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Author Spotlight: Advancing Hepatic Fibrosis Diagnosis Using Magnetic Resonance Elastography and AI
Published on: July 21, 2023
Magnetic Resonance Elastography Derived Stiffness to Predict Postoperative Pancreatic Fistula After Partial
Dingxia Liu1, Jiejun Chen2, Yunfei Zhang3
1Shanghai Institute of Medical Imaging, No 130, Dongan Rd, Xuhui District, Shanghai200032, PR China (D.L., Y.Z., Y.G., X.Y.); Department of Radiology, Zhongshan Hospital, Fudan University, No 138, Fenglin Rd, Xuhui District, Shanghai 200032, PR China (J.C., X.Y.).
Rationale And Objectives:
To investigate the magnetic resonance elastography (MRE)-derived pancreatic stiffness for predicting the occurrence of clinically relative postoperative pancreatic fistula (CR-POPF) in patients with partial pancreatectomy, and establish a predictive model for POPF before surgery.
Background:
Pancreatic stiffness reflects fibrosis and fat infiltration, which are associated with CR-POPF. But preoperative prediction remains a challenge. MRE was proven to evaluate pancreatic stiffness accurately, potentially being a predictive imaging biomarker of POPF.
Methods:
This prospective study included adult patients who underwent magnetic resonance imaging with MRE sequence and subsequent partial pancreatectomy between August 2021 and December 2023. The relationships of MRE stiffness and main pancreatic duct diameter (MPD) with the risk of POPF were analyzed using logistic regression. Independent risk factors were identified to construct the nomogram prediction model. The predictive performance of each parameter and the model was conducted by calculating the area under the ROC curve (AUC).
Results:
A total of 73 patients (age 58.99±12.55 years; 30 pancreatoduodenectomy and 43 distal pancreatectomy) were enrolled, among whom 15 developed CR-POPF and 58 did not. After conducting uni- and multivariate logistic regression analyses, high BMI was found to be an independent risk factor for the occurrence of POPF (OR=2.916, 95% CI: 1.472-9.394, P=0.02), while high pancreatic MRE stiffness (OR=0.0633, 95% CI: 0.0022-0.5273, P=0.04) and large MPD (OR=0.0728, 95% CI: 0.003-0.5165, P=0.04) were independent protective factors. A preoperative prediction model for POPF was constructed by combining the three indicators, which has excellent predictive performance with an AUC of 0.97.
Conclusion:
MRE can quantitatively evaluate the mechanical property of pancreas, which is a reliable indicator for predicting the risk of POPF. The POPF prediction model established by combining BMI, pancreatic stiffness value, and MPD has promising clinical application prospects.
