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Characteristics of Pediatric Pancreatitis on Magnetic Resonance Cholangiopancreatography.

Hwang JY, Yoon HK, Kim KM - Pediatr Gastroenterol Hepatol Nutr (2015)

Bottom Line: Pediatric pancreatitis is not uncommon and results in considerable morbidity and mortality in the affected children.Unlike adults, pediatric pancreatitis is more frequently associated with underlying structural abnormalities, trauma, and drugs rather than an idiopathic etiology.This article focuses on MRCP findings associated with various causes of pancreatitis in children, particularly structural abnormalities of the pancreaticobiliary system, as well as describing the feasibility, limitations, and solutions associated with pediatric MRCP.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. ; Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea.

ABSTRACT
Pediatric pancreatitis is not uncommon and results in considerable morbidity and mortality in the affected children. Unlike adults, pediatric pancreatitis is more frequently associated with underlying structural abnormalities, trauma, and drugs rather than an idiopathic etiology. Magnetic resonance cholangiopancreatography (MRCP) is a good imaging modality for evaluating pancreatitis and determining etiology without exposure to radiation. This article focuses on MRCP findings associated with various causes of pancreatitis in children, particularly structural abnormalities of the pancreaticobiliary system, as well as describing the feasibility, limitations, and solutions associated with pediatric MRCP.

No MeSH data available.


Related in: MedlinePlus

A 4-year-old girl diagnosed with acute pancreatitis. (A, B) Axial single shot fast spin echo (half-Fourier acquisition single-shot turbo spin-echo) T2-weighted image and a single-shot radial acquisition with relaxation enhancement oblique axial image showing diffuse swelling that is worse in the tail of pancreas (asterisk), mild irregular dilatation of the pancreatic duct (open arrow), a dilated common bile duct (curved arrow), and peripancreatic fluid collection (arrow).
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Figure 1: A 4-year-old girl diagnosed with acute pancreatitis. (A, B) Axial single shot fast spin echo (half-Fourier acquisition single-shot turbo spin-echo) T2-weighted image and a single-shot radial acquisition with relaxation enhancement oblique axial image showing diffuse swelling that is worse in the tail of pancreas (asterisk), mild irregular dilatation of the pancreatic duct (open arrow), a dilated common bile duct (curved arrow), and peripancreatic fluid collection (arrow).

Mentions: Cross-sectional MRI is useful for assessing the extent of inflammation, peripancreatic fluid collection, and perfusion in the pancreatic parenchyma after administering paramagnetic contrast material. MRCP is indicated to evaluate structural abnormality of the pancreaticobiliary system in pediatric pancreatitis. The normal pancreas demonstrates high signal intensity relative to the liver on T1-weighted fat-suppressed images and low signal intensity relative to the liver parenchyma on T2-weighted images. The signal intensity of the inflamed pancreas is high on T2-weighted images, but remains normal or slightly low on T1weighted fat-suppressed images depending on the severity of pancreatic inflammation. Heavily T2-weighted image is sensitive to demonstrate the signal change of the pancreas parenchyma and peripancreatic fluid collection due to suppression of the fat tissue (Fig. 1A). Diffuse or focal dilatation and a discontinuous pancreatic duct can be seen on MRCP (Fig. 1B), but the small ductal anomalies might be obscured by inflammatory change in the acute stage of pancreatitis. Stones or sludge can be also identified in the pancreatic duct or common bile duct (CBD). In severe cases, there may be parenchymal necrosis and hemorrhage (so- called necrotizing or hemorrhagic pancreatitis) (Fig. 2).


Characteristics of Pediatric Pancreatitis on Magnetic Resonance Cholangiopancreatography.

Hwang JY, Yoon HK, Kim KM - Pediatr Gastroenterol Hepatol Nutr (2015)

A 4-year-old girl diagnosed with acute pancreatitis. (A, B) Axial single shot fast spin echo (half-Fourier acquisition single-shot turbo spin-echo) T2-weighted image and a single-shot radial acquisition with relaxation enhancement oblique axial image showing diffuse swelling that is worse in the tail of pancreas (asterisk), mild irregular dilatation of the pancreatic duct (open arrow), a dilated common bile duct (curved arrow), and peripancreatic fluid collection (arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4493250&req=5

Figure 1: A 4-year-old girl diagnosed with acute pancreatitis. (A, B) Axial single shot fast spin echo (half-Fourier acquisition single-shot turbo spin-echo) T2-weighted image and a single-shot radial acquisition with relaxation enhancement oblique axial image showing diffuse swelling that is worse in the tail of pancreas (asterisk), mild irregular dilatation of the pancreatic duct (open arrow), a dilated common bile duct (curved arrow), and peripancreatic fluid collection (arrow).
Mentions: Cross-sectional MRI is useful for assessing the extent of inflammation, peripancreatic fluid collection, and perfusion in the pancreatic parenchyma after administering paramagnetic contrast material. MRCP is indicated to evaluate structural abnormality of the pancreaticobiliary system in pediatric pancreatitis. The normal pancreas demonstrates high signal intensity relative to the liver on T1-weighted fat-suppressed images and low signal intensity relative to the liver parenchyma on T2-weighted images. The signal intensity of the inflamed pancreas is high on T2-weighted images, but remains normal or slightly low on T1weighted fat-suppressed images depending on the severity of pancreatic inflammation. Heavily T2-weighted image is sensitive to demonstrate the signal change of the pancreas parenchyma and peripancreatic fluid collection due to suppression of the fat tissue (Fig. 1A). Diffuse or focal dilatation and a discontinuous pancreatic duct can be seen on MRCP (Fig. 1B), but the small ductal anomalies might be obscured by inflammatory change in the acute stage of pancreatitis. Stones or sludge can be also identified in the pancreatic duct or common bile duct (CBD). In severe cases, there may be parenchymal necrosis and hemorrhage (so- called necrotizing or hemorrhagic pancreatitis) (Fig. 2).

Bottom Line: Pediatric pancreatitis is not uncommon and results in considerable morbidity and mortality in the affected children.Unlike adults, pediatric pancreatitis is more frequently associated with underlying structural abnormalities, trauma, and drugs rather than an idiopathic etiology.This article focuses on MRCP findings associated with various causes of pancreatitis in children, particularly structural abnormalities of the pancreaticobiliary system, as well as describing the feasibility, limitations, and solutions associated with pediatric MRCP.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. ; Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea.

ABSTRACT
Pediatric pancreatitis is not uncommon and results in considerable morbidity and mortality in the affected children. Unlike adults, pediatric pancreatitis is more frequently associated with underlying structural abnormalities, trauma, and drugs rather than an idiopathic etiology. Magnetic resonance cholangiopancreatography (MRCP) is a good imaging modality for evaluating pancreatitis and determining etiology without exposure to radiation. This article focuses on MRCP findings associated with various causes of pancreatitis in children, particularly structural abnormalities of the pancreaticobiliary system, as well as describing the feasibility, limitations, and solutions associated with pediatric MRCP.

No MeSH data available.


Related in: MedlinePlus