Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 21, 2017; 23(11): 2044-2051
Published online Mar 21, 2017. doi: 10.3748/wjg.v23.i11.2044
Pancreatic hardness: Correlation of surgeon’s palpation, durometer measurement and preoperative magnetic resonance imaging features
Tae Ho Hong, Joon-Il Choi, Michael Yong Park, Sung Eun Rha, Young Joon Lee, Young Kyoung You, Moon Hyung Choi
Tae Ho Hong, Young Kyoung You, Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, South Korea
Joon-Il Choi, Michael Yong Park, Moon Hyung Choi, Cancer Research Institute, Seoul St. Mary’s Hospital, College of Medicine, the Catholic University of Korea, Seoul 06591, South Korea
Joon-Il Choi, Michael Yong Park, Sung Eun Rha, Young Joon Lee, Moon Hyung Choi, Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, South Korea
Author contributions: Hong TH and Choi JI contributed equally to this work; Hong TH, Choi JI, You YK and Choi MH collected and analyzed the data; Choi JI, and Choi MH designed and supervised the study; Hong TH, Choi MH wrote the manuscript; Rha SE revised the manuscript for important intellectual content; Lee YJ provide administrative support; Park MY reviewed the statistical methods; all authors have read and approved the final version to be published.
Institutional review board statement: The study was reviewed and approved by the Catholic Medical Center of Korea institutional Review Board.
Informed consent statement: Institutional review board waived the informed consent due to the retrospective nature of the study.
Conflict-of-interest statement: All authors are free from any economical or personal interest this paper may cause. There is no conflict of interest to report for any of the authors.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Moon Hyung Choi, MD, Clinical Assistant Professor, Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, South Korea. choimh1205@gmail.com
Telephone: +82-2-22581459 Fax: +82-2-5996771
Received: December 27, 2016
Peer-review started: December 28, 2016
First decision: February 10, 2017
Revised: February 15, 2017
Accepted: March 2, 2017
Article in press: March 2, 2017
Published online: March 21, 2017
Processing time: 82 Days and 5.2 Hours
Abstract
AIM

To evaluate the correlation between subjective assessments of pancreatic hardness based on the palpation, objective measurements using a durometer, and magnetic resonance imaging (MRI) findings for assessing pancreatic hardness.

METHODS

Eighty-three patients undergoing pancreatectomies were enrolled. An experienced surgeon subjectively evaluated the pancreatic hardness in the surgical field by palpation. The pancreatic hardness was also objectively evaluated using a durometer. Preoperative MRI findings were evaluated by a radiologist in terms of the apparent diffusion coefficient (ADC) values, the relative signal intensity decrease (RSID) of the pancreatic parenchyma, and the diameter of the pancreatic parenchyma and duct. Durometer measurement results, ADC values, RSID, pancreatic duct and parenchyma diameters, and the ratio of the diameters of the duct and parenchyma were compared between pancreases judged to be soft or hard pancreas on the palpation. A correlation analysis was also performed between the durometer and MRI measurements.

RESULTS

The palpation assessment classified 44 patients as having a soft pancreas and 39 patients as having a hard pancreas. ADC values were significantly lower in the hard pancreas group. The ductal diameter and duct-to-pancreas ratio were significantly higher in the hard pancreas group. For durometer measurements, a correlation analysis showed a positive correlation with the ductal diameter and the duct-to-pancreas ratio and a negative correlation with ADC values.

CONCLUSION

Hard pancreases showed lower ADC values, a wider pancreatic duct diameter and a higher duct-to-pancreas ratio than soft pancreases. Additionally, the ADC values, diameter of the pancreatic duct and duct-to-pancreas ratio were closely correlated with the durometer results.

Keywords: Pancreas; Texture; Hardness; Magnetic resonance imaging; Fistula

Core tip: The texture of the pancreas is an important predictive factor for the development of postoperative complications following pancreatic surgery. Durometric measurements correlated well with surgeons’ palpation-based assessment of the hardness of pancreas and histologic evaluation for fibrosis and fat content. If we could estimate the texture of the pancreas preoperatively, it would be very helpful for surgeons to prepare for the possibility of postoperative pancreatic leakage or fistula. Preoperative magnetic resonance imaging (MRI) can be used to predict the hardness of pancreas. Apparent diffusion coefficient (ADC) values measured in MRI were significantly lower in the hard pancreas than soft pancreas. The ductal diameter and duct-to-pancreas ratio were significantly higher in the hard pancreas. For durometer measurements, a correlation analysis showed a positive correlation with the ductal diameter and the duct-to-pancreas ratio and a negative correlation with ADC values.