Fibrosis and Postoperative Fistula of the Pancreas: Correlation with MR Imaging Findings-Preliminary Results

Purpose: To assess the potential value of magnetic resonance (MR) imaging in evaluating pancreatic fibrosis and predicting the development of postoperative pancreatic fistula. Materials and Methods: This retrospective study had institutional review board approval, and the requirement for informed consent was waived. MR images obtained in 29 consecutive patients (15 men, 14 women; mean age, 64.9 years; age range, 21-80 years) who underwent pancreatectomy were evaluated. The pancreas-to-muscle signal intensity (SI) ratio on unenhanced T1- and T2-weighted, dynamic contrast material-enhanced, and diffusion-weighted images and the apparent diffusion coefficient (ADC) of the pancreas were measured. MR imaging parameters were correlated with the degrees of pancreatic fibrosis and expression of activated pancreatic stellate cells (PSCs) by using univariate and multivariate regression analyses and receiver operating characteristic curve analysis. The relationships between the development of postoperative pancreatic fistula and the MR imaging measurements were examined by using logistic regression analysis and the Mann-Whitney U test. Results: Multiple regression analysis showed that pancreas-tomuscle SI ratios on T1-weighted images and ADC values were independently associated with pancreatic fibrosis (r(2) = 0.66, P <.001) and with activated PSC expression (r(2) = 0.67, P <.001). The mean pancreas-to-muscle SI ratio (6 standard deviation) on T1-weighted images was higher (P =.0029) for patients with postoperative pancreatic fistula (1.6 +/- 0.2) than for those without (1.2 +/- 0.2), and the odds ratio for postoperative pancreatic fistula was 21.3 in patients with an SI ratio of 1.41 and higher. Conclusion: The pancreas-to-muscle SI ratio on T1-weighted MR images of the pancreas may be a potential biomarker for assessment of pancreatic fibrosis and prediction of postoperative pancreatic fistula. (C) RSNA, 2013