基于超声剪切波弹性成像预测胰腺切除术后并发临床胰瘘的前瞻性研究

Application of ultrasound shear wave elastography in the prediction of clinically relevant post-operative pancreatic fistula after pancreatectomy:a prospective study

目的运用超声剪切波弹性成像(SWE)的声触诊组织弹性成像与量化(VTIQ)技术定量评估胰腺实质与病灶的质地,并探讨其在预测胰腺切除术后并发临床相关术后胰瘘(CR-POPF)中的潜在价值。方法前瞻性地纳入2021年3-12月拟于复旦大学附属中山医院行胰腺切除术的患者。在计划手术前1周内应用VTIQ对患者进行SWE定量评估,测量胰腺病灶内及门静脉前方胰体部正常腺体实质的剪切波速度值(SWV)。外科医师术中直接触诊胰腺并定性评估其软硬度。术后根据2016年国际胰瘘研究小组(ISGPF)的标准,经3周的随访,评估是否发生胰瘘并对其进行分级。将并发B/C级胰瘘患者归为CR-POPF阳性组,并发A级胰瘘(生化瘘)或未并发者归为CR-POPF阴性组。通过ROC曲线分析,确定预测胰腺切除术后并发CR-POPF的临界SWV值,并评估其诊断效力。结果共有72例患者被纳入本研究,包括胰十二指肠切除术47例(65.3%,47/72),胰体尾切除术25例(34.7%,25/72)。术后随访3周显示,共有22例(30.6%,22/72)患者并发CR-POPF。CR-POPF阳性组门静脉前方胰体部实质SWV值显著低于CR-POPF阴性组(P<0.001),而胰腺病灶内部的SWV值在两组之间差异无统计学意义(P=0.664)。两组之间通过术中触诊定性的胰腺质地分类(软/中等-硬)的比例差异无统计学意义(P=0.689)。以门静脉前方胰体部实质SWV值>1.16 m/s作为预测CR-POPF的临界值,ROC曲线下面积为0.816,敏感性为0.760,特异性为0.634,阳性预测值为67.5%,阴性预测值为72.5%。结论VTIQ技术通过术前无创、定量评估胰腺实质软硬度,有助于提高胰腺切除术后并发CR-POPF预测的客观性与准确性,具有潜在的临床应用价值。

Objective To quantitatively evaluate the stiffness of pancreatic parenchyma and lesions by virtual touch tissue imaging and quantification(VTIQ)technique,and to investigate the potential usefulness of ultrasound shear wave elastography(SWE)in the prediction of clinically relevant post-operative pancreatic fistula(CR-POPF)after pancreatectomy.Methods Patients who scheduled to receive pancreatectomy were prospectively enrolled in Zhongshan Hospital,Fudan University from March 2021 to December 2021.VTIQ assessment was applied to patients within one week before the scheduled surgery to make quantitative SWE evaluation of target tissue.The SWV values of body part pancreatic parenchyma and lesions were measured and recorded.The palpation stiffness of pancreas was qualitatively evaluated during the operation by the surgeon.CR-POPF was diagnosed according to 2016 International Study Group of Pancreatic Fistula(ISGPF)standard.Grade B/C pancreatic fistula was defined as CR-POPF positive.Recognized peri-operative risk factors of CR-POPF were analyzed.ROC curve analysis was used to evaluate the diagnostic efficacy of SWV value in predicting CR-POPF.Results A total of 72 patients were finally enrolled in this study,including 47(65.3%,47/72)patients who received pancreaticoduodenectomy(PD)and 25(34.7%,25/72)patients who underwent distal pancreatectomy.CR-POPF occurred in 22(30.6%,22/72)patients after pancreatectomy.The SWV value of body part pancreatic parenchyma was significant lower in CR-POPF positive group than in CR-POPF negative group(P<0.001).There was no significant difference in lesion SWV value between CR-POPF positive and negative groups(P=0.664).Besides,the palpation stiffness was no difference between the two groups(P=0.689).Taking SWV value of pancreatic parenchyma>1.16 m/s as a cut-off value for predicting CR-POPF,the area under the ROC curve(AUROC)was 0.816 with 0.760 of sensitivity,0.634 of specificity,67.5% of positive predictive value and 72.5% of negative predictive value,respectively.Conclusions The VTIQ method may improve the objectivity and accuracy of CR-POPF prediction via pre-operative,non-invasive and quantitative evaluation of pancreatic stiffness,which has potential value in clinical applications.