Imaging options outlined for docs diagnosing, treating pediatric pancreatitis

Increasing numbers of children are turning up with pancreatitis and other abnormalities involving that glandular organ. Spurred by this observation, a multicenter literature-review team has written a paper offering an update on existing imaging techniques and interventional endoscopic modalities.

Lead author Tom Lin, MD, of Cincinnati Children’s Hospital and colleagues at five other academic medical centers looked at studies that incorporated CT, MRI, transabdominal ultrasound, endoscopic ultrasound, MR cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP).

According to the study abstract, which posted online Aug. 6 in the Journal of Pediatric Gastroenterology and Nutrition, the team’s key pro-and-con takeaways included:

• Transabdominal ultrasound offers non-invasive images of the pancreas but has limitations to details of parenchyma and ductal structures.
• CT offers improved detail of pancreatic parenchyma, solid masses and traumatic injuries, but the modality requires relatively high levels of ionizing radiation and does not adequately assess ductal anatomy.
• MRI/MRCP offers detailed intrinsic tissue assessment and pancreatic ductal characterization, but it requires longer image acquisition time and is relatively poor at imaging calcifications.
• Endoscopic ultrasound provides excellent evaluation of pancreatic parenchyma and ductal anatomy but can be subjective and operator-dependent while also requiring sedation or anesthesia.

The latter modality further offers the capacity to obtain tissue samples and drain fluid collections, the authors note, and ERCP allows clinicians to improve drainage by performing sphincterotomy or placing pancreatic stents across duct injuries and strictures.

“Various imaging modalities may be utilized in pediatric pancreatology, but transabdominal ultrasonography and MRI/MRCP are favored,” they conclude. “Interventional therapeutic maneuvers primarily involve use of ERCP and endoscopic ultrasonography. Future research is necessary to optimize equipment, expertise and appropriate indications.”