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Usefulness of MRI T1 Mapping in Predicting Postoperative Pancreatic Fistula After Distal Pancreatectomy
Noriyuki Kitagawa1, Akira Shimizu1, Akira Yamada2
1Division of Gastroenterological, Department of Surgery, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery.
Objectives:
Postoperative pancreatic fistula (POPF) is the most significant and potentially lethal complication of pancreatectomy. This study evaluated the association between MRI pancreatic T1 mapping and POPF and developed a new, useful, and noninvasive predictor of distal pancreatectomy (DP).
Methods:
The study included 39 patients who underwent preoperative MRI T1 mapping using the Modified Look-Locker Inversion Recovery Sequence (MOLLI) followed by DP between January 2018 and July 2024. Patients with [POPF (+), n=15] and those without POPF [POPF (-), n=24] were compared for their characteristics, perioperative outcomes, and parameters derived from MRI. The circular region of interest was positioned on the pancreatic head, ventral side of the portal vein, and transection site to measure the T1 mapping value. The data were analyzed using R1 values (R1=1/T1), and the cutoff values were calculated using the receiver operating characteristic (ROC) curve.
Results:
The R1 value of the pancreatic transection site in the POPF (+) group was significantly higher than that in the POPF (-) group (1.180 vs. 1.066 s - 1 ; P <0.001). The R1 value of the pancreatic transection site was an independent risk factor for grade B/C POPF (odds ratio, 5.01; P =0.005). To predict POPF, a cutoff R1 value of 1.116 s -1 at the transection site was obtained by maximizing the Youden index.
Conclusions:
High R1 values at the pancreatic transection site indicate a higher possibility of developing grade B/C POPF. Preoperative MRI T1 mapping may be valuable for predicting POPF after DP.
Insights
Preoperative MRI T1 mapping can predict postoperative pancreatic fistula (POPF) after distal pancreatectomy. Higher R1 values at the pancreatic transection site indicate an increased risk of developing POPF.
Area of Science:
- Radiology
- Gastroenterology
- Surgical Oncology
Background:
- Postoperative pancreatic fistula (POPF) is a major complication following pancreatectomy.
- Accurate prediction of POPF is crucial for patient management and outcomes.
Purpose of the Study:
- To evaluate the association between preoperative MRI T1 mapping and POPF after distal pancreatectomy (DP).
- To develop a noninvasive predictor for POPF using MRI T1 mapping.
Main Methods:
- 39 patients undergoing DP had preoperative MRI T1 mapping (MOLLI sequence).
- R1 values (R1=1/T1) were measured at the pancreatic transection site.
- Receiver operating characteristic (ROC) curve analysis determined cut-off values.
Main Results:
- Significantly higher R1 values were observed at the transection site in patients who developed POPF (1.180 sec⁻¹) compared to those who did not (1.066 sec⁻¹).
- R1 value at the transection site was an independent risk factor for grade B/C POPF (OR, 5.01).
- A cut-off R1 value of 1.116 sec⁻¹ predicted POPF with high accuracy.
Conclusions:
- Elevated R1 values at the pancreatic transection site predict a higher likelihood of grade B/C POPF.
- Preoperative MRI T1 mapping shows promise as a valuable tool for predicting POPF after DP.
