Radiological parameters to predict pancreatic texture: Current evidence and future perspectives

Abstract

Preoperative prediction of the postoperative pancreatic fistula risk is critical in the current era of minimally invasive pancreatic surgeries to tailor perioperative management, thereby minimizing postoperative morbidity. Pancreatic duct diameter can be readily measured by any routine imaging used to diagnose pancreatic disease. However, radiological evaluation of pancreatic texture, an important determinant of pancreatic fistula, has not been widely used to predict the risk of postoperative pancreatic fistula. Qualitative and quantitative assessment of pancreatic fibrosis and fat fraction provides the basis for predicting pancreatic texture. Traditionally computed tomography has been utilized in identifying and characterizing pancreatic lesions and background parenchymal pathologies. With the increasing utilisation of endoscopic ultrasound and magnetic resonance imaging for evaluating pancreatic pathologies, elastography is emerging as a promising tool for predicting pancreatic texture. Also, recent studies have shown that early surgery for chronic pancreatitis is associated with better pain relief and preservation of pancreatic function. Pancreatic texture assessment can allow early diagnosis of chronic pancreatitis, facilitating early intervention. The present review outlines the current evidence in utilizing various imaging modalities for determining the pancreatic texture based on different parameters and image sequences. However, multidisciplinary investigations using strong radiologic-pathologic correlation are needed to standardize and establish the role of these non-invasive diagnostic tools in predicting pancreatic texture.

Keywords: Pancreatic fistula; Minimally invasive; Pancreaticoduodenectomy; Pancreatic cancer; Neoplasms; Computed tomography; Endoscopic ultrasound; Ultrasonography; Magnetic resonance imaging

Core Tip: Preoperative prediction of pancreatic texture and pancreatic fistula risk can guide selecting patients who could derive maximum benefit from minimally invasive pancreatoduodenectomy. Also, pancreatic texture evaluation could facilitate early diagnosis of chronic pancreatitis. Endoscopic ultrasound and magnetic resonance imaging-based elastography has improved the diagnostic accuracy of pancreatic fibrosis. Future studies should focus on combining different radiological modalities and correlating with histological parameters to standardize the radiological evaluation of pancreatic texture.