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Published on: August 23, 2022
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Biliary Disorders, Anomalies, and Malignancies in Children
Curtis L Simmons1, Laura K Harper1, Mittun C Patel1
1From the Department of Radiology, Phoenix Children's Hospital, 1919 E Thomas Rd, Main Tower, Phoenix, AZ 85016 (C.L.S., M.C.P., R.N.S., L.G., D.R.B.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (L.K.H.); Department of Radiology, UT Health San Antonio, San Antonio, Tex (V.S.K.); and Baylor College of Medicine, Houston, Tex (E.T.).
Summary
Pediatric biliary disorders are diverse, ranging from congenital anomalies to inflammatory conditions. Accurate diagnosis relies on a multimodal imaging approach, with ultrasound as the initial tool, complemented by MRI and MRCP for detailed assessment.
Area of Science:
- Pediatric Radiology
- Gastroenterology
- Medical Imaging
Background:
- Biliary abnormalities in children present a broader spectrum than in adults, are rarely neoplastic, and often stem from congenital or embryologic origins.
- Common pediatric biliary disorders include anatomical gallbladder anomalies, anomalous pancreaticobiliary tracts, cholestatic processes, congenital cysts, and genetic conditions, alongside benign entities like motility and inflammatory disorders.
Purpose of the Study:
- To outline the diverse range of pediatric biliary disorders and emphasize the challenges in their diagnosis using a single imaging modality.
- To highlight the essential role of a multimodal imaging strategy in the accurate diagnosis and management of pediatric biliary abnormalities.
Main Methods:
- Ultrasound (US) is the primary imaging modality for initial evaluation due to its accessibility, safety, and cost-effectiveness.
- Magnetic Resonance Imaging (MRI), Computed Tomography (CT), and nuclear medicine provide complementary anatomic and functional information.
- Hepatobiliary-specific contrast-enhanced MRI and Magnetic Resonance Cholangiopancreatography (MRCP) offer superior visualization of biliary anatomy compared to traditional MRI and Endoscopic Retrograde Cholangiopancreatography (ERCP).
Main Results:
- Distinguishing between various pediatric biliary entities is challenging with a single imaging technique.
- A combination of US and MRCP is crucial for diagnosing conditions like choledochal cysts.
- Suspected biliary atresia necessitates a multimodal diagnostic approach for timely intervention.
Conclusions:
- A comprehensive understanding of imaging appearances is vital for appropriate workup, differential diagnosis, and management of pediatric biliary abnormalities.
- Multimodal imaging, integrating US, MRI, and MRCP, is essential for accurate diagnosis and guiding treatment strategies in pediatric biliary disorders.
- Biopsy may be required for definitive diagnosis of both benign and malignant biliary masses in children.
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