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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

An 11-year-old boy diagnosed with autoimmune pancreatitis. (A) Fat-suppressed T2-weighted image showing diffuse pancreatic enlargement and increased signal intensity in the parenchyma (asterisk). Note the capsule-like low-signal rim surrounding the pancreas (curved arrow). (B) Single-shot radial acquisition with relaxation enhancement magnetic resonance cholangiopancreatography image showing the segmented absence of the pancreatic duct in the body and tail of the pancreas (between arrowheads) and the irregular dilatation of the upstream duct (arrow). (C) Follow-up magnetic resonance image obtained 20 days later shows less pancreas swelling after steroid therapy.
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Figure 5: An 11-year-old boy diagnosed with autoimmune pancreatitis. (A) Fat-suppressed T2-weighted image showing diffuse pancreatic enlargement and increased signal intensity in the parenchyma (asterisk). Note the capsule-like low-signal rim surrounding the pancreas (curved arrow). (B) Single-shot radial acquisition with relaxation enhancement magnetic resonance cholangiopancreatography image showing the segmented absence of the pancreatic duct in the body and tail of the pancreas (between arrowheads) and the irregular dilatation of the upstream duct (arrow). (C) Follow-up magnetic resonance image obtained 20 days later shows less pancreas swelling after steroid therapy.

Mentions: Autoimmune pancreatitis is histologically characterized by marked fibrosis and the infiltration of CD4-positive T-lymphocytes and immunoglobulin G4-positive plasma cells around the pancreatic duct [15]. Autoimmune pancreatitis is increasingly encountered in adults, but a few cases have been also reported in children and adolescents [16]. The representative characteristics of autoimmune pancreatitis on MR include the diffuse enlargement of the pancreas without focal lesions, multifocal pancreatic duct narrowing, and a peripancreatic hypodense or hypointense rim on contrast-enhanced CT or MRI (Fig. 5A and 5B). Improvement in the radiological findings after steroid therapy may be a diagnostic clue of autoimmune pancreatitis, as it usually indicates a good response to steroids.


Characteristics of Pediatric Pancreatitis on Magnetic Resonance Cholangiopancreatography.

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

An 11-year-old boy diagnosed with autoimmune pancreatitis. (A) Fat-suppressed T2-weighted image showing diffuse pancreatic enlargement and increased signal intensity in the parenchyma (asterisk). Note the capsule-like low-signal rim surrounding the pancreas (curved arrow). (B) Single-shot radial acquisition with relaxation enhancement magnetic resonance cholangiopancreatography image showing the segmented absence of the pancreatic duct in the body and tail of the pancreas (between arrowheads) and the irregular dilatation of the upstream duct (arrow). (C) Follow-up magnetic resonance image obtained 20 days later shows less pancreas swelling after steroid therapy.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 5: An 11-year-old boy diagnosed with autoimmune pancreatitis. (A) Fat-suppressed T2-weighted image showing diffuse pancreatic enlargement and increased signal intensity in the parenchyma (asterisk). Note the capsule-like low-signal rim surrounding the pancreas (curved arrow). (B) Single-shot radial acquisition with relaxation enhancement magnetic resonance cholangiopancreatography image showing the segmented absence of the pancreatic duct in the body and tail of the pancreas (between arrowheads) and the irregular dilatation of the upstream duct (arrow). (C) Follow-up magnetic resonance image obtained 20 days later shows less pancreas swelling after steroid therapy.
Mentions: Autoimmune pancreatitis is histologically characterized by marked fibrosis and the infiltration of CD4-positive T-lymphocytes and immunoglobulin G4-positive plasma cells around the pancreatic duct [15]. Autoimmune pancreatitis is increasingly encountered in adults, but a few cases have been also reported in children and adolescents [16]. The representative characteristics of autoimmune pancreatitis on MR include the diffuse enlargement of the pancreas without focal lesions, multifocal pancreatic duct narrowing, and a peripancreatic hypodense or hypointense rim on contrast-enhanced CT or MRI (Fig. 5A and 5B). Improvement in the radiological findings after steroid therapy may be a diagnostic clue of autoimmune pancreatitis, as it usually indicates a good response to steroids.

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