Comparison Of MRCP And CT For Diagnostic Evaluation Of Pancreatic Duct Injury In Children
*Eric H Rosenfeld1, *Adam M. Vogel1, *Robert Russell2, Ilan Maizlin2, *Mubeen Jafri3, *Brandon Behrens4, *Denise B. Klinkner5, Stephanie Polites5, *Barbara Gaines6, *Christine Leeper6, *Anthony Stallion7, Megan Waddell7, *Shawn St. Peter8, *David Juang9, *Rajan Thakkar10, *Joseph Drews11, *Randall Burd12, *Marianne Beaudin13, Laurence Carmant13, *Richard A. Falcone, Jr.14, *Suzanne Moody15, *Bindi J. Naik-Mathuria1
1Baylor College of Medicine/Texas Children's Hospital, Houston, TX;2University of Alabama at Birmingham, Birmingham, AL;3Randall Children's Hospital at Legacy Emanuel Medical Center, Portland, OR;4Oregon Health and Science University, Portland, OR;5Mayo Clinic, Rochester, MN;6Children’s Hospital of Pittsburgh`, Pittsburgh, PA;7Carolinas HealthCare System, Charlotte, NC;8Children’s Mercy Hospital, Kansas City, MO;9Children’s Mercy Hospital, Kansas City, MO, TX;10Nationwide Children’s Hospita, Colombus, OH;11Nationwide Children’s Hospital, Columbus, OH;12Children’s National Medical Center, Washington, DC;13Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC;14Cincinnati Children's, Cincinnati, OH;15Cincinnati Children's, Cincinnati, TX
Background: Determining the integrity of the pancreatic duct is important in pancreatic trauma. Our purpose was to compare magnetic resonance cholangiopancreatography (MRCP) and computed tomography (CT) for evaluating the pancreatic duct in children with pancreatic injury. Methods: Retrospective review of imaging reports of MRCP and CT obtained within a 7 day interval for children with suspected pancreatic duct injury between 2010-15. Comparisons were made using descriptive statistics, Students t-test and McNemar’s test. Findings: Data was collected from 11 trauma centers for 21 patients whose mean age was 7.8 years (range 1-15). Median time from injury to CT was 0.5 days and MRCP 2 days. The duct was visualized on CT: 1/21(5%) vs MRCP: 10/21(48%), was not visualized on CT: 3/21(14%) vs MRCP: 7/21(33%), and was not mentioned on CT: 17/21 (81%) vs MRCP: 2/21 (10%). Duct disruption was confirmed on CT: 1/21 (5%) vs MRCP: 5/21(24%), suspected due to secondary findings on CT: 11/21(52%) vs MRCP: 6/21(29%), and indeterminate on CT: 9/21(43%) vs MRCP: 6/21(29%). MRCP was better than CT for pancreatic duct identification (MRCP: 10(48%) vs CT: 1(5%), p=0.004), but not for determining duct integrity (suspected or confirmed) (MRCP: 15(71%) vs CT: 12(57%), p=0.5). Patient age did not correlate with success of determining duct integrity in either (median age MRCP: yes 8.0 vs no 7.3 years, p=0.8; CT: yes 6.1 vs no 9.0, p=0.13). Conclusions: In children with pancreatic trauma, MRCP is better than CT for identifying the pancreatic duct, but not for confirming duct integrity. Endoscopic retrograde cholangiopancreatography may be necessary when management decisions depend on duct integrity.
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