Original Article Pancreatic volume does not correlate with histologic fibrosis in adult patients with recurrent acute and chronic pancreatitis Mahya Faghih a , Micha € el No € e c , Rifat Mannan d , Ihab R. Kamel e , Atif Zaheer b, e , Rita R. Kalyani f , Erica Hall f , Elham Afghani a, b , Daniel Warren g , Niraj Desai g , Zhaoli Sun g , Christi Walsh h , Martin A. Makary h , Michael Goggins a, c, i , Ralph H. Hruban c, i , Jin He h , Vikesh K. Singh a, b, * a Division of Gastroenterology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA b Pancreatitis Center, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA c Sidney Kimmel Comprehensive Cancer Center, Department of Oncology, Johns Hopkins Medical Institutions, Baltimore, MD, USA d Division of Gastrointestinal, Liver and Pancreatic Pathology, Department of Pathology, University of Pennsylvania, Perelman, School of Medicine, philadelphia, USA e Division of Abdominal Imaging, Department of Radiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA f Division of Endocrinology, Diabetes, & Metabolism, Department of Medicine Johns Hopkins Medical Institutions, Baltimore, MD, USA g Division of Transplant Surgery, Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, MD, USA h Division of Surgical Oncology, Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, MD, USA i The Sol Goldman Pancreatic Cancer Research Center, Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD, USA article info Article history: Received 7 May 2020 Received in revised form 27 June 2020 Accepted 28 July 2020 Available online 1 August 2020 The preliminary data for this study were presented as an oral presentation in the AGA Clinical Chronic Pancreatitis Session at Digestive Disease Week on May 20, 2019 in San Diego, CA. Keywords: Chronic pancreatitis Recurrent acute pancreatitis Pancreatic volume Pancreatic atrophy TPIAT abstract Objectives: Reduced pancreatic volume, often referred to as atrophy, is a commonly reported imaging feature of chronic pancreatitis (CP). This study evaluated whether there is an association between pancreatic volume and fibrosis, the criterion standard of CP, in patients undergoing total pancreatectomy with islet autotransplantation (TPIAT) for recurrent acute pancreatitis (RAP) and CP. Methods: All adult patients who underwent TPIAT between 2010 and 2019 were categorized into 3 groups: RAP, definite CP and indeterminate CP. Pancreatic volume was calculated by summing up the areas from each thin section of the pancreas on 3D CT imaging. Excisional biopsies of the pancreatic head as well as body/tail region were obtained at the time of TPIAT. Two different fibrosis scores were used for histologic assessment. Results: A total of 16, 29 and 15 patients underwent TPIAT for RAP, definite CP and indeterminate CP, respectively. The mean pancreatic volumes for patients with RAP, definite CP and indeterminate CP were 65.7 ± 28.5 cc, 54.9 ± 22.9 cc and 61.8 ± 23.6 cc, respectively (p ¼ 0.3). The mean fibrosis scores were significantly higher in patients with definite CP compared to RAP (p < 0.001) and indeterminate CP (p < 0.001). Pancreatic volume was not associated with either fibrosis score after adjusting for age, gender, duration of disease, BMI and diabetes in the multivariable analysis. Conclusions: While the fibrosis scores were higher in definite CP compared to both RAP and indeter- minate CP, there was no correlation between pancreatic volume and fibrosis. This suggests that atrophy alone cannot be used to diagnose CP. © 2020 Published by Elsevier B.V. on behalf of IAP and EPC. Introduction Chronic pancreatitis (CP) is a progressive and irreversible fibroinflammatory disease of the pancreas that frequently results in symptoms and functional deficiencies including diabetes and exocrine insufficiency. Features of advanced CP on imaging include calcifications and/or moderate to marked changes of the pancreatic * Corresponding author. Division of Gastroenterology, Johns Hopkins University School of Medicine, 1830 E. Monument Street, Room 428, Baltimore, MD, 21205, USA. E-mail address: vsingh1@jhmi.edu (V.K. Singh). Contents lists available at ScienceDirect Pancreatology journal homepage: www.elsevier.com/locate/pan https://doi.org/10.1016/j.pan.2020.07.409 1424-3903/© 2020 Published by Elsevier B.V. on behalf of IAP and EPC. Pancreatology 20 (2020) 1078e1084