Background The present study aimed to explore the feasibility of using pancreatic two-dimensional shear wave elastography (2D-SWE) to predict post-operative pancreatic fistula (POPF) following partial pancreatectomy.

Methods The present study prospectively included 170 patients who underwent partial pancreatectomy for pancreatic or periampullary disease and underwent pancreatic 2D-SWE examination within one week before the surgery. According to the order of enrollment, patients were divided into a training group (n =140) and a validation group (n =30). For the training group, Logistic regression analysis was performed to identify the predictive factors of POPF and establish a prediction model. The model’s ability to predict POPF was analyzed in both groups using the receiver operating characteristic curve (ROC) and the area under the curve (AUC). Spearman correlation analysis was used to explore the correlation between pancreatic 2D-SWE measurement values (Emean) and histological characteristics to investigate the histological basis in predicting POPF.

Results ROC analysis indicated that Emean could be used to predict POPF occurrence (AUC =0.67, p <0.001). Logistic regression analysis revealed that higher body mass index (BMI; p =0.006), lower Emean (p =0.015), and non-dilated main pancreatic duct (p =0.012) were the independent risk factors for POPF. Accordingly, a prediction model was built and showed an AUC of 0.77 (p <0.001) and 0.72 (p =0.047) in the training and validation groups, respectively. Subgroup analysis revealed that the model had an AUC >0.70 (p <0.001) in surgical types. Correlation analysis showed a positive correlation between Emean and pancreatic fibrosis degree (p =0.040), while no significant correlation was found between Emean with fat infiltration and exocrine atrophy (all p >0.050).

Conclusions It’s feasible to use 2D-SWE to predict POPF. Lower Emean, higher BMI, and non-dilated main pancreatic duct are independent predictive factors of POPF. The model based on pre-operative Emean, BMI, and condition of main pancreatic duct dilation demonstrated good predictive ability in patients undergoing partial pancreatectomy. The histological basis of 2D-SWE in predicting POPF might be related to its ability to assess pancreatic fibrosis.