreas, which is a reliable indicator for predicting the risk of POPF. The POPF prediction model established by combining BMI, pancreatic stiffness value, and MPD has promising clinical application prospects.
期刊介绍：
Academic Radiology publishes original reports of clinical and laboratory investigations in diagnostic imaging, the diagnostic use of radioactive isotopes, computed tomography, positron emission tomography, magnetic resonance imaging, ultrasound, digital subtraction angiography, image-guided interventions and related techniques. It also includes brief technical reports describing original observations, techniques, and instrumental developments; state-of-the-art reports on clinical issues, new technology and other topics of current medical importance; meta-analyses; scientific studies and opinions on radiologic education; and letters to the Editor.
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