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Published on: June 5, 2014
Imaging findings in 75 pediatric patients with pancreaticobiliary maljunction: a retrospective case study
Wan-liang Guo1, Shun-gen Huang, Jian Wang
1Radiology Department, The Children's Hospital Affliated to Soochow University, Suzhou, 215003, China.
Insights
Magnetic resonance cholangiopancreatography (MRCP) is the preferred diagnostic imaging for pediatric pancreaticobiliary maljunction (PBM), offering clear views of the pancreaticobiliary junction. Other methods like ultrasonography, intraoperative cholangiography, and computed tomography also aid in diagnosis.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Imaging
- Surgical Pathology
Background:
- Pancreaticobiliary maljunction (PBM) is a congenital condition often linked to choledochal cysts, protein plugs, and pancreatitis.
- Accurate diagnosis through imaging is crucial for timely intervention in pediatric cases.
Purpose of the Study:
- To compare the diagnostic accuracy of various imaging modalities for pediatric pancreaticobiliary maljunction (PBM).
- To evaluate the effectiveness of ultrasonography (US), intraoperative cholangiography (IOC), computed tomography (CT), and magnetic resonance cholangiopancreatography (MRCP) in diagnosing PBM.
Main Methods:
- Retrospective analysis of 75 pediatric patients diagnosed with PBM (defined as common channel >5 mm).
- Comparison of imaging findings (bile duct and gallbladder shape, pancreatitis) with surgical pathology, symptoms, operative notes, and pathological records.
- Assessment of diagnosis rates for PBM across CT, US, MRCP, and IOC.
Main Results:
- Magnetic resonance cholangiopancreatography (MRCP) demonstrated a high diagnosis rate for PBM (39 out of 39 subjects diagnosed).
- Intraoperative cholangiography (IOC) also showed high diagnostic yield (60 out of 75 cases).
- Diagnostic accuracy varied significantly among modalities, with MRCP and IOC showing comparable and high performance.
Conclusions:
- Ultrasonography (US), intraoperative cholangiography (IOC), computed tomography (CT), and magnetic resonance cholangiopancreatography (MRCP) are all valuable for detecting bile duct dilatation and complications in pediatric PBM.
- Magnetic resonance cholangiopancreatography (MRCP) is recommended as the primary imaging choice due to its non-invasive nature and clear visualization of the pancreaticobiliary junction.
Background:
Pancreaticobiliary maljunction (PBM) is often associated with congenital choledochal cyst, protein plugs and pancreatitis. Early diagnosis and timely treatment largely depend on imaging. We assessed a series of PBM in children, comparing imaging procedure with histological and pathological findings with regard to diagnosis.
Methods:
A retrospective analysis was conducted in 75 pediatric patients with PBM. PBM was defined as common channel at >5 mm. Two radiologists assess the shape of the bile duct and gallbladder, pancreatitis, surgical pathology, symptom profiles, operative notes and pathological records were compared with the imaging findings.
Results:
Dilatation of the bile duct was detected in 45 subjects out of the 46 subjects who underwent computed tomography (CT) and nine was diagnosis as PBM. Forty out of 41 subjects were revealed bile duct dilatation in ultrasonography (US). Bile duct dilatation was seen in 59 out of 60 subjects receiving magnetic resonance cholangiopancreatography (MRCP) and 39 were diagnosed as PBM. Seventy-four out of 75 subjects successfully underwent intraoperative cholangiography (IOC); a diagnosis of PBM was established in 60 cases based on IOC alone. The diagnosis rate of pediatric PBM varied significantly among the four groups (P < 0.0001). Pair-wise comparison showed a significant difference between the groups of MRCP and CT (P < 0.0001), MRCP and US (P < 0.0001), IOC and CT (P < 0.0001), IOC and US (P < 0.0001), CT and US (P = 0.0027), and there is no significant difference between the groups of IOC and MRCP (P = 0.0502).
Conclusion:
US, IOC, CT and MRCP are valuable in showing dilatation of the bile duct and complications in pediatric PBM. MRCP is non-invasive, gives clear views of the pancreaticobiliary junction and should be the first choice for the diagnosis of PBM in children.
