Development of a prediction model of pancreatic fistula after duodenopancreatectomy and soft pancreas by assessing the preoperative image.

BACKGROUND: Pancreatic consistency is one of the most widely accepted risk factors of clinically relevant postoperative pancreatic fistula (CR-POPF) after pancreatectoduodenectomy (PD). The present study aims to identify preoperative characteristics from the preoperative computed tomography (CT) associated with an increased risk. METHODS: Retrospective observational cohort study of patients who underwent PD surgery (January 2010-2019) were enrolled. All patients with available preoperative imaging were included; 103 met the inclusion criteria. Several parameters were measured on preoperative abdominal CT: retrorenal adipose tissue; abdominal perimeter; total adipose tissue, visceral and subcutaneous; skeletal muscle mass; main pancreatic duct (MPD) diameter; pancreatic thickness; remnant pancreatic volume; pancreatic attenuation (pancreas-to-spleen ratio). Primary endpoints were the association of radiological variables with soft pancreatic consistency and POPF development. All variables possibly associated with POPF and soft pancreas were subsequently included into a multivariable logistic regression model. RESULTS: Soft pancreas consistency was found in 43 patients (41.7%) and CR-POPF was higher (51.2% vs. 18%, p < 0.001). Multivariable analysis identified MPD ≤ 3 mm (OR = 7.2, 95%CI 2.3-23, p = 0.001), a remnant pancreatic volume ≥ 20 cm3 (OR = 6.4, 95%CI 2-21, p = 0.041), pancreas-to-spleen < 0.8 (OR = 3.2, 95%CI 1.2-8.4, p = 0.039), and retrorenal adipose tissue ≥ 12 cm3 (OR = 5.3, 95%CI 1.8-15.7, p = 0.013). Multivariable analysis showed MPD ≤ 3 mm (OR = 8.25, 95%CI 2.2-30.8, p = 0.002) and total adipose tissue ≥ 190 cm3 (OR = 3.2, 95%CI 1.1-9.1, p = 0.0027) were independent predictors of CR-POPF. CONCLUSION: The preoperative assessment of MPD, remnant pancreatic volume, pancreas-to-spleen ratio, total adipose tissue, and retrorenal adipose tissue are associated with soft pancreas texture and the risk of CR-POPF.

Chondroid Tumors: Review of Salient Imaging Features and Update on the WHO Classification.

Chondrogenic tumors are typically well recognized on radiographs, but differentiation between benign and malignant cartilaginous lesions can be difficult both for the radiologist and for the pathologist. Diagnosis is based on a combination of clinical, radiological and histological findings. While treatment of benign lesions does not require surgery, the only curative treatment for chondrosarcoma is resection. This article (1) emphasizes the update of the WHO classification and its diagnostic and clinical effects; (2) describes the imaging features of the various types of cartilaginous tumors, highlighting findings that can help differentiate benign from malignant lesions; (3) presents differential diagnoses; and (4) provides pathologic correlation. We attempt to offer valuable clues in the approach to this vast entity.