title: Pancreatic perfusion data and post-pancreaticoduodenectomy outcomes.
abstract: BACKGROUND
  Precise risk assessment for postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD) may be facilitated using imaging modalities. Computed tomography perfusion (CTP) of the pancreas may represent histologic findings. This study aimed to evaluate the utility of CTP data for the risk of POPF after PD, in relation to histologic findings.
  
  
  METHODS
  Twenty patients who underwent preoperative pancreatic CTP measurement using 320-detector row CT before PD were investigated. Clinicopathologic findings, including CTP data, were analyzed to assess the occurrence of POPF. In addition, the correlation between CTP data and histologic findings was evaluated.
  
  
  RESULTS
  POPF occurred in 11 cases (grade A, 6; grade B, 5; and grade C, 0). In CTP data, both high arterial flow (AF) and short mean transit time (MTT) were related to POPF occurrence (P = 0.001, P = 0.001). AF was negatively correlated with fibrosis in the pancreatic parenchyma (r = -0.680), whereas MTT was positively correlated with fibrosis (r = 0.725). AF >80 mL/min/100 mL and MTT <16 s showed high sensitivity, specificity, positive predictive value, and negative predictive value (80.0%, 100.0%, 100.0%, and 83.3%, respectively) for the occurrence of POPF.
  
  
  CONCLUSIONS
  CTP data for the pancreas were found to be correlated with the occurrence of POPF after PD. Alterations in the blood flow to the remnant pancreas may reflect histological changes, including fibrosis in the pancreatic stump, and influence the outcome after PD. CTP may thus facilitate objective and quantitative risk assessment of POPF after PD.
authors.affiliation: Department of Hepatobiliary-Pancreatic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan; Division of Pathology, Research Center for Innovative Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
authors.forename: Motokazu
authors.initials: M
authors.lastname: Sugimoto
authors.affiliation: Department of Hepatobiliary-Pancreatic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan. Electronic address: shtakaha@east.ncc.go.jp.
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Takahashi
authors.affiliation: Department of Radiology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
authors.forename: Tatsushi
authors.initials: T
authors.lastname: Kobayashi
authors.affiliation: Division of Pathology, Research Center for Innovative Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
authors.forename: Motohiro
authors.initials: M
authors.lastname: Kojima
authors.affiliation: Department of Hepatobiliary-Pancreatic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
authors.forename: Naoto
authors.initials: N
authors.lastname: Gotohda
authors.affiliation: Department of Radiology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Satake
authors.affiliation: Division of Pathology, Research Center for Innovative Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Ochiai
authors.affiliation: Department of Hepatobiliary-Pancreatic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
authors.forename: Masaru
authors.initials: M
authors.lastname: Konishi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004067:Digestive System Neoplasms / Q000601:surgery; D005260:Female; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D010185:Pancreatic Fistula / Q000453:epidemiology / Q000209:etiology*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D055420:Perfusion Imaging; D011446:Prospective Studies
keywords: Fibrosis; Pancreatic CT perfusion; Pancreaticoduodenectomy; Postoperative pancreatic fistula