Abdominal CT predictors of fibrosis in patients with chronic pancreatitis undergoing surgery

Amitasha Sinha, Vikesh K. Singh, Michael Cruise, Elham Afghani, Karen Matsukuma, Sumera Ali, Dana Andersen, Martin A. Makary, Siva P. Raman, Elliot K. Fishman, Atif Zaheer

Research output: Contribution to journalArticle

10 Scopus citations

Abstract

Objective: To determine which abdominal CT findings predict severe fibrosis and post-operative pain relief in chronic pancreatitis (CP). Methods: Pre-operative abdominal CTs of 66 patients (mean age 52 ± 12 years, 53 % males) with painful CP who underwent the Whipple procedure (n = 32), Frey procedure (n = 32) or pancreatic head biopsy (n = 2), between 1/2003-3/2014, were evaluated. CT was evaluated for parenchymal calcifications, intraductal calculi, main pancreatic duct dilation (>5 mm), main pancreatic duct stricture, and abnormal side branch(es). The surgical histopathology was graded for fibrosis. CT findings were evaluated as predictors of severe fibrosis and post-operative pain relief using regression and area under receiver operating curve (AUC) analysis. Results: Thirty-eight (58 %) patients had severe fibrosis. Parenchymal calcification(s) were an independent predictor of severe fibrosis (p = 0.03), and post-operative pain relief over a mean follow-up of 1-year (p = 0.04). Presence of >10 parenchymal calcifications had higher predictive accuracy for severe fibrosis than 1-10 parenchymal calcification(s) (AUC 0.88 vs. 0.59, p = 0.003). The predictive accuracy of >10 versus 1-10 parenchymal calcifications increased after adjusting for all other CT findings (AUC 0.89 vs. 0.63, p = 0.01). Conclusion: Parenchymal calcification(s) independently predict severe fibrosis and are significantly associated with post-operative pain relief in CP. The presence of >10 parenchymal calcifications is a better predictor of severe fibrosis than 1-10 parenchymal calcification(s). Key Points: • Parenchymal calcifications in chronic pancreatitis independently predict post-operative pain relief • Intraductal calculi and MPD dilation are not associated with post-operative pain relief • Better patient selection for pancreatic resection surgery in painful chronic pancreatitis

Original languageEnglish (US)
Pages (from-to)1339-1346
Number of pages8
JournalEuropean Radiology
Volume25
Issue number5
DOIs
Publication statusPublished - May 1 2015
Externally publishedYes

Keywords

  • Calcification
  • Chronic Pancreatitis
  • Fibrosis
  • Post-operative pain management
  • Surgical procedures

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Medicine(all)

Cite this

Sinha, A., Singh, V. K., Cruise, M., Afghani, E., Matsukuma, K., Ali, S., ... Zaheer, A. (2015). Abdominal CT predictors of fibrosis in patients with chronic pancreatitis undergoing surgery. European Radiology, 25(5), 1339-1346. https://doi.org/10.1007/s00330-014-3526-x