Estimation of pancreatic histology and likelihood of postoperative pancreatic fistula using extracellular volume fraction from contrast-enhanced computed tomography

BACKGROUND Pancreatic fibrosis, which decreases risk of postoperative pancreatic fistula (POPF), can be estimated using extracellular volume fraction (ECVf). AIM To investigate the correlation between ECVf and pancreatic histology, as well as the usefulness of ECVf in predicting POPF. METHODS In 71 patients who underwent pancreatic resection, we caluculated pancreatic ECVf by comparing absolute enhancements of the pancreas and aorta between pre-contrast and equilibrium phases. Areas of fibrosis, fat, acini, and islets were calculated based on resection specimens. RESULTS ECVf correlated with fibrosis (r = 0.724; P < 0.001) and negatively correlated with acini (r = -0.510; P < 0.001). Among 48 patients who underwent pancreatoduodenectomy, 21 developed POPF. Main pancreatic duct diameter ≤ 2 mm and ECVf < 36% were selected as risk factors by multivariate analysis [respective odds ratios (OR) and P values, 4.26 and P = 0.048; OR = 11.07 and P = 0.036]. Using these factors as a risk score (0-2 points), POPF occurred in 0%, 50%, and 70% of patients with 0, 1, and 2 points, respectively. CONCLUSION ECVf is useful in predicting acinar loss and pancreatic fibrosis, and ECVf < 36% may be a risk factor for POPF.