Do preoperative pancreatic computed tomography attenuation index and enhancement ratio predict pancreatic fistula after pancreaticoduodenectomy?

Figure 1 Calculation of preoperative radiological indices. A: Hounsfield unit (HU) of the pancreatic neck in plain phase; B: HU of the spleen in plain phase; C: HU of the pancreatic neck in the arterial phase; D: HU of the pancreatic neck in the equilibrium phase. ROI: Region of interest.

Figure 2 Histopathological evaluation of pancreatic neck fat fraction and fibrosis. A: Photomicrograph showing moderate fat inclusion (hematoxylin and eosin [H&E], × 100); B: Photomicrograph showing heavy intralobular fibrosis (Masson's trichome stain, H&E, × 100); C: Photomicrograph showing heavy interlobular fibrosis (Masson's trichome stain, × 40); D: Photomicrograph showing weak intra and interlobular fibrosis (Masson's trichome stain, × 200).

Figure 3 Receiver operating characteristic curve of the computed tomography indices for predicting clinically relevant postoperative fistula. The area under curve for the pancreatic attenuation index is 0.461 (95%CI: 0.304-0.617), which is not significant (P = 0.630). The area under curve for the pancreatic enhancement ratio is 0.661 (95%CI: 0.517-0.804), which is significant (P = 0.049). ROC: Receiver operating characteristic; PAI: Pancreatic attenuation index; PER: Pancreatic enhancement ratio.