Comparison of diagnostic imaging modalities for the evaluation of pancreatic duct injury in children: a multi-institutional analysis from the Pancreatic Trauma Study Group

Eric H. Rosenfeld, Adam Vogel, Robert T. Russell, Ilan Maizlin, Denise B. Klinkner, Stephanie Polites, Barbara Gaines, Christine Leeper, Stallion Anthony, Megan Waddell, Shawn St. Peter, David Juang, Rajan Thakkar, Joseph Drews, Brandon Behrens, Mubeen Jafri, Randall S. Burd, Marianne Beaudin, Laurence Carmant, Richard A. FalconeSuzanne Moody, Bindi J. Naik-Mathuria

Research output: Contribution to journalArticle

Abstract

Purpose: Determining the integrity of the pancreatic duct is important in high-grade pancreatic trauma to guide decision making for operative vs non-operative management. Computed tomography (CT) is generally an inadequate study for this purpose, and magnetic resonance cholangiopancreatography (MRCP) is sometimes obtained to gain additional information regarding the duct. The purpose of this multi-institutional study was to directly compare the results from CT and MRCP for evaluating pancreatic duct disruption in children with these rare injuries. Methods: Retrospective study of data obtained from eleven pediatric trauma centers from 2010 to 2015. Children up to age 18 with suspected blunt pancreatic duct injury who had both CT and MRCP within 1 week of injury were included. Imaging findings of both studies were directly compared and analyzed using descriptive statistics, Chi square, Wilcoxon rank-sum, and McNemar’s tests. Results: Data were collected for 21 patients (mean age 7.8 years). The duct was visualized more often on MRCP than CT (48 vs 5%, p < 0.05). Duct disruption was confirmed more often on MRCP than CT (24 vs 0%), suspected based on secondary findings equally (38 vs 38%), and more often indeterminate on CT (62 vs 38%). Overall, MRCP was not superior to CT for determining duct integrity (62 vs 38%, p = 0.28). Conclusions: In children with blunt pancreatic injury, MRCP is more useful than CT for identifying the pancreatic duct but may not be superior for confirmation of duct integrity. Endoscopic retrograde cholangiogram (ERCP) may be necessary to confirm duct disruption when considering pancreatic resection. Level of evidence: III.

Original languageEnglish (US)
Pages (from-to)961-966
Number of pages6
JournalPediatric Surgery International
Volume34
Issue number9
DOIs
StatePublished - Sep 1 2018
Externally publishedYes

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Magnetic Resonance Cholangiopancreatography
Pancreatic Ducts
Diagnostic Imaging
Tomography
Wounds and Injuries
Nonpenetrating Wounds
Trauma Centers
Endoscopic Retrograde Cholangiopancreatography
Nonparametric Statistics
Decision Making
Retrospective Studies
Pediatrics

Keywords

  • CT
  • Diagnostic imaging
  • MRCP
  • Pancreatic trauma
  • Pediatrics

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery

Cite this

Comparison of diagnostic imaging modalities for the evaluation of pancreatic duct injury in children : a multi-institutional analysis from the Pancreatic Trauma Study Group. / Rosenfeld, Eric H.; Vogel, Adam; Russell, Robert T.; Maizlin, Ilan; Klinkner, Denise B.; Polites, Stephanie; Gaines, Barbara; Leeper, Christine; Anthony, Stallion; Waddell, Megan; St. Peter, Shawn; Juang, David; Thakkar, Rajan; Drews, Joseph; Behrens, Brandon; Jafri, Mubeen; Burd, Randall S.; Beaudin, Marianne; Carmant, Laurence; Falcone, Richard A.; Moody, Suzanne; Naik-Mathuria, Bindi J.

In: Pediatric Surgery International, Vol. 34, No. 9, 01.09.2018, p. 961-966.

Research output: Contribution to journalArticle

Rosenfeld, EH, Vogel, A, Russell, RT, Maizlin, I, Klinkner, DB, Polites, S, Gaines, B, Leeper, C, Anthony, S, Waddell, M, St. Peter, S, Juang, D, Thakkar, R, Drews, J, Behrens, B, Jafri, M, Burd, RS, Beaudin, M, Carmant, L, Falcone, RA, Moody, S & Naik-Mathuria, BJ 2018, 'Comparison of diagnostic imaging modalities for the evaluation of pancreatic duct injury in children: a multi-institutional analysis from the Pancreatic Trauma Study Group', Pediatric Surgery International, vol. 34, no. 9, pp. 961-966. https://doi.org/10.1007/s00383-018-4309-2
Rosenfeld, Eric H. ; Vogel, Adam ; Russell, Robert T. ; Maizlin, Ilan ; Klinkner, Denise B. ; Polites, Stephanie ; Gaines, Barbara ; Leeper, Christine ; Anthony, Stallion ; Waddell, Megan ; St. Peter, Shawn ; Juang, David ; Thakkar, Rajan ; Drews, Joseph ; Behrens, Brandon ; Jafri, Mubeen ; Burd, Randall S. ; Beaudin, Marianne ; Carmant, Laurence ; Falcone, Richard A. ; Moody, Suzanne ; Naik-Mathuria, Bindi J. / Comparison of diagnostic imaging modalities for the evaluation of pancreatic duct injury in children : a multi-institutional analysis from the Pancreatic Trauma Study Group. In: Pediatric Surgery International. 2018 ; Vol. 34, No. 9. pp. 961-966.
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abstract = "Purpose: Determining the integrity of the pancreatic duct is important in high-grade pancreatic trauma to guide decision making for operative vs non-operative management. Computed tomography (CT) is generally an inadequate study for this purpose, and magnetic resonance cholangiopancreatography (MRCP) is sometimes obtained to gain additional information regarding the duct. The purpose of this multi-institutional study was to directly compare the results from CT and MRCP for evaluating pancreatic duct disruption in children with these rare injuries. Methods: Retrospective study of data obtained from eleven pediatric trauma centers from 2010 to 2015. Children up to age 18 with suspected blunt pancreatic duct injury who had both CT and MRCP within 1 week of injury were included. Imaging findings of both studies were directly compared and analyzed using descriptive statistics, Chi square, Wilcoxon rank-sum, and McNemar’s tests. Results: Data were collected for 21 patients (mean age 7.8 years). The duct was visualized more often on MRCP than CT (48 vs 5{\%}, p < 0.05). Duct disruption was confirmed more often on MRCP than CT (24 vs 0{\%}), suspected based on secondary findings equally (38 vs 38{\%}), and more often indeterminate on CT (62 vs 38{\%}). Overall, MRCP was not superior to CT for determining duct integrity (62 vs 38{\%}, p = 0.28). Conclusions: In children with blunt pancreatic injury, MRCP is more useful than CT for identifying the pancreatic duct but may not be superior for confirmation of duct integrity. Endoscopic retrograde cholangiogram (ERCP) may be necessary to confirm duct disruption when considering pancreatic resection. Level of evidence: III.",
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T1 - Comparison of diagnostic imaging modalities for the evaluation of pancreatic duct injury in children

T2 - a multi-institutional analysis from the Pancreatic Trauma Study Group

AU - Rosenfeld, Eric H.

AU - Vogel, Adam

AU - Russell, Robert T.

AU - Maizlin, Ilan

AU - Klinkner, Denise B.

AU - Polites, Stephanie

AU - Gaines, Barbara

AU - Leeper, Christine

AU - Anthony, Stallion

AU - Waddell, Megan

AU - St. Peter, Shawn

AU - Juang, David

AU - Thakkar, Rajan

AU - Drews, Joseph

AU - Behrens, Brandon

AU - Jafri, Mubeen

AU - Burd, Randall S.

AU - Beaudin, Marianne

AU - Carmant, Laurence

AU - Falcone, Richard A.

AU - Moody, Suzanne

AU - Naik-Mathuria, Bindi J.

PY - 2018/9/1

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N2 - Purpose: Determining the integrity of the pancreatic duct is important in high-grade pancreatic trauma to guide decision making for operative vs non-operative management. Computed tomography (CT) is generally an inadequate study for this purpose, and magnetic resonance cholangiopancreatography (MRCP) is sometimes obtained to gain additional information regarding the duct. The purpose of this multi-institutional study was to directly compare the results from CT and MRCP for evaluating pancreatic duct disruption in children with these rare injuries. Methods: Retrospective study of data obtained from eleven pediatric trauma centers from 2010 to 2015. Children up to age 18 with suspected blunt pancreatic duct injury who had both CT and MRCP within 1 week of injury were included. Imaging findings of both studies were directly compared and analyzed using descriptive statistics, Chi square, Wilcoxon rank-sum, and McNemar’s tests. Results: Data were collected for 21 patients (mean age 7.8 years). The duct was visualized more often on MRCP than CT (48 vs 5%, p < 0.05). Duct disruption was confirmed more often on MRCP than CT (24 vs 0%), suspected based on secondary findings equally (38 vs 38%), and more often indeterminate on CT (62 vs 38%). Overall, MRCP was not superior to CT for determining duct integrity (62 vs 38%, p = 0.28). Conclusions: In children with blunt pancreatic injury, MRCP is more useful than CT for identifying the pancreatic duct but may not be superior for confirmation of duct integrity. Endoscopic retrograde cholangiogram (ERCP) may be necessary to confirm duct disruption when considering pancreatic resection. Level of evidence: III.

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