the pancreas can be a little bit difficult to see sometimes. Especially in larger patients and as you say, in patients that are NPO, if you've got a stomach full of gas or if you have an ileus because there's a real inflammatory process going on, all that bowel gas can really affect the penetration of the ultrasound waves
MRI has advantages over CT in terms of the soft tissue contrast that you get with the multiple different MRI sequences, and Going to provide you the best visualization of both parenchymal and duct changes that we see with chronic pancreatitis.
clinicalUltrasound is the initial imaging modality for acute pancreatitis because it is radiation-free and can identify gallstones and CBD dilation, but is limited for detecting complications↗
▶Ep 2 · 25:39
quotethe pancreas can be a little bit difficult to see sometimes. Especially in larger patients and as you say, in patients that are NPO, if you've got a stomach full of gas or if you have an ileus because there's a real inflammatory process going on, all that bowel gas can really affect the penetration of the ultrasound waves↗
▶Ep 2 · 28:19
clinicalCT is the imaging modality of choice for suspected complicated pancreatitis; a portal venous phase is sufficient without multi-phase imaging in pediatric patients↗
▶Ep 2 · 28:41
clinicalOral contrast is helpful in CT to separate fluid-filled bowel loops from pancreatic fluid collections, but is not a deal breaker if the patient cannot tolerate it↗
▶Ep 2 · 29:51
clinicalAbsent enhancement on contrast CT is highly concerning for pancreatic necrosis↗
▶Ep 2 · 30:00
quotewhen we see absent enhancement like that, that's highly concerning for necrosis within the. Pancreas.↗
Function Tests & Pain Management: Pancreatic Disease
▶Ep 3 · 5:07
quoteWhat we're trying to do here at Cincinnati Children's with the MRPFTs or MR pancreatic function testing is to non-invasively accomplish or at least simulate what's going on with the endoscopic pancreatic function testing.↗
▶Ep 3 · 5:18
clinicalMR pancreatic function testing acquires identical imaging both prior to and following administration of secretin↗
▶Ep 3 · 6:27
clinicalThe delay between pre and post secretin imaging in their protocol is about 15 minutes to allow fluid to accumulate↗
▶Ep 3 · 7:38
clinicalMR sequences can be thresholded to quantify the volume of fluid secreted by subtracting pre-secretin from post-secretin fluid volume↗
▶Ep 3 · 7:48
quoteThe goal of this ultimately is to even go less invasive. You've gone from drying to endoscopic. Can we now go from endoscopic to completely noninvasive, just an IV in your arm for the secretin and measure your fluid by MRI.↗
▶Ep 3 · 8:13
clinicalAccurate fluid quantitation has been proven using phantoms in the MR scanner↗
▶Ep 3 · 8:28
clinicalPreliminary data in about 35 patients is examining correlation between endoscopic pancreatic function testing and MR-based assessment↗
▶Ep 3 · 8:49
opinionQualitative assessment of exocrine function appears different between pediatric and adult patients↗
▶Ep 3 · 9:41
clinicalIn chronic pancreatitis patients with ductal changes, the duct at baseline is dilated and abnormal, making it visible even without secretin↗
Chronic Pancreatitis, Function Tests, & Pain Management: Pancreatic Disease
▶Ep 4 · 29:53
guidelineMR pancreatic function testing acquires identical imaging both prior to and following secretin administration, with about 15 minutes between pre and post imaging↗
▶Ep 4 · 32:00
clinicalMR sequences can be thresholded to quantify the volume of fluid secreted in response to secretin by subtracting pre from post measurements↗
▶Ep 4 · 34:15
opinionIn chronic pancreatitis patients with dilated and abnormal ducts at baseline, it is unclear whether secretin is needed to increase conspicuity of the duct↗
Acute and Acute Recurrent Pancreatitis: Pancreatic Disease
▶Ep 6 · 33:31
guidelineCT for pancreatitis should use portal venous phase only, not multi-phase, to assess for complications like venous thrombosis, necrosis, and fluid collections↗
▶Ep 6 · 33:50
clinicalOral contrast is helpful for CT to separate fluid-filled bowel loops from pancreatic fluid collections, but exam can provide useful information without it in sick patients↗
▶Ep 6 · 45:01
opinionEvidence for secretin use in pediatric MRCP is limited; adult literature shows iffy data on added value↗
▶Ep 6 · 45:18
clinicalIn chronic pancreatitis or acute recurrent cases, pancreatic ducts are often dilated enough to visualize without secretin↗
Acute Pancreatitis
▶Ep 12 · 2:09
guidelineUltrasound is the initial imaging modality for suspected uncomplicated acute pancreatitis in children because it is radiation-free and gives a reasonably good look at the pancreas, though limited for detecting complications.↗
▶Ep 12 · 25:39
clinicalThe pancreas can be difficult to visualize on ultrasound in larger patients, when the patient is not NPO (stomach full of gas), or when there is ileus from inflammation; bowel gas affects ultrasound wave penetration.↗
▶Ep 12 · 28:19
clinicalFor pediatric pancreatitis CT, a single portal venous phase is sufficient; multi-phase imaging is not needed unless looking for masses. Oral contrast helps separate fluid-filled bowel from pancreatic fluid collections but is not mandatory.↗
▶Ep 12 · 29:05
guidelineCT is the test of choice when complications are suspected in acute pancreatitis; it provides the best view of the pancreas, adjacent structures, and potential complications like necrosis, fluid collections, and vascular thrombosis.↗
▶Ep 12 · 30:00
clinicalAbsent enhancement on contrast-enhanced CT is highly concerning for pancreatic necrosis.↗
▶Ep 12 · 42:36
opinionSecretin-enhanced MRCP may improve visualization of ductal anomalies, but adult literature shows iffy data on added value, and in pediatric acute recurrent pancreatitis the ducts are often dilated enough to see without secretin.↗
Chronic Pancreatitis - Pancreatic Pathologies by Cincinnati Children's Pancreas Care Center
▶Ep 20 · 2:15
guidelineFor CT imaging, a single phase with portal venous contrast is adequate↗
▶Ep 20 · 2:19
quoteMRI has advantages over CT in terms of the soft tissue contrast that you get with the multiple different MRI sequences, and Going to provide you the best visualization of both parenchymal and duct changes that we see with chronic pancreatitis.↗
▶Ep 20 · 2:19
clinicalMRI has advantages over CT in terms of soft tissue contrast with multiple different sequences, providing the best visualization of both parenchymal and duct changes in chronic pancreatitis↗
▶Ep 20 · 2:50
quoteAnd non-contrast CT is essentially never needed in a child with pancreatitis.↗
▶Ep 20 · 2:50
guidelineNon-contrast CT is essentially never needed in a child with pancreatitis because calcifications can be seen on post-contrast phases↗
▶Ep 20 · 3:13
clinicalKey MRI sequences are 3D MRCP to characterize the duct and its relationship to the bile duct, and T1 weighted sequence to understand parenchymal health↗
▶Ep 20 · 3:25
guidelineMRI exams can often be performed without IV contrast except for initial characterization when understanding vascular complications or fluid collections↗
