title: Comparison of preoperative CT-based imaging parameters to predict postoperative pancreatic fistula.
abstract: OBJECTIVE
  To review all reported methods of preoperative computed tomography (CT) in one patient cohort and to identify which were the strongest to predict postoperative pancreatic fistula (POPF) after pancreatoduodenectomy.
  
  
  METHODS
  Consecutive patients undergoing pancreatoduodenectomy were included if they had unenhanced CT images for review. Eighteen variables and two scores were tested. Receiver operator characteristics (ROC) were explored.
  
  
  RESULTS
  POPF affected 26 of 107 patients (24.3%). Nine variables were significantly related to POPF with pancreatic duct width having the largest area under the ROC curve (AUROC; 0.808, p<0.001). An obese body habitus was associated with POPF with six of nine related variables using data from CT images associated with POPF; of these intra-abdominal wall thickness yielded the largest AUROC (0.713, p=0.001). This corresponded to the finding that body mass index (BMI) was related to POPF (AUROC 0.705, p=0.002). The largest AUROC of all was associated with one of the predictive scores (0.828, p<0.001). Substituting BMI for intra-abdominal wall thickness in this score yielded a non-significant increase to predict POPF (AUROC 0.840, p=0.676). None of the assessments of organ density (in Hounsfield Units) were associated with POPF.
  
  
  CONCLUSIONS
  Data from preoperative CT imaging provides valuable information regarding a patient's risk of POPF. Obesity as assessed by CT images strongly relates to POPF, but the largest single risk factor for POPF is a narrow pancreatic duct.
authors.affiliation: Department of HPB Surgery, University Hospitals Birmingham NHS Trust, Edgbaston B15 2TH, UK.
authors.forename: K J
authors.initials: KJ
authors.lastname: Roberts
authors.affiliation: Department of HPB Surgery, University Hospitals Birmingham NHS Trust, Edgbaston B15 2TH, UK. Electronic address: salil.karkhanis@doctors.org.uk.
authors.forename: S
authors.initials: S
authors.lastname: Karkhanis
authors.affiliation: Department of HPB Surgery, University Hospitals Birmingham NHS Trust, Edgbaston B15 2TH, UK.
authors.forename: M
authors.initials: M
authors.lastname: Pitchaimuthu
authors.affiliation: Department of HPB Surgery, University Hospitals Birmingham NHS Trust, Edgbaston B15 2TH, UK.
authors.forename: M S
authors.initials: MS
authors.lastname: Khan
authors.affiliation: Department of HPB Surgery, University Hospitals Birmingham NHS Trust, Edgbaston B15 2TH, UK.
authors.forename: J
authors.initials: J
authors.lastname: Hodson
authors.affiliation: Department of HPB Surgery, University Hospitals Birmingham NHS Trust, Edgbaston B15 2TH, UK.
authors.forename: Z
authors.initials: Z
authors.lastname: Zia
authors.affiliation: Department of HPB Surgery, University Hospitals Birmingham NHS Trust, Edgbaston B15 2TH, UK.
authors.forename: H
authors.initials: H
authors.lastname: Mehrzad
authors.affiliation: Department of HPB Surgery, University Hospitals Birmingham NHS Trust, Edgbaston B15 2TH, UK.
authors.forename: R
authors.initials: R
authors.lastname: Marudanayagam
authors.affiliation: Department of HPB Surgery, University Hospitals Birmingham NHS Trust, Edgbaston B15 2TH, UK.
authors.forename: P
authors.initials: P
authors.lastname: Muiesan
authors.affiliation: Department of HPB Surgery, University Hospitals Birmingham NHS Trust, Edgbaston B15 2TH, UK.
authors.forename: J
authors.initials: J
authors.lastname: Isaac
authors.affiliation: Department of HPB Surgery, University Hospitals Birmingham NHS Trust, Edgbaston B15 2TH, UK.
authors.forename: D
authors.initials: D
authors.lastname: Mirza
authors.affiliation: Department of HPB Surgery, University Hospitals Birmingham NHS Trust, Edgbaston B15 2TH, UK.
authors.forename: R P
authors.initials: RP
authors.lastname: Sutcliffe
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D010179:Pancreas / Q000000981:diagnostic imaging; D010185:Pancreatic Fistula / Q000175:diagnosis*; D016577:Pancreaticoduodenectomy; D011183:Postoperative Complications / Q000175:diagnosis*; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014057:Tomography, X-Ray Computed / Q000379:methods*