Prediction of postoperative pancreatic fistulas after pancreatectomy: assessment with acoustic radiation force impulse elastography.
OBJECTIVE
The purpose of this prospective study was to investigate the usefulness of acoustic radiation force impulse (ARFI) elastography of the pancreas for predicting postoperative pancreatic fistula occurrence after pancreatic resection.


METHODS
Twenty-five patients underwent ARFI elastography of the pancreas before pancreatic resection (11 men and 14 women; mean age, 59.1 years; range, 28-76 years). In each patient, 3 valid ARFI measurements (meters per second) were performed at the head of the pancreas, and the median values were calculated. Patients underwent pancreaticoduodenectomy (n = 18) or distal pancreatectomy (n = 7). Clinically relevant fistulas (grade B or higher) were determined according to the standard criteria used by the International Study Group on Pancreatic Fistula. Preoperative ARFI values were compared between the fistula and nonfistula groups (Mann-Whitney test).


RESULTS
Clinically relevant fistulas (grade B or higher) were observed in 8 patients (32%; fistula group), including 5 of 18 patients with pancreaticoduodenectomy (28%) and 3 of 7 patients with distal pancreatectomy (43%). The ARFI values in the fistula group (median, 1.45 m/s; range, 0.80-1.98 m/s) were lower than in the nonfistula group (median, 1.54 m/s; range, 0.98-3.40 m/s), but there was no statistical significance (P = .1374). When confining the results to only patients with pancreaticoduodenectomy, the ARFI values were significantly lower in the patients with fistulas (median, 0.98 m/s; range, 0.80-1.94 m/s) than in those without fistulas (median, 1.60 m/s; range, 1.08-3.40 m/s; P = .0460).


CONCLUSIONS
This preliminary study showed the potential feasibility of a clinical application of ARFI elastography in preoperatively predicting postoperative pancreatic fistulas after pancreaticoduodenectomy. Investigation of this method in larger studies is needed.
Department of Radiology, Severance Hospital, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul 120-752, Korea. radpms@yuhs.ac.
Tae Kil
TK
Lee
Chang Moo
CM
Kang
Mi-Suk
MS
Park
Sung Hoon
SH
Choi
Yong-Eun
YE
Chung
Jin Young
JY
Choi
Myeong-Jin
MJ
Kim
D000328:Adult; D000368:Aged; D054459:Elasticity Imaging Techniques; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000009:adverse effects*; D010185:Pancreatic Fistula / Q000000981:diagnostic imaging* / Q000209:etiology*; D011379:Prognosis; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
acoustic radiation force impulse elastography; gastrointestinal ultrasound; pancreas; pancreatectomy; pancreatic fistula