Korean J Radiol.  2019 Apr;20(4):599-608. 10.3348/kjr.2018.0557.

Measurement of Pancreatic Fat Fraction by CT Histogram Analysis to Predict Pancreatic Fistula after Pancreaticoduodenectomy

Affiliations
  • 1Department of Radiology, Hallym University Sacred Heart Hospital, Anyang, Korea. ha.hongil@gmail.com
  • 2Department of Surgery, Hallym University Sacred Heart Hospital, Anyang, Korea.

Abstract


OBJECTIVE
To evaluate the effectiveness of computed tomography (CT) Hounsfield unit histogram analysis (HUHA) in postoperative pancreatic fistula (PF) prediction.
MATERIALS AND METHODS
Fifty-four patients (33 males and 21 females; mean age, 65.6 years; age range, 37-89 years) who had undergone preoperative CT and pancreaticoduodenectomy were included in this retrospective study. Two radiologists measured mean CT Hounsfield unit (CTHU) values by drawing regions of interest (ROIs) at the level of the pancreaticojejunostomy site on preoperative pre-contrast images. The HUHA values were arbitrarily divided into three categories, comprising HUHA-A ≤ 0 HU, 0 HU < HUHA-B < 30 HU, and HUHA-C ≥ 30 HU. Each HUHA value within the ROI was calculated as a percentage of the entire area using commercial 3-dimensional analysis software. Pancreas texture was evaluated as soft or hard by manual palpation.
RESULTS
Fifteen patients (27.8%) had clinically relevant PFs. The PF group had significantly higher HUHA-A (p < 0.01) and significantly lower mean CTHU (p < 0.01) values than those of the non-PF group. The HUHA-A value had a moderately strong correlation with PF occurrence (r = 0.60, p < 0.01), whereas the mean CTHU had a weak negative correlation with PF occurrence (r = −0.27, p < 0.01). The HUHA-A and mean CTHU areas under the curve (AUCs) for predicting PF occurrence were 0.86 and 0.65, respectively, with significant difference (p < 0.01). The HUHA-A and mean CTHU AUCs for predicting pancreatic softness were 0.86 and 0.64, respectively, with significant difference (p < 0.01).
CONCLUSION
The HUHA-A values on preoperative pre-contrast CT images demonstrate a strong correlation with PF occurrence.

Keyword

Pancreaticoduodenectomy; Pancreatic fistula; MDCT; Histogram analysis; Attenuation; Pancreatic softness

MeSH Terms

Area Under Curve
Female
Humans
Male
Palpation
Pancreas
Pancreatic Fistula*
Pancreaticoduodenectomy*
Pancreaticojejunostomy
Retrospective Studies
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