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MRCP in the evaluation of pancreaticobiliary disease in children
C M Arcement1, M P Meza, S Arumanla
1Children's Hospital of Pittsburgh, Department of Radiology, PA 15213, USA.
Insights
Magnetic resonance cholangiopancreatography (MRCP) is an effective, non-invasive tool for diagnosing pancreaticobiliary ductal disease in children. This imaging technique can help avoid more invasive procedures like ERCP and PTC.
Area of Science:
- Pediatric Radiology
- Gastroenterology
- Medical Imaging
Background:
- Current methods for diagnosing pancreaticobiliary ductal disease (PBDD) in children involve invasive procedures like ERCP and PTC.
- A non-invasive, accurate, and reproducible imaging technique is needed to guide further diagnostic steps in pediatric PBDD.
Purpose of the Study:
- To evaluate the effectiveness of Magnetic Resonance Cholangiopancreatography (MRCP) as a screening tool for PBDD in pediatric patients.
Main Methods:
- Prospective evaluation of 33 pediatric patients (7 months to 20 years) using 1.5 T MRCP.
- Utilized various MRCP sequences including SPGR, T-2W FSE, SSFSE, and 3D MIP reconstructions.
- Correlated MRCP findings with established methods like ERCP, PTC, liver biopsy, surgery, and autopsy.
Main Results:
- All 34 MRCP studies were diagnostic, unaffected by factors like periportal fluid or gallbladder distention.
- MRCP accurately identified abnormalities such as stones, strictures, tumors, and extrinsic compression, confirmed by other diagnostic methods.
- No false-negative MRCP examinations were recorded, and normal findings helped rule out pancreatitis.
Conclusions:
- MRCP is a rapid, non-invasive imaging modality for evaluating the pediatric pancreatic and biliary systems.
- A normal MRCP can potentially eliminate the need for more invasive procedures (PTC, ERCP).
- Abnormalities identified by MRCP can effectively direct subsequent interventional strategies.
Background:
Radiologic assessment of pancreaticobiliary ductal disease (PBDD) in children currently consists of physiologic tests (radionuclide examinations) or invasive anatomic studies (ERCP and PTC). An accurate noninvasive and reproducible examination that can direct the subsequent need for more invasive studies would be helpful in this patient group.
Objective:
To determine the effectiveness of MRCP as a screening tool for PBBD in the pediatric population.
Materials And Methods:
Over the last year, 33 patients ranging from 7 months to 20 years of age were prospectively evaluated with MRCP on a 1.5 T magnet. One patient was examined twice, several months apart. Thirteen patients had liver transplants. Coronal SPGR and heavily T-2W FSE cross-sectional images were obtained. Standard and oblique 2- to 6-cm-thick slab SSFSE (single-shot fast spin echo) acquisition and 3D MIP reconstruction of 2D FSE images were obtained in the planes of the CBD and pancreatic duct. Nine studies were performed with the patient under sedation with chloral hydrate or nembutal and fentanyl with quiet respiration, and the non-sedated patients were assessed with single breath hold or quiet respiration. Three patients received secretin. MRCP results were correlated with ERCP (9), PTC (7), liver biopsy (13), clinical information (6), surgery (3), and autopsy (2).
Results:
All 34 studies performed were considered diagnostic. Periportal fluid, proximal bowel fluid, and gallbladder distention did not significantly diminish the diagnostic information in any cases. Motion artifact did not cause serious degradation in image quality. MRCP depicted abnormalities including stones, stricture, intraductal tumor, and extrinsic compression, all of which were confirmed at ERCP, PTC ( two unsuccessful in patients with non-dilated ducts by MRCP), surgery, liver biopsy, and autopsy. There were no false-negative examinations. Normal pancreatic studies performed to exclude pancreas divisum were followed without additional clinical or laboratory evidence of pancreatitis. Secretin administration increased the conspicuity of the pancreatic duct in two of three patients.
Conclusion:
MRCP is a fast non-invasive method of evaluating the pancreatic duct and biliary tree in children. A normal MRCP may obviate the need for PTC or ERCP. Abnormalities detected on MRCP can direct the type of intervention.