{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T12:30:10Z","timestamp":1768825810225,"version":"3.49.0"},"reference-count":30,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2021,6,24]],"date-time":"2021-06-24T00:00:00Z","timestamp":1624492800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Postoperative pancreatic fistula after cephalic pancreatoduodenectomy (CPD) is still the leading cause of postoperative morbidity, entailing long hospital stay and costs or even death. The aim of this study was to propose the use of morphologic parameters based on a preoperative multisequence computer tomography (CT) scan in predicting the clinically relevant postoperative pancreatic fistula (CRPF) and a risk score based on a multiple regression analysis. Materials and Methods: For 78 consecutive patients with CPD, we measured the following parameters on the preoperative CT scans: the density of the pancreas on the unenhanced, arterial, portal and delayed phases; the unenhanced density of the liver; the caliber of the main pancreatic duct (MPD); the preoperatively estimated pancreatic remnant volume (ERPV) and the total pancreatic volume. We assessed the correlation of the parameters with the clinically relevant pancreatic fistula using a univariate analysis and formulated a score using the strongest correlated parameters; the validity of the score was appreciated using logistic regression models and an ROC analysis. Results: When comparing the CRPF group (28.2%) to the non-CRPF group, we found significant differences of the values of unenhanced pancreatic density (UPD) (44.09 \u00b1 6.8 HU vs. 50.4 \u00b1 6.31 HU, p = 0.008), delayed density of the pancreas (48.67 \u00b1 18.05 HU vs. 61.28 \u00b1 16.55, p = 0.045), unenhanced density of the liver (UDL) (44.09 \u00b1 6.8 HU vs. 50.54 \u00b1 6.31 HU, p = 0.008), MPD (0.93 \u00b1 0.35 mm vs. 3.14 \u00b1 2.95 mm, p = 0.02) and ERPV (46.37 \u00b1 10.39 cm3 vs. 34.87 \u00b1 12.35 cm3, p = 0.01). Based on the odds ratio from the multiple regression analysis and after calculating the optimum cut-off values of the variables, we proposed two scores that both used the MPD and the ERPV and differing in the third variable, either including the UPD or the UDL, producing values for the area under the receiver operating characteristic curve (AUC) of 0.846 (95% CI 0.694\u20130.941) and 0.774 (95% CI 0.599\u20130.850), respectively. Conclusions: A preoperative CT scan can be a useful tool in predicting the risk of clinically relevant pancreatic fistula.<\/jats:p>","DOI":"10.3390\/medicina57070650","type":"journal-article","created":{"date-parts":[[2021,6,24]],"date-time":"2021-06-24T11:01:38Z","timestamp":1624532498000},"page":"650","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Proposal of a Preoperative CT-Based Score to Predict the Risk of Clinically Relevant Pancreatic Fistula after Cephalic Pancreatoduodenectomy"],"prefix":"10.3390","volume":"57","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9569-7319","authenticated-orcid":false,"given":"Marius Lucian","family":"Savin","sequence":"first","affiliation":[{"name":"\u201cGr. T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Department of Radiology, \u201cSt. Spiridon\u201d Emergency Hospital, 700111 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Florin","family":"Mihai","sequence":"additional","affiliation":[{"name":"\u201cGr. T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Department of Radiology, \u201cSt. Spiridon\u201d Emergency Hospital, 700111 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liliana","family":"Gheorghe","sequence":"additional","affiliation":[{"name":"\u201cGr. T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Department of Radiology, \u201cSt. Spiridon\u201d Emergency Hospital, 700111 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Corina","family":"Lupascu Ursulescu","sequence":"additional","affiliation":[{"name":"\u201cGr. T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Department of Radiology, \u201cSt. Spiridon\u201d Emergency Hospital, 700111 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dragos","family":"Negru","sequence":"additional","affiliation":[{"name":"\u201cGr. T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Department of Radiology, \u201cSt. Spiridon\u201d Emergency Hospital, 700111 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana Maria","family":"Trofin","sequence":"additional","affiliation":[{"name":"\u201cGr. T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Department of Surgery, \u201cSt. Spiridon\u201d Emergency Hospital, 700111 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mihai","family":"Zabara","sequence":"additional","affiliation":[{"name":"\u201cGr. T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Department of Surgery, \u201cSt. Spiridon\u201d Emergency Hospital, 700111 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vlad","family":"Nutu","sequence":"additional","affiliation":[{"name":"\u201cGr. T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Department of Surgery, \u201cSt. Spiridon\u201d Emergency Hospital, 700111 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ramona","family":"Cadar","sequence":"additional","affiliation":[{"name":"Department of Surgery, \u201cSt. Spiridon\u201d Emergency Hospital, 700111 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mihaela","family":"Blaj","sequence":"additional","affiliation":[{"name":"\u201cGr. T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Department of Anesthesiology and Intensive Care, \u201cSt. Spiridon\u201d Emergency Hospital, 700111 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oana","family":"Lovin","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care, \u201cSt. Spiridon\u201d Emergency Hospital, 700111 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Felicia","family":"Crumpei","sequence":"additional","affiliation":[{"name":"Department of Surgery, \u201cSt. Spiridon\u201d Emergency Hospital, 700111 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristian","family":"Lupascu","sequence":"additional","affiliation":[{"name":"\u201cGr. T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Department of Surgery, \u201cSt. Spiridon\u201d Emergency Hospital, 700111 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,6,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1007\/s00423-014-1242-2","article-title":"Diagnosis and management of postoperative pancreatic fistula","volume":"399","author":"Malleo","year":"2014","journal-title":"Langenbeck\u2019s Arch. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"554","DOI":"10.1016\/j.jamcollsurg.2005.05.007","article-title":"Risk factors of massive bleeding related to pancreatic leak after pancreaticoduodenectomy","volume":"201","author":"Tien","year":"2005","journal-title":"J. Am. Coll. 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Tumors"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/57\/7\/650\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:22:56Z","timestamp":1760163776000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/57\/7\/650"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6,24]]},"references-count":30,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2021,7]]}},"alternative-id":["medicina57070650"],"URL":"https:\/\/doi.org\/10.3390\/medicina57070650","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,6,24]]}}}