title: Abdominal CT predictors of fibrosis in patients with chronic pancreatitis undergoing surgery.
abstract: OBJECTIVE
  To determine which abdominal CT findings predict severe fibrosis and post-operative pain relief in chronic pancreatitis (CP).
  
  
  METHODS
  Pre-operative abdominal CTs of 66 patients (mean age 52 ± 12 years, 53 % males) with painful CP who underwent the Whipple procedure (n = 32), Frey procedure (n = 32) or pancreatic head biopsy (n = 2), between 1/2003-3/2014, were evaluated. CT was evaluated for parenchymal calcifications, intraductal calculi, main pancreatic duct dilation (>5 mm), main pancreatic duct stricture, and abnormal side branch(es). The surgical histopathology was graded for fibrosis. CT findings were evaluated as predictors of severe fibrosis and post-operative pain relief using regression and area under receiver operating curve (AUC) analysis.
  
  
  RESULTS
  Thirty-eight (58 %) patients had severe fibrosis. Parenchymal calcification(s) were an independent predictor of severe fibrosis (p = 0.03), and post-operative pain relief over a mean follow-up of 1-year (p = 0.04). Presence of >10 parenchymal calcifications had higher predictive accuracy for severe fibrosis than 1-10 parenchymal calcification(s) (AUC 0.88 vs. 0.59, p = 0.003). The predictive accuracy of >10 versus 1-10 parenchymal calcifications increased after adjusting for all other CT findings (AUC 0.89 vs. 0.63, p = 0.01).
  
  
  CONCLUSIONS
  Parenchymal calcification(s) independently predict severe fibrosis and are significantly associated with post-operative pain relief in CP. The presence of >10 parenchymal calcifications is a better predictor of severe fibrosis than 1-10 parenchymal calcification(s).
  
  
  CONCLUSIONS
  • Parenchymal calcifications in chronic pancreatitis independently predict post-operative pain relief • Intraductal calculi and MPD dilation are not associated with post-operative pain relief • Better patient selection for pancreatic resection surgery in painful chronic pancreatitis.
authors.affiliation: Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA, amitashasinha@gmail.com.
authors.forename: Amitasha
authors.initials: A
authors.lastname: Sinha
authors.forename: Vikesh K
authors.initials: VK
authors.lastname: Singh
authors.forename: Michael
authors.initials: M
authors.lastname: Cruise
authors.forename: Elham
authors.initials: E
authors.lastname: Afghani
authors.forename: Karen
authors.initials: K
authors.lastname: Matsukuma
authors.forename: Sumera
authors.initials: S
authors.lastname: Ali
authors.forename: Dana K
authors.initials: DK
authors.lastname: Andersen
authors.forename: Martin A
authors.initials: MA
authors.lastname: Makary
authors.forename: Siva P
authors.initials: SP
authors.lastname: Raman
authors.forename: Elliot K
authors.initials: EK
authors.lastname: Fishman
authors.forename: Atif
authors.initials: A
authors.lastname: Zaheer
mesh_terms: D000328:Adult; D000368:Aged; D003287:Contrast Media; D005260:Female; D005355:Fibrosis / Q000000981:diagnostic imaging; D006801:Humans; D007472:Iohexol; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain; D010179:Pancreas / Q000000981:diagnostic imaging / Q000473:pathology; D010183:Pancreatic Ducts / Q000473:pathology; D050500:Pancreatitis, Chronic / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D011237:Predictive Value of Tests; D011856:Radiographic Image Enhancement; D011860:Radiography, Abdominal; D015203:Reproducibility of Results; D036542:Tomography, Spiral Computed; D014283:Triiodobenzoic Acids; D055815:Young Adult
chemical_list: D003287:Contrast Media; D014283:Triiodobenzoic Acids; D007472:Iohexol; C044834:iodixanol