Abstract：
OBJECTIVE: To investigate the value of extracellular volume (ECV) fraction and fat fraction (FF) derived from dual- energy CT (DECT) for predicting postpancreatectomy acute pancreatitis (PPAP) after pancreatoduodenectomy (PD).
METHODS: This retrospective study included patients who underwent DECT and PD between April 2022 and September 2022. PPAP was determined according to the International Study Group for Pancreatic Surgery (ISGPS) definition. Iodine concentration (IC) and FF of the pancreatic parenchyma were measured on preoperative DECT. The ECV fraction was calculated from iodine map images of the equilibrium phase. The independent predictors for PPAP were assessed by univariate and multivariable logistic regression analysis and receiver operating characteristic (ROC) curve analysis.
RESULTS: Sixty-nine patients were retrospectively enrolled (median age, 60 years; interquartile range, 55-70 years; 47 men). Of these, nine patients (13.0%) developed PPAP. These patients had lower portal venous phase IC, equilibrium phase IC, FF, and ECV fraction, and higher pancreatic parenchymal-to-portal venous phase IC ratio and pancreatic parenchymal-to-equilibrium phase IC ratio, compared with patients without PPAP. After multivariable analysis, ECV fraction was independently associated with PPAP (odd ratio [OR], 0.87; 95% confidence interval [CI]: 0.79, 0.96; p < 0.001), with an area under the curve (AUC) of 0.839 (sensitivity 100.0%, specificity 58.3%).
CONCLUSIONS: A lower ECV fraction is independently associated with the occurrence of PPAP after PD. ECV fraction may serve as a potential predictor for PPAP after PD.
CONCLUSIONS: DECT-derived ECV fraction of pancreatic parenchyma is a promising biomarker for surgeons to preoperatively identify patients with higher risk for postpancreatectomy acute pancreatitis after PD and offer selective perioperative management.
CONCLUSIONS: PPAP is a complication of pancreatic surgery, early identification of higher-risk patients allows for risk mitigation. Lower DECT-derived ECV fraction was independently associated with the occurrence of PPAP after PD. DECT aids in preoperative PAPP risk stratification, allowing for appropriate treatment to minimize complications.
METHODS: This retrospective study included patients who underwent DECT and PD between April 2022 and September 2022. PPAP was determined according to the International Study Group for Pancreatic Surgery (ISGPS) definition. Iodine concentration (IC) and FF of the pancreatic parenchyma were measured on preoperative DECT. The ECV fraction was calculated from iodine map images of the equilibrium phase. The independent predictors for PPAP were assessed by univariate and multivariable logistic regression analysis and receiver operating characteristic (ROC) curve analysis.
RESULTS: Sixty-nine patients were retrospectively enrolled (median age, 60 years; interquartile range, 55-70 years; 47 men). Of these, nine patients (13.0%) developed PPAP. These patients had lower portal venous phase IC, equilibrium phase IC, FF, and ECV fraction, and higher pancreatic parenchymal-to-portal venous phase IC ratio and pancreatic parenchymal-to-equilibrium phase IC ratio, compared with patients without PPAP. After multivariable analysis, ECV fraction was independently associated with PPAP (odd ratio [OR], 0.87; 95% confidence interval [CI]: 0.79, 0.96; p < 0.001), with an area under the curve (AUC) of 0.839 (sensitivity 100.0%, specificity 58.3%).
CONCLUSIONS: A lower ECV fraction is independently associated with the occurrence of PPAP after PD. ECV fraction may serve as a potential predictor for PPAP after PD.
CONCLUSIONS: DECT-derived ECV fraction of pancreatic parenchyma is a promising biomarker for surgeons to preoperatively identify patients with higher risk for postpancreatectomy acute pancreatitis after PD and offer selective perioperative management.
CONCLUSIONS: PPAP is a complication of pancreatic surgery, early identification of higher-risk patients allows for risk mitigation. Lower DECT-derived ECV fraction was independently associated with the occurrence of PPAP after PD. DECT aids in preoperative PAPP risk stratification, allowing for appropriate treatment to minimize complications.
摘要：
目的：探讨双能量CT(DECT)细胞外体积(ECV)和脂肪含量(FF)对胰十二指肠切除术(PD)后急性胰腺炎(PPAP)的预测价值。
方法：这项回顾性研究包括2022年4月至2022年9月期间接受DECT和PD的患者。根据国际胰腺手术研究组(ISGPS)定义确定PPAP。在术前DECT上测量胰腺实质的碘浓度（IC）和FF。从平衡相的碘图图像计算ECV分数。通过单变量和多变量逻辑回归分析以及受试者工作特征（ROC）曲线分析评估PPAP的独立预测因子。
结果：回顾性纳入了69例患者（中位年龄，60年；四分位数范围，55-70岁；47名男性）。其中,9例患者（13.0%）发生PPAP。这些患者有较低的门静脉相IC，平衡相位IC，FF,和ECV分数，和更高的胰腺实质与门静脉相IC比率和胰腺实质与平衡相IC比率，与无PPAP患者相比。经过多变量分析，ECV分数与PPAP独立相关(奇数比[OR]，0.87；95%置信区间[CI]：0.79，0.96；p<0.001)，曲线下面积(AUC)为0.839(灵敏度100.0%,特异性58.3%）。
结论：较低的ECV分数与PD后PPAP的发生独立相关。ECV分数可作为PD后PPAP的潜在预测因子。
结论：DECT衍生的胰腺实质ECV分数是外科医生术前识别PD后胰腺切除术后急性胰腺炎风险较高的患者并提供选择性围手术期管理的有前景的生物标志物。
结论：PPAP是胰腺手术的并发症，早期发现高危患者有助于降低风险.较低的DECT衍生的ECV分数与PD后PPAP的发生独立相关。DECT有助于术前PAPP风险分层，允许适当的治疗，以尽量减少并发症。
方法：这项回顾性研究包括2022年4月至2022年9月期间接受DECT和PD的患者。根据国际胰腺手术研究组(ISGPS)定义确定PPAP。在术前DECT上测量胰腺实质的碘浓度（IC）和FF。从平衡相的碘图图像计算ECV分数。通过单变量和多变量逻辑回归分析以及受试者工作特征（ROC）曲线分析评估PPAP的独立预测因子。
结果：回顾性纳入了69例患者（中位年龄，60年；四分位数范围，55-70岁；47名男性）。其中,9例患者（13.0%）发生PPAP。这些患者有较低的门静脉相IC，平衡相位IC，FF,和ECV分数，和更高的胰腺实质与门静脉相IC比率和胰腺实质与平衡相IC比率，与无PPAP患者相比。经过多变量分析，ECV分数与PPAP独立相关(奇数比[OR]，0.87；95%置信区间[CI]：0.79，0.96；p<0.001)，曲线下面积(AUC)为0.839(灵敏度100.0%,特异性58.3%）。
结论：较低的ECV分数与PD后PPAP的发生独立相关。ECV分数可作为PD后PPAP的潜在预测因子。
结论：DECT衍生的胰腺实质ECV分数是外科医生术前识别PD后胰腺切除术后急性胰腺炎风险较高的患者并提供选择性围手术期管理的有前景的生物标志物。
结论：PPAP是胰腺手术的并发症，早期发现高危患者有助于降低风险.较低的DECT衍生的ECV分数与PD后PPAP的发生独立相关。DECT有助于术前PAPP风险分层，允许适当的治疗，以尽量减少并发症。
