Magnetic Resonance Cholangiopancreatography in Assessing the Cause of Acute Pancreatitis in Children

Abstract

Magnetic resonance cholangiopancreatography (MRCP) is a new noninvasive method of obtaining images of the pancreaticobiliary tract. Recent advances in MR technology and image quality have made it easy to diagnose structural abnormalities of the pancreaticobiliary tract (SAPBT) in children. To examine the usefulness of MRCP in assessing the cause of acute pancreatitis in children, we performed MRCP in 16 patients with acute pancreatitis. The study population was divided into two groups according to the cause of acute pancreatitis as follows: group 1 consisted of seven patients sonographically diagnosed with choledochal cysts; and group 2 consisted of nine patients with no obvious cause of acute pancreatitis. Non-breath-hold MRCP using the half-Fourier, single-shot, fast spin-echo imaging method was performed within 7 days after the onset of pancreatitis. Abnormal union of the pancreaticobiliary junction was detected in six of seven group 1 patients and in one of nine group 2 patients. Pancreatic divisum was detected in one patient of group 1, but could not be confirmed in one patient of group 2. Dilatation of the main pancreatic duct was detected in one patient of group 1 and in three patients of group 2. Our results suggest that MRCP is a useful, noninvasive method of identifying and ruling out SAPBT as a cause of acute pancreatitis in children with early-stage pancreatitis.

The use of magnetic resonance cholangiopancreatography in children

“…In our review of the literature, we found that 16 of the 18 false negatives and three of the six false positives involved evaluation of the pancreatobiliary junction. MRCP correctly identified anomalous union of the pancreatobiliary junction in 53% to 85% of children with choledochal cysts [18,23], 67% in idiopathic chronic pancreatitis [20], and 69% to 72% in children with known or suspected pancreatobiliary malformation [17,25•]. The reasons for incorrect diagnosis of pancreas divisum and anomalous union of the pancreatobiliary junction include an unclear relationship between the dorsal pancreatic duct and common bile duct, a long inferior branch of the dorsal pancreatic duct crossing a short or fine ventral pancreatic duct, and sphincter of Oddi spasm resulting in an artifactual short common channel length [25•].…”

“…Shimizu et al [18] reported on 16 consecutive children (ages 2.5-15.6 years) evaluated for acute pancreatitis. All children were also studied by ultrasonography.…”

Idiopathic fibrosing pancreatitis in a 3-year-old girl: a case report and review of the literature

“…However, ERCP requires cannulation of the pancreatic duct and the CBD, which carries the risk of several complications including pancreatitis, infection, bleeding, and bile leak [27]. A prospective study by Shimizu et al [28] on the use of MRCP in assessing the causes of acute pancreatitis in children found that it is a useful, noninvasive method in identifying the structural abnormalities of the pancreaticobiliary tree when compared to ERCP. Prasad et al [29] also found that MRCP is a viable noninvasive alternative to ERCP in the assessment of pediatric pancreaticobiliary disorders.…”

Role of magnetic resonance cholangiopancreatography in diagnosing choledochal cysts: Case series and review

“…Retrospective Hirohashi et al [47] 5 4 0 0 1 HASTE Sugiyama et al [22] 7 5 0 0 2 HASTE Chan et al [44] 6 0 4 0 2 2D TSE Irie et al [56] 16 10 1 0 5 HASTE Matos et al [57] 8 6 2 0 0 SSTSE Miyazaki et al [43] 6 2 3 0 1 HASTE Frampas et al [54] 5 1 4 0 0 HASTE Shimuzu et al [59] 7 6 0 0 1 HASTE Tang et al [77] 10 6 2 0 2 HASTE Kim et al [60] 20 12 3 0 5 SSFSE Park et al [55] 72 34 28 3 7 HASTE Suzuki et al [61] 32 16 2 0 14 HASTE Fitoz et al [62] 5 1 4 0 0 SSFSE Saito et al [64] overall diagnostic accuracy of 56%-100%. In contrast, ERCP has been reported with sensitivity and specificity > 90% for diagnosing APBJ [11] .…”