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Monitoring Fibrosis of the Pancreatic Remnant After a Pancreaticoduodenectomy With Dynamic MRI.


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Title: Monitoring Fibrosis of the Pancreatic Remnant After a Pancreaticoduodenectomy With Dynamic MRI.
Authors: Tajima, Yoshitsugu / Kuroki, Tamotsu / Tsuneoka, Noritsugu / Adachi, Tomohiko / Isomoto, Ichiro / Uetani, Masataka / Kanematsu, Takashi
Issue Date: Jan-2010
Publisher: Elsevier B.V.
Citation: Journal of Surgical Research, 158(1), pp.61-68; 2010
Abstract: BACKGROUND: The time-signal intensity curve (TIC) of the pancreas obtained from dynamic contrast-enhanced magnetic resonance imaging closely reflects the histological degree of pancreatic fibrosis. MATERIALS AND METHODS: Seventy-six patients who had undergone a pancreatic TIC analysis prior to receiving a pancreaticoduodenectomy for various reasons were subjected to a yearly monitoring with pancreatic TIC for the pancreatic remnants. The pancreatic TIC profiles were classified into 3 types: type I, indicating a normal pancreas without fibrosis; and types II and III indicating fibrotic pancreas. RESULTS: The preoperative pancreatic TICs were type-I in 51 patients, type-II in 20, and type-III in 5, and the corresponding pancreatic fibrosis ratios were proved histologically to be 4.1%, 13.3%, and 21.2%, respectively. The mean postoperative follow-up period was 40.2 mo. A type-I changed to type-II in 16 patients, by 32.3 mo after surgery. In these patients, the exocrine remnant pancreatic function was preserved at the time of TIC conversion, but it significantly deteriorated thereafter. Pancreatic anastomotic leakage was found to be a significant risk factor predisposing a patient to undergo postoperative TIC conversion. In contrast, a preoperative type-II or III showed a postoperative conversion to type-I or II in 6 patients. In this group, the exocrine pancreatic function was noted to show a good recovery. In 35 patients who had a type-I TIC throughout the study, the remnant pancreatic function was well maintained. CONCLUSIONS: Pancreatic TIC analysis has the ability to detect an early fibrotic change that precedes a functional deterioration of the pancreatic remnant after a pancreaticoduodenectomy. Following a pancreaticoduodenectomy, some patients show an improvement in pancreatic fibrosis, but they may also experience remnant pancreatic fibrosis when pancreatic anastomotic leakage occurs after surgery.
Keywords: pancreatic fibrosis / pancreatic function / remnant pancreas / pancreaticoduodenectomy / dynamic magnetic resonance imaging / time-signal intensity curve
URI: http://hdl.handle.net/10069/21348
ISSN: 10958673
DOI: 10.1016/j.jss.2008.07.033
PubMed ID: 19215944
Rights: © Copyright 2009 Elsevier B.V., All rights reserved.
Type: Journal Article
Text Version: author
Appears in Collections:Articles in academic journal

Citable URI : http://hdl.handle.net/10069/21348

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