Highly resolved free-breathing magnetic resonance cholangiopancreatography in the diagnostic workup of pancreaticobiliary diseases in infants and young children--initial experiences.
OBJECTIVE
A new generation of magnetic resonance imaging scanner offers a 3-dimensional magnetic resonance cholangiopancreatography (MRCP) with very high spatial resolution using a non-breath-hold technique with prospective navigator gating. The study aimed to investigate the new technology of the MRCP in infants with suspected pancreaticobiliary diseases.


METHODS
Seven patients (4 girls, 3 boys; mean age, 2.8 years; range, 3 months to 5.6 years) were examined. All patients underwent magnetic resonance imaging examination using a 1.5-T whole-body scanner (Magnetom Avanto, Siemens Medical, Erlangen, Germany). For MRCP, a heavily T2-weighted (time to echo, 678 ms) 3-dimensional turbo spin echo in coronal plane was performed with the voxel size of 1 x 1 x 1.5 mm. To enable non-breath-holding imaging, a diaphragm navigator sequence was simultaneously carried out. The MRCP findings were compared prospectively with the endoscopic retrograde cholangiopancreatography and/or with the surgical findings in 6 of 7 cases. In 1 patient, the follow-up was considered reference standard.


RESULTS
The high spatial resolution of the images without breathing artifacts allowed an excellent demonstration of all relevant pancreaticobiliary ducts and of the pathologic findings. All patients (n = 4) with choledocholithiasis were identified through MRCP. The finding of a high pancreaticobiliary junction (n = 3) was confirmed by endoscopic retrograde cholangiopancreatography in all cases. The length of the common channel ranged from 16 to 24 mm. In 1 patient, the long common channel was associated with a choledochal cyst. In a 1.7-year-old boy with recurrent abdominal pain and mild pancreatitis, the rare case of a gastric duplication with connection to the main pancreatic duct was diagnosed. A regular gastric wall with normal mucosa and parts of the duodenal wall with a circular layer of muscle (pylorus-like) were found in histology after surgical resection of the mass.


CONCLUSIONS
The newly developed technique may be a reliable tool in the workup of pancreaticobiliary diseases in infants.
Schaefer
Juergen F
JF
Department of Diagnostic Radiology, University of Tuebingen, 72076 Tuebingen, Germany. juergen.schaefer@med.uni-tuebingen.de
Kirschner
Hans-Joachim
HJ
Lichy
Matthias
M
Schlemmer
Heinz P
HP
Schick
Fritz
F
Claussen
Claus D
CD
Fuchs
Joerg
J
D001659:Biliary Tract / Q000002:abnormalities; D001660:Biliary Tract Diseases / Q000000981:diagnostic imaging*; D002675:Child, Preschool; D002760:Cholangiopancreatography, Endoscopic Retrograde; D049448:Cholangiopancreatography, Magnetic Resonance / Q000379:methods*; D015529:Choledochal Cyst / Q000150:complications / Q000000981:diagnostic imaging; D042883:Choledocholithiasis / Q000000981:diagnostic imaging; D004065:Digestive System Abnormalities / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D042882:Gallstones / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D007223:Infant; D008297:Male; D010179:Pancreas / Q000002:abnormalities; D010182:Pancreatic Diseases / Q000000981:diagnostic imaging*; D013270:Stomach / Q000002:abnormalities