Pancreatic extracellular volume fraction on multiphasic contrast-enhanced computed tomography for predicting pancreatic fistula after pancreatoduodenectomy

Purpose: This study aimed to assess whether the pancreatic extracellular volume (ECV) fraction on multiphasic contrast-enhanced computed tomography (CE-CT) can estimate histological pancreatic fibrosis and predict clinically relevant postoperative pancreatic fistula (CR-POPF) after pancreatoduodenectomy (PD). Methods: This single-center retrospective study included 106 patients who underwent multiphasic CE-CT and PD. ECV fractions were calculated based on absolute enhancements of the pancreas and aorta between the pre-contrast and equilibrium-phase images, followed by a comparison between different fibrosis grades. Multivariate logistic regression analyses were used to evaluate the association between the risk of CR-POPF development and perioperative factors. Results: Of 106 patients, 45 (42.5%) developed POPF (biochemical leak, n = 8; grades B and C, n = 37). The ECV fraction (median, 40.1%; range, 20.0–87.7%) showed a moderate positive correlation with pancreatic fibrosis grade (r = 0.549, P < 0.001). In the multivariate analysis, the ECV fraction (< 40%; odds ratio, 10.1; 95% confidence interval, 3.32–36.3; P < 0.001) was identified as the only independent risk factor for CR-POPF. The area under the receiver operating characteristic curve was 0.824 for the correlation between ECV fraction and CR-POPF prediction, with a cutoff value of 40.9%. Conclusion: The pancreatic ECV fraction provides quantitative information for assessing pancreatic fibrosis and predicting CR-POPF after PD.