Khatkov IE, Lesko KA, Dubtsova EA, Khomeriki SG, Karnaukhov NS, Vinokurova LV, Shurygina EI, Makarenko NV, Izrailov RE, Savina IV, Salimgereeva DA, Kiriukova MA, Bordin DS. Possibilities of post-processing of multislice computed tomography results in non-invasive diagnosis of pancreatic fibrosis. Terapevticheskii Arkhiv (Ter. Arkh.). 2024;96(8):780–789. DOI: 10.26442/00403660.2024.08.202831
Возможности постобработки результатов мультиспиральной компьютерной томографии в неинвазивной диагностике фиброза поджелудочной железы
Khatkov IE, Lesko KA, Dubtsova EA, Khomeriki SG, Karnaukhov NS, Vinokurova LV, Shurygina EI, Makarenko NV, Izrailov RE, Savina IV, Salimgereeva DA, Kiriukova MA, Bordin DS. Possibilities of post-processing of multislice computed tomography results in non-invasive diagnosis of pancreatic fibrosis. Terapevticheskii Arkhiv (Ter. Arkh.). 2024;96(8):780–789. DOI: 10.26442/00403660.2024.08.202831
Цель. Оценить возможности постобработки результатов мультиспиральной компьютерной томографии (МСКТ) в неинвазивной диагностике фиброза поджелудочной железы (ПЖ). Материалы и методы. В исследование включены 165 пациентов в возрасте 57,91±13,5 года, находившихся на хирургическом лечении с апреля 2022 по февраль 2024 г. по поводу хронического панкреатита и рака ПЖ. Всем больным проведена МСКТ. Измерялись нормализованные коэффициенты контрастирования ткани ПЖ в панкреатическую (ПФ) и венозную фазы, а также коэффициент соотношения контрастирования (КК). Патоморфологическая оценка фиброза ПЖ проводилась в тканях препарата, не включающих новообразование или десмопластическую реакцию. Степень фиброза оценивали по шкале Kloppel и Maillet. Результаты. Значения показателей постобработки результатов КТ сравнивались в группах с разными значениями степеней фиброза. Средние значения КК оказались статистически значимо выше (p=0,001) у пациентов с тяжелой степенью фиброза ПЖ (КК 1,16±0,65 Ед. Х), чем у пациентов со слабой степенью фиброза ПЖ (КК 0,78±0,31 Ед. Х). Обнаружено статистически значимое повышение (p=0,03) значения КК у пациентов с признаками воспалительных изменений в ткани ПЖ (КК 1,14±0,6 Ед. Х), по сравнению с пациентам без них (КК 0,81±0,3 Ед. Х). Статистически значимых отличий между значениями нормализованных коэффициентов контрастирования ткани ПЖ в ПФ и венозную фазу, а также степенью фиброза не получено. Заключение. При тяжелой степени фиброза ПЖ, подтвержденной результатами морфологического исследования, значение КК повышается, а значения рентгенологической плотности ткани ПЖ в бесконтрастную фазу и ПФ снижаются по сравнению с легкой интегративной степенью фиброза. Выявлена связь между повышением значений КК и рентгенологической плотности ткани ПЖ в бесконтрастную фазу при наличии ранних признаков воспалительных изменений в ткани ПЖ. Таким образом, обнаружена взаимосвязь между данными МСКТ и морфологическими признаками фиброза ПЖ, что может использоваться для неинвазивной диагностики фиброза ПЖ и выявления дополнительных признаков раннего хронического панкреатита.
Aim. To evaluate the possibilities of post-processing of multidetector computed tomography (CT) results in the non-invasive diagnosis of pancreatic fibrosis (PF). Materials and methods. The study included 165 patients aged 57.91±13.5 years who underwent preoperative CT during surgical treatment for chronic pancreatitis and pancreatic cancer from April 2022 to February 2024. The normalized contrast ratios of pancreatic tissue in the pancreatic (NCPP) and venous (NCVP) phases, as well as the contrast ratio (CR) were measured. Pathomorphological assessment of PF performed in tissues outside neoplasm or desmoplastic reaction by the Kloppel and Maillet scale. Results. The values of post-processing CT results were compared in groups with different degrees of PF. Mean CR values were significantly higher (p=0.001) in patients with severe PF (CR 1.16±0.65 HU) than in patients with mild PF (CR 0.78±0.31 HU). CR value significant increase (p=0.03) was found in patients with signs of inflammatory changes in the pancreas tissue (CR 1.14±0.6 HU) than in those without them (CR 0.81±0.3 HU). There were no significant differences between the values of NCPP and NCVP, and the degree of PF. Conclusion. The CR value increased in patients with severe degree of PF. There was a relationship between CR value increase and the radiological density of pancreatic tissue in non-contrast phase and presence of early signs of pancreatic inflammatory changes. Thus, there was a relationship between CT postprocessing results and morphological signs of PF, which can be used for pancreatic fibrosis non-invasive diagnosis and identification of additional signs of early chronic pancreatitis.
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15. Tirkes T, Yadav D, Conwell DL, et al. Diagnosis of chronic pancreatitis using semi-quantitative MRI features of the pancreatic parenchyma: results from the multi-institutional MINIMAP study. Abdom Radiol (NY). 2023;48(10):3162-73. DOI:10.1007/s00261-023-04000-1
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21. Yamashita Y, Ashida R, Kitano M. Imaging of Fibrosis in Chronic Pancreatitis. Front Physiol. 2022;12:800516. DOI:10.3389/fphys.2021.800516
22. Ohgi K, Okamura Y, Sugiura T, et al. Pancreatic attenuation on computed tomography predicts pancreatic fistula after pancreaticoduodenectomy. HPB (Oxford). 2020;22(1):67-74. DOI:10.1016/j.hpb.2019.05.008
23. Hashimoto Y, Sclabas GM, Takahashi N, et al. Dual-phase computed tomography for assessment of pancreatic fibrosis and anastomotic failure risk following pancreatoduodenectomy. J Gastrointest Surg. 2011;15(12):2193-204. DOI:10.1007/s11605-011-1687-3
24. Sano S, Okamura Y, Ohgi K, et al. Histological pancreatic findings correlate with computed tomography attenuation and predict postoperative pancreatic fistula following pancreatoduodenectomy. HPB (Oxford). 2022;24(9):1519-26. DOI:10.1016/j.hpb.2022.03.008
25. Hata H, Mori H, Matsumoto S, et al. Fibrous stroma and vascularity of pancreatic carcinoma: correlation with enhancement patterns on CT. Abdom Imaging. 2010;35(2):172-80. DOI:10.1007/s00261-008-9460-0
26. Torphy RJ, Wang Z, True-Yasaki A, et al. Stromal Content Is Correlated With Tissue Site, Contrast Retention, and Survival in Pancreatic Adenocarcinoma. JCO Precis Oncol. 2018;2018:PO.17.00121. DOI:10.1200/PO.17.00121
27. Klöppel G, Maillet B. Pseudocysts in chronic pancreatitis: A morphological analysis of 57 resection specimens and 9 autopsy pancreata. Pancreas. 1991;6:266-74.
28. Esposito I, Hruban RH, Verbeke C, et al. Guidelines on the histopathology of chronic pancreatitis. Recommendations from the working group for the international consensus guidelines for chronic pancreatitis in collaboration with the International Association of Pancreatology, the American Pancreatic Association, the Japan Pancreas Society, and the European Pancreatic Club. Pancreatology. 2020;20(4):586-93. DOI:10.1016/j.pan.2020.04.009
29. Khatkov IE, Bordin DS, Lesko KA, et al. Contrast-Enhanced Computed Tomography and Laboratory Parameters as Non-Invasive Diagnostic Markers of Pancreatic Fibrosis. Diagnostics (Basel). 2023;13(14):2435. DOI:10.3390/diagnostics13142435
30. Maqueda González R, Di Martino M, Galán González I, et al. Development of a prediction model of pancreatic fistula after duodenopancreatectomy and soft pancreas by assessing the preoperative image. Langenbecks Arch Surg. 2022;407(6):2363-72. DOI:10.1007/s00423-022-02564-y
31. Gnanasekaran S, Durgesh S, Gurram R, et al. Do preoperative pancreatic computed tomography attenuation index and enhancement ratio predict pancreatic fistula after pancreaticoduodenectomy?. World J Radiol. 2022;14(6):165-76. DOI:10.4329/wjr.v14.i6.165
32. Yardimci S, Kara YB, Tuney D, et al. A Simple Method to Evaluate Whether Pancreas Texture Can Be Used to Predict Pancreatic Fistula Risk After Pancreatoduodenectomy. J Gastrointest Surg. 2015;19(9):1625-31. DOI:10.1007/s11605-015-2855-7
33. Lim S, Bae JH, Chun EJ, et al. Differences in pancreatic volume, fat content, and fat density measured by multidetector-row computed tomography according to the duration of diabetes. Acta Diabetol. 2014;51(5):739-48. DOI:10.1007/s00592-014-0581-3
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2020;49(3):301-12. DOI:10.1097/MPA.0000000000001495
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________________________________________________
1. Whitcomb DC, Frulloni L, Garg P, et al. Chronic pancreatitis: An international draft consensus proposal for a new mechanistic definition. Pancreatology. 2016;16(2):218-24. DOI:10.1016/j.pan.2016.02.001
2. Machicado JD, Amann ST, Anderson MA, et al. Quality of Life in Chronic Pancreatitis is Determined by Constant Pain, Disability/Unemployment, Current Smoking, and Associated Co-Morbidities. Am J Gastroenterol. 2017;112(4):633-42. DOI:10.1038/ajg.2017.42
3. Khat’kov IE, Maev IV, Abdulkhakov SR, et al. The Russian consensus on the diagnosis and treatment of chronic pancreatitis. Terapevticheskii Arkhiv (Ter. Arkh.). 2017;89(2):105‑13 (in Russian). DOI:10.17116/terarkh2017892105-113
4. Gudipaty L, Rickels МR. Pancreatogenic (Type 3c) Diabetes. Pancreapedia: Exocrine Pancreas Knowledge Base. DOI:10.3998/panc.2015.35
5. Capurso G, Traini M, Piciucchi M, et al. Exocrine pancreatic insufficiency: prevalence, diagnosis, and management. Clin Exp Gastroenterol. 2019;12:129-39. DOI:10.2147/CEG.S168266
6. Whitcomb DC, Shimosegawa T, Chari ST, et al. International consensus statements on early chronic Pancreatitis. Recommendations from the working group for the international consensus guidelines for chronic pancreatitis in collaboration with the International Association of Pancreatology, American Pancreatic Association, Japan Pancreas Society, Pancreas Fest Working Group and European Pancreatic Club. Pancreatology. 2018;18(5):516-27. DOI:10.1016/j.pan.2018.05.008
7. Etemad B, Whitcomb DC. Chronic pancreatitis: diagnosis, classification, and new genetic developments. Gastroenterology. 2001;120(3):682-707. DOI:10.1053/gast.2001.22586
8. Shimosegawa T, Kataoka K, Kamisawa T, et al. The revised Japanese clinical diagnostic criteria for chronic pancreatitis. J Gastroenterol. 2010;45(6):584-91.
DOI:10.1007/s00535-010-0242-4
9. Masamune A, Nabeshima T, Kikuta K, et al. Prospective study of early chronic pancreatitis diagnosed based on the Japanese diagnostic criteria. J Gastroenterol. 2019;54(10):928-35. DOI:10.1007/s00535-019-01602-9
10. Ge QC, Dietrich CF, Bhutani MS, et al. Comprehensive review of diagnostic modalities for early chronic pancreatitis. World J Gastroenterol. 2021;27(27):4342-57. DOI:10.3748/wjg.v27.i27.4342
11. Kikuta K, Masamune A. Early Chronic Pancreatitis. In: The Pancreas (eds HG Beger, MW Büchler, RH Hruban, et al). 2023. DOI:10.1002/9781119876007.ch50
12. Beyer G, Mahajan UM, Budde C, et al. Development and Validation of a Chronic Pancreatitis Prognosis Score in 2 Independent Cohorts. Gastroenterology. 2017;153(6):1544-54 e2. DOI:10.1053/j.gastro.2017.08.073
13. Steinkohl E. Progression of Pancreas Morphology in Chronic Pancreatitis: Exploration of New Potential MRI Biomarkers. Aalborg Universitetsforlag. 2021. 70 p. DOI:10.54337/aau460285861
14. Liu C, Shi Y, Lan G, et al. Evaluation of Pancreatic Fibrosis Grading by Multiparametric Quantitative Magnetic Resonance Imaging. J Magn Reson Imaging. 2021;54(5):1417-29. DOI:10.1002/jmri.27626
15. Tirkes T, Yadav D, Conwell DL, et al. Diagnosis of chronic pancreatitis using semi-quantitative MRI features of the pancreatic parenchyma: results from the multi-institutional MINIMAP study. Abdom Radiol (NY). 2023;48(10):3162-73. DOI:10.1007/s00261-023-04000-1
16. Ito T, Ishiguro H, Ohara H, et al. Evidence-based clinical practice guidelines for chronic pancreatitis 2015. J Gastroenterol. 2016;51(2):85-92. DOI:10.1007/s00535-015-1149-x
17. Shah J, Chatterjee A, Kothari TH. The Role of Endoscopic Ultrasound in Early Chronic Pancreatitis. Diagnostics. 2024;14(3):298. DOI:10.3390/diagnostics14030298
18. LeBlanc JK, Chen JH, Al-Haddad M, et al. Endoscopic ultrasound and histology in chronic pancreatitis: how are they associated? Pancreas. 2014;43(3):440-4. DOI:10.1097/MPA.0000000000000047
19. Löhr JM, Dominguez-Munoz E, Rosendahl J, et al. United European Gastroenterology evidence-based guidelines for the diagnosis and therapy of chronic pancreatitis (HaPanEU). United European Gastroenterol J. 2017;5(2):153-99. DOI:10.1177/2050640616684695
20. Ivashkin VT, Kriger AG, Okhlobystin AV, et al. Clinical Guidelines of the Russian Society of Surgeons, the Russian Gastroenterological Association, the Association of Surgeons-Hepatologists and the Endoscopic Society “REndO” on Diagnostics and Treatment of Chronic Pancreatitis. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2022;32(2):99-156 (in Russian). DOI:10.22416/1382-4376-2022-32-2-99-156
21. Yamashita Y, Ashida R, Kitano M. Imaging of Fibrosis in Chronic Pancreatitis. Front Physiol. 2022;12:800516. DOI:10.3389/fphys.2021.800516
22. Ohgi K, Okamura Y, Sugiura T, et al. Pancreatic attenuation on computed tomography predicts pancreatic fistula after pancreaticoduodenectomy. HPB (Oxford). 2020;22(1):67-74. DOI:10.1016/j.hpb.2019.05.008
23. Hashimoto Y, Sclabas GM, Takahashi N, et al. Dual-phase computed tomography for assessment of pancreatic fibrosis and anastomotic failure risk following pancreatoduodenectomy. J Gastrointest Surg. 2011;15(12):2193-204. DOI:10.1007/s11605-011-1687-3
24. Sano S, Okamura Y, Ohgi K, et al. Histological pancreatic findings correlate with computed tomography attenuation and predict postoperative pancreatic fistula following pancreatoduodenectomy. HPB (Oxford). 2022;24(9):1519-26. DOI:10.1016/j.hpb.2022.03.008
25. Hata H, Mori H, Matsumoto S, et al. Fibrous stroma and vascularity of pancreatic carcinoma: correlation with enhancement patterns on CT. Abdom Imaging. 2010;35(2):172-80. DOI:10.1007/s00261-008-9460-0
26. Torphy RJ, Wang Z, True-Yasaki A, et al. Stromal Content Is Correlated With Tissue Site, Contrast Retention, and Survival in Pancreatic Adenocarcinoma. JCO Precis Oncol. 2018;2018:PO.17.00121. DOI:10.1200/PO.17.00121
27. Klöppel G, Maillet B. Pseudocysts in chronic pancreatitis: A morphological analysis of 57 resection specimens and 9 autopsy pancreata. Pancreas. 1991;6:266-74.
28. Esposito I, Hruban RH, Verbeke C, et al. Guidelines on the histopathology of chronic pancreatitis. Recommendations from the working group for the international consensus guidelines for chronic pancreatitis in collaboration with the International Association of Pancreatology, the American Pancreatic Association, the Japan Pancreas Society, and the European Pancreatic Club. Pancreatology. 2020;20(4):586-93. DOI:10.1016/j.pan.2020.04.009
29. Khatkov IE, Bordin DS, Lesko KA, et al. Contrast-Enhanced Computed Tomography and Laboratory Parameters as Non-Invasive Diagnostic Markers of Pancreatic Fibrosis. Diagnostics (Basel). 2023;13(14):2435. DOI:10.3390/diagnostics13142435
30. Maqueda González R, Di Martino M, Galán González I, et al. Development of a prediction model of pancreatic fistula after duodenopancreatectomy and soft pancreas by assessing the preoperative image. Langenbecks Arch Surg. 2022;407(6):2363-72. DOI:10.1007/s00423-022-02564-y
31. Gnanasekaran S, Durgesh S, Gurram R, et al. Do preoperative pancreatic computed tomography attenuation index and enhancement ratio predict pancreatic fistula after pancreaticoduodenectomy?. World J Radiol. 2022;14(6):165-76. DOI:10.4329/wjr.v14.i6.165
32. Yardimci S, Kara YB, Tuney D, et al. A Simple Method to Evaluate Whether Pancreas Texture Can Be Used to Predict Pancreatic Fistula Risk After Pancreatoduodenectomy. J Gastrointest Surg. 2015;19(9):1625-31. DOI:10.1007/s11605-015-2855-7
33. Lim S, Bae JH, Chun EJ, et al. Differences in pancreatic volume, fat content, and fat density measured by multidetector-row computed tomography according to the duration of diabetes. Acta Diabetol. 2014;51(5):739-48. DOI:10.1007/s00592-014-0581-3
34. Barreto SG, Dirkzwager I, Windsor JA, Pandanaboyana S. Predicting post-operative pancreatic fistulae using preoperative pancreatic imaging: a systematic review. ANZ J Surg. 2019;89(6):659-65. DOI:10.1111/ans.14891
35. Awe AM, Rendell VR, Lubner MG, Winslow ER. Texture Analysis: An Emerging Clinical Tool for Pancreatic Lesions. Pancreas.
2020;49(3):301-12. DOI:10.1097/MPA.0000000000001495
36. Bartoli M, Barat M, Dohan A, et al. CT and MRI of pancreatic tumors: an update in the era of radiomics. Jpn J Radiol. 2020;38(12):1111-24. DOI:10.1007/s11604-020-01057-6
37. Mokhtari A, Casale R, Salahuddin Z, et al. Development of Clinical Radiomics-Based Models to Predict Survival Outcome in Pancreatic Ductal Adenocarcinoma: A Multicenter Retrospective Study. Diagnostics (Basel). 2024;14(7):712. DOI:10.3390/diagnostics14070712
38. Li Q, Song Z, Li X, et al. Development of a CT radiomics nomogram for preoperative prediction of Ki-67 index in pancreatic ductal adenocarcinoma: a two-center retrospective study. Eur Radiol. 2024;34(5):2934-43. DOI:10.1007/s00330-023-10393-w
39. Tirkes T, Yadav D, Conwell DL, et al. Quantitative MRI of chronic pancreatitis: results from a multi-institutional prospective study, magnetic resonance imaging as a non-invasive method for assessment of pancreatic fibrosis (MINIMAP). Abdom Radiol (NY). 2022;47(11):3792-805. DOI:10.1007/s00261-022-03654-7
40. Bieliuniene E, Frøkjær JB, Pockevicius A, et al. Magnetic Resonance Imaging as a Valid Noninvasive Tool for the Assessment of Pancreatic Fibrosis. Pancreas. 2019;48(1):85-93. DOI:10.1097/MPA.0000000000001206
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1ГБУЗ «Московский клинический научно-практический центр им. А.С. Логинова» Департамента здравоохранения г. Москвы, Москва, Россия; 2ФГБОУ ВО «Российский университет медицины» Минздрава России, Москва, Россия; 3ФГБОУ ВО «Тверской государственный медицинский университет» Минздрава России, Тверь, Россия
*dbordin@mail.ru
________________________________________________
Igor E. Khatkov1,2, Konstantin A. Lesko1, Elena A. Dubtsova1, Sergey G. Khomeriki1, Nikolay S. Karnaukhov1, Ludmila V. Vinokurova1, Elena I. Shurygina1, Nadezhda V. Makarenko1, Roman E. Izrailov1, Irina V. Savina1, Diana A. Salimgereeva1, Mariia A. Kiriukova1, Dmitry S. Bordin*1–3
1Loginov Moscow Clinical Scientific Center, Moscow, Russia; 2Russian University of Medicine, Moscow, Russia; 3Tver State Medical University, Tver, Russia
*dbordin@mail.ru