• Tae Kil Lee, Chang Moo Kang, Mi-Suk Park, Sung Hoon Choi, Yong-Eun Chung, Jin Young Choi, and Myeong-Jin Kim.
• Department of Radiology, Severance Hospital, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul 120-752, Korea. radpms@yuhs.ac.
• J Ultrasound Med. 2014 May 1;33(5):781-6.

ObjectivesThe purpose of this prospective study was to investigate the usefulness of acoustic radiation force impulse (ARFI) elastography of the pancreas for predicting postoperative pancreatic fistula occurrence after pancreatic resection.MethodsTwenty-five patients underwent ARFI elastography of the pancreas before pancreatic resection (11 men and 14 women; mean age, 59.1 years; range, 28-76 years). In each patient, 3 valid ARFI measurements (meters per second) were performed at the head of the pancreas, and the median values were calculated. Patients underwent pancreaticoduodenectomy (n = 18) or distal pancreatectomy (n = 7). Clinically relevant fistulas (grade B or higher) were determined according to the standard criteria used by the International Study Group on Pancreatic Fistula. Preoperative ARFI values were compared between the fistula and nonfistula groups (Mann-Whitney test).ResultsClinically relevant fistulas (grade B or higher) were observed in 8 patients (32%; fistula group), including 5 of 18 patients with pancreaticoduodenectomy (28%) and 3 of 7 patients with distal pancreatectomy (43%). The ARFI values in the fistula group (median, 1.45 m/s; range, 0.80-1.98 m/s) were lower than in the nonfistula group (median, 1.54 m/s; range, 0.98-3.40 m/s), but there was no statistical significance (P = .1374). When confining the results to only patients with pancreaticoduodenectomy, the ARFI values were significantly lower in the patients with fistulas (median, 0.98 m/s; range, 0.80-1.94 m/s) than in those without fistulas (median, 1.60 m/s; range, 1.08-3.40 m/s; P = .0460).ConclusionsThis preliminary study showed the potential feasibility of a clinical application of ARFI elastography in preoperatively predicting postoperative pancreatic fistulas after pancreaticoduodenectomy. Investigation of this method in larger studies is needed.

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