Background: The purpose of the study is to evaluate the utility of acoustic radiation force impulse (ARFI) on pancreatic tissue as a preoperative predictor of postoperative pancreatic fistula (POPF). Studied patients underwent exclusively to pancreaticoduodenectomy (PD) surgery. Methods: Shear wave velocity of pancreas was measured using ARFI in 71 patients scheduled for PD. An intraoperative pancreas palpation was made by surgeons. A postoperative clinical evaluation to detect occurrence of POPF was performed. Sensitivity, specificity, positive and negative predictive values together with the accuracy of the method were investigated. Results: Incidence of fistula observed in 17 patients with soft pancreas was approximately 53% vs. 47% without fistula. Percentage of patients without fistula was higher (66%) among 24 patients with medium parenchymal texture values, and was even higher (69%) in 26 patients with hard pancreas. Comparing ARFI and intraoperative pancreatic palpation, low wave velocity values (≤1.40 m/s) match 60% with soft parenchyma assessed by palpation and high values (>2 m/s) match 59% with hard pancreas on palpation. Conclusions: This study shows that ARFI elastography may be clinically useful as a preoperative predictor of pancreatic fistula following PD.

Keywords:
Acoustic radiation force impulse elastography, Pancreas, Pancreatic fistula, Pancreaticoduodenectomy
1.
Schima W, Ba-Ssalamah A, Kölblinger C, et al: Pancreatic adenocarcinoma. Eur Radiol 2007;17:638-649.
2.
Ho CK, Kleeff J, Friess H, et al: Complications of pancreatic surgery. HPB 2005;7:99-108.
3.
Butturini G, Marcucci S, Molinari E, et al: Complications after pancreaticoduodenectomy: the problem of current definitions. J Hepatobiliary Pancreat Surg 2006;13:207-211.
4.
Bassi C, Butturini G, Molinari E, et al: Pancreatic fistula rate after pancreatic resection. The importance of definitions. Dig Surg 2004;21:54-59.
5.
Butturini G, Daskalaki D, Molinari E, et al: Pancreatic fistula: definition and current problems. J Hepatobiliary Pancreat Surg 2008;15:247-251.
6.
Machado NO: Pancreatic fistula after pancreatectomy: definitions, risk factors, preventive measures, and management. Int J Surg Oncol 2012;2012:602478.
7.
Callery MP, Pratt WB, Kent TS, et al: A prospectively validated clinical risk score accurately predicts pancreatic fistula after pancreatoduodenectomy. J Am Coll Surg 2013;216:1-14.
8.
Bassi C, Dervenis C, Butturini G, et al: Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 2005;138:8-13.
9.
Hackert T, Werner J, Büchler M: Postoperative pancreatic fistula. Surgeon 2011;9:211-217.
10.
Harada N, Ishizawa T, Inoue Y, et al: Acoustic radiation force impulse imaging of the pancreas for estimation of pathologic fibrosis and risk of postoperative pancreatic fistula. J Am Coll Surg 2014;219:887-894.
11.
Lee TK, Kang CM, Park MS, et al: Prediction of postoperative pancreatic fistulas after pancreatectomy. J Ultrasound Med 2014;33:781-786.
12.
Callery MP, Pratt WB, Vollmer CM Jr: Prevention and management of pancreatic fistula. J Gastrointest Surg 2009;13:163-173.
13.
Schmidt CM, Choi J, Powell ES, et al: Pancreatic fistula following pancreaticoduodenectomy: clinical predictors and patient outcomes. HPB Surg 2009;2009:404520.
14.
D'Onofrio M, Gallotti A, Salvia R, et al: Acoustic Radiation Force Impulse (ARFI) ultrasound imaging of pancreatic cystic lesions. Eur J Radiol 2011;80:241-244.
15.
Nightingale K, Bentley R, Trahey G: Observations of tissue response to acoustic radiation force: opportunities for imaging. Ultrason Imaging 2002;24:129-138.
16.
Nightingale K, McAleavey S, Trahey G: Shear-wave generation using acoustic radiation force: in vivo and ex vivo results. Ultrasound Med Biol 2003;29:1715-1723.
17.
McAleavey SA, Menon M, Orszulak J: Shear-modulus estimation by application of spatially-modulated impulsive acoustic radiation force. Ultrason Imaging 2007;29:87-104.
18.
Fahey BJ, Palmeri ML, Trahey GE: The impact of physiological motion on tissue tracking during radiation force imaging. Ultrasound Med Biol 2007;33:1149-1166.
19.
Piscaglia F, Salvatore V, Di Donato R, et al: Accuracy of VirtualTouch acoustic radiation force impulse (ARFI) imaging for the diagnosis of cirrhosis during liver ultrasonography. Ultraschall Med 2011;32:167-175.
20.
Gallotti A, D'Onofrio M, Pozzi Mucelli R: Acoustic Radiation Force Impulse (ARFI) technique in ultrasound with virtual touch tissue quantification of the upper abdomen. Radiol Med 2010;115:889-897.
21.
D'Onofrio M, Crosara S, De Robertis R, et al: Elastography of the pancreas. Eur J Radiol 2014;83:415-419.
22.
Bamber J, Cosgrove D, Dietrich CF, et al: EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 1: basic principles and technology. Ultraschall Med 2013;34:169-184.
23.
Sporea I, Gilja OH, Bota S, et al: Liver elastography - an update. Med Ultrason 2013;15:304-314.
24.
Nightingale K, Soo MS, Nightingale R, et al: Acoustic Radiation Force Impulse imaging: in vivo demonstration of clinical feasibility. Ultrasound Med Biol 2002;28:227-235.
25.
Lyshchik A, Higashi T, Asato R, et al: Thyroid gland tumor diagnosis at US elastography. Radiology 2005;237:202-211.
26.
Itoh A, Ueno E, Tohno E, et al: Breast disease: clinical application of US elastography for diagnosis. Radiology 2006;239:341-350.
27.
Cochlin DL, Ganatra RH, Griffiths DF: Elastography in the detection of prostatic cancer. Clin Radiol 2002;57:1014-1020.
28.
Hsu SJ, Bouchard RR, Dumont DM, et al: In vivo assessment of myocardial stiffness with Acoustic Radiation Force Impulse imaging. Ultrasound Med Biol 2007;33:1706-1719.
29.
Rubin JM, Aglyamov SR, Wakefield TW, et al: Clinical application of sonographic elasticity imaging for aging of deep venous thrombosis: preliminary findings. J Ultrasound Med 2003;22:443-448.
30.
Lamproye A, Belaiche J, Delwaide J: [The FibroScan: a new non invasive method of liver fibrosis evaluation]. Rev Med Liege 2007;62:68-72.
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2017
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