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Pancreas

  • Monica JohnsonEmail author
  • Sudha A. Anupindi
  • Michael S. Gee
Chapter
  • 13 Downloads

Abstract

Diagnostic imaging, including magnetic resonance (MR) imaging, plays an important role in diagnosing pancreatic disease in the pediatric population. MR cholangiopancreatography (MRCP) is a valuable noninvasive method for evaluating the pancreas and pancreaticobiliary tree. While MR imaging remains challenging in children, in recent years, novel pulse sequences have greatly improved image quality by increasing the speed of image acquisition and decreasing/compensating for motion and respiratory artifacts.

This chapter reviews the up-to-date and fundamental basics of pediatric pancreatic MR imaging protocols. Familiarity with the normal development and appearance of the pancreas allows radiologists to provide accurate and timely diagnoses. Therefore, this chapter discusses pancreatic embryology and common and less common congenital anomalies, including pancreas divisum, annular pancreas, agenesis and hypoplasia of the pancreas, and pancreatic ectopia. Next, congenital disorders which affect the pancreas are reviewed, including von Hippel-Lindau disease syndrome, cystic fibrosis, and Shwachman-Diamond syndrome. In these disorders, the pancreas undergoes cystic or fatty degeneration.

Pancreatitis is the most common pancreatic disease in children and may cause significant morbidity and mortality. MR imaging may play an important role in diagnosis and prognosis, as nearly a quarter of children eventually develop severe complications. The imaging features of acute pancreatitis, its complications, and chronic pancreatitis are described in this chapter.

Pancreatic neoplasms are fortunately uncommon in children. Even the most common pancreatic tumor, pancreaticoblastoma, is quite rare. The typical imaging and demographic features of pancreaticoblastoma and other pediatric pancreatic tumors are discussed, including solid pseudopapillary tumor, islet cell tumors, and lymphoma.

Lastly, this chapter also briefly discusses pancreatic traumatic injury, which may occur with seatbelt-type injuries or non-accidental trauma.

Keywords

Pancreas Magnetic resonance cholangiopancreatography (MRCP) Pancreatic divisum Annular pancreas Cystic fibrosis Pancreatitis Pancreaticoblastoma Solid pseudopapillary tumor Pancreatic traumatic injury 

References

  1. 1.
    Howard JM, Hess W. History of the 9ancreas: mysteries of a hidden organ. 2nd ed. New York: Springer; 2002.CrossRefGoogle Scholar
  2. 2.
    Restrepo R, Hagerott HE, Kulkarni S, Yasrebi M, Lee EY. Acute pancreatitis in pediatric patients: demographics, etiology, and diagnostic imaging. Am J Roentgenol. 2016;206(3):632–44.CrossRefGoogle Scholar
  3. 3.
    Trout AT, Podberesky DJ, Serai SD, Ren Y, Altaye M, Towbin AJ. Does secretin add value in pediatric magnetic resonance cholangiopancreatography? Pediatr Radiol. 2013;43(4):479–86.CrossRefGoogle Scholar
  4. 4.
    Jaimes C, Gee MS. Strategies to minimize sedation in pediatric body magnetic resonance imaging. Pediatr Radiol. 2016;46(6):926–7.CrossRefGoogle Scholar
  5. 5.
    Semelka RC, Ascher SM. MR imaging of the pancreas. Radiology. 1993;188(3):593–602.CrossRefGoogle Scholar
  6. 6.
    Nievelstein RA, Robben SGF, Blickman JG. Hepatobiliary and pancreatic imaging in children—techniques and an overview of neo-neoplastic disease entities. Pediatr Radiol. 2011;41(1):55–75.CrossRefGoogle Scholar
  7. 7.
    Jaimes C, Kirsch JE, Gee MS. Fast, free-breathing and motion-minimized techniques for pediatric body magnetic resonance imaging. Pediatr Radiol. 2018;48(9):1197–208.CrossRefGoogle Scholar
  8. 8.
    Chavhan GB, AlSabban Z, Babyn PS. Diffusion-weighted imaging in pediatric body mr imaging: principles, techniques, and emerging applications. Radiographics. 2014;34(3):E73–88.CrossRefGoogle Scholar
  9. 9.
    Manfredi R, Pozzi Mucelli R. Secretin-enhanced MR imaging of the pancreas. Radiology. 2016;279(1):29–43.CrossRefGoogle Scholar
  10. 10.
    Chavhan GB, Babyn PS, Vasanawala SS. Abdominal MR imaging in children: motion compensation, sequence optimization, and protocol organization. Radiographics. 2013;33(3):703–19.CrossRefGoogle Scholar
  11. 11.
    Sadler TW. Langman’s medical embryology. 11th ed. Philadelphia: Lippincott Williams and Wilkins; 2010.Google Scholar
  12. 12.
    Borghei P, Sokhandon F, Shirkhoda A, Morgan DE. Anomalies, anatomic variants, and sources of diagnostic pitfalls in pancreatic imaging. Radiology. 2013;266(1):28–36.CrossRefGoogle Scholar
  13. 13.
    Bülow R, Simon P, Thiel R, Thamm P, Messner P, Lerch MM, et al. Anatomic variants of the pancreatic duct and their clinical relevance: an MR-guided study in the general population. Eur Radiol. 2014;24(12):3142–9.CrossRefGoogle Scholar
  14. 14.
    Sandrasegaran K, Patel A, Fogel E, Zyromski NJ, Pitt HA. Annular pancreas in adults. AJR Am J Roentgenol. 2009;193(2):455–60.CrossRefGoogle Scholar
  15. 15.
    Schnedl WJ, Piswanger-Soeklner C, Wallner SJ, Reittner P, Krause R, Lipp RW, et al. Agenesis of the dorsal pancreas and associated diseases. Dig Dis Sci. 2009;54(3):481–7.CrossRefGoogle Scholar
  16. 16.
    Berrocal T, Pajares MP, Zubillaga AF. Pancreatic cystosis in children and young adults with cystic fibrosis: sonographic, CT, and MRI findings. AJR Am J Roentgenol. 2005;184(4):1305–9.CrossRefGoogle Scholar
  17. 17.
    Fields TM, Michel SJ, Butler CL, Kriss VM, Albers SL. Abdominal manifestations of cystic fibrosis in older children and adults. AJR Am J Roentgenol. 2006;187(5):1199–203.CrossRefGoogle Scholar
  18. 18.
    Toivianinen-Salo S, Raade M, Durie PR, Ip W, Marttinen E, Savilahti MO. Magnetic resonance imaging findings of the pancreas with Shwachman-Diamond syndrome and mutations in the SBDS gene. J Pediatr. 2008;152(3):434–6.CrossRefGoogle Scholar
  19. 19.
    Arnoux JB, de Lonlay P, Ribeiro MJ, Hussain K, Blankenstein O, Mohnike K, et al. Congenital hyperinsulinism. Early Hum Dev. 2010;86(5):287–94.CrossRefGoogle Scholar
  20. 20.
    Adzick NS, De Leon DD, States LJ, Lord K, Bhatti TR, Becker SA, Stanley CA. Surgical treatment of congenital hyperinsulinism: results from 500 pancreatectomies in neonates and children. J Pediatr Surg. 2019;54(1):27–32.CrossRefGoogle Scholar
  21. 21.
    Shukla-Udawatta M, Madani S, Kamat D. An update on pediatric pancreatitis. Pediatr Ann. 2017;46(5):e207–11.CrossRefGoogle Scholar
  22. 22.
    Morinville VD, Husain SZ, Bai H, Barth B, Alhosh R, Durie PR, et al. Definitions of pediatric pancreatitis and survey on present clinical practices. J Pediatr Gastroenterol Nutr. 2012;55(3):261–5.CrossRefGoogle Scholar
  23. 23.
    Anupini SA, Chauvin NA, Khwaja A, Biko DM. Magnetic resonance imaging of pancreaticobiliary diseases in children: from technique to practice. Pediatr Radiol. 2016;46(6):778–90.CrossRefGoogle Scholar
  24. 24.
    Thai TC, Riherd DM, Rust KR. MRI manifestations of pancreatic disease, especially pancreatitis, in the pediatric population. AJR Am J Roentgenol. 2013;201(6):W877–92. Review.CrossRefGoogle Scholar
  25. 25.
    Raizner A, Phatak UP, Baker K, Patel MG, Husain SZ, Pashankar DS. Acute necrotizing pancreatitis in children. J Pediatr. 2013;162(4):788–92.CrossRefGoogle Scholar
  26. 26.
    Kumar S, Ooi CY, Werlin S, Abu-El-Haija M, Barth B, Bellin MD, et al. Risk factors associated with pediatric acute recurrent and chronic pancreatitis: lessons from INSPPIRE. JAMA Pediatr. 2016;170(6):562–9.CrossRefGoogle Scholar
  27. 27.
    Bai HX, Lowe ME, Hussain SZ. What have we learned about acute pancreatitis in children? J Pediat Gastroenterol Nutr. 2011;52(3):262–70.CrossRefGoogle Scholar
  28. 28.
    Schwarzenberg SJ, Bellin M, Husain SZ, Monika A, Barth B, Davis H, et al. Pediatric chronic pancreatitis is associated with genetic risk factors and substantial disease burden. J Pediatr. 2015;166(4):890–6.CrossRefGoogle Scholar
  29. 29.
    Scheers I, Palermo JJ, Freedman S, Wilschanski M, Shah U, Abu-El-Haij M, et al. Autoimmune pancreatitis in children: characteristic features, diagnosis, and management. Am J Gastroenterol. 2017;112(10):1604–11.CrossRefGoogle Scholar
  30. 30.
    Chung EM, Travis MD, Conran RM. Pancreatic tumors in children: radiologic-pathologic correlation. Radiographics. 2006;26:1211–38.CrossRefGoogle Scholar
  31. 31.
    Shet NS, Cole BL, Iyer RS. Imaging of pediatric pancreatic neoplasms with radiologic histopathologic correlation. AJR Am J Roentgenol. 2014;202:1337–48.CrossRefGoogle Scholar
  32. 32.
    Koc G, Sugimoto S, Kuperman R, Kammen BF, Karakas SP. Pancreatic tumors in children and young adults with tuberous sclerosis complex. Pediatr Radiol. 2016;47(1):39–45.CrossRefGoogle Scholar
  33. 33.
    Amodio J, Brodsky JE. Pediatric Burkitt lymphoma presenting as acute pancreatitis: MRI characteristics. Pediatr Radiol. 2010;40(5):770–2.CrossRefGoogle Scholar
  34. 34.
    Kim SJ, Kim WS, Cheon JE, Shin SM, Youn BJ, Kim IO, Yeon KM. Inflammatory myofibroblastic tumors of the abdomen as mimickers of malignancy: imaging features in nine children. AJR Am J Roentgenol. 2009;193:1419–24.CrossRefGoogle Scholar
  35. 35.
    Sivit CJ. Imaging children with abdominal trauma. AJR Am J Roentgenol. 2009;192(5):1179–89.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Monica Johnson
    • 1
    Email author
  • Sudha A. Anupindi
    • 2
  • Michael S. Gee
    • 3
  1. 1.Department of RadiologyMassachusetts General Hospital, Harvard Medical SchoolBostonUSA
  2. 2.Department of Radiology, The Children’s Hospital of Philadelphia, Perelman School of Medicine, University of PennsylvaniaPhiladelphiaUSA
  3. 3.Division of Pediatric Imaging, Department of RadiologyMassachusetts General Hospital, Harvard Medical SchoolBostonUSA

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