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



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.


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.


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).


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.

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  1. 1.

    Stawicki SP, Schwab CW (2008) Pancreatic trauma: demographics, diagnosis, and management. Am Surg 74(12):1133–1145

    PubMed  Google Scholar 

  2. 2.

    Iqbal CW, St Peter SD, Tsao K, Cullinane DC, Gourlay DM, Ponsky TA et al (2014) Operative vs nonoperative management for blunt pancreatic transection in children: multi-institutional outcomes. J Am Coll Surg 218(2):157–162

    Article  PubMed  Google Scholar 

  3. 3.

    Naik-Mathuria B (2016) Practice variability exists in the management of high-grade pediatric pancreatic trauma. Pediatr Surg Int 32(8):789–794

    Article  PubMed  Google Scholar 

  4. 4.

    Wong YC, Wang LJ, Fang JF, Lin BC, Ng CJ, Chen RJ (2008) Multidetector-row computed tomography (CT) of blunt pancreatic injuries: can contrast-enhanced multiphasic CT detect pancreatic duct injuries? J Trauma 64(3):666–672

    Article  PubMed  Google Scholar 

  5. 5.

    Rosenfeld EH, Vogel AM, Klinkner DB, Escobar M, Gaines B, Russell R et al (2017) The utility of ERCP in pediatric pancreatic trauma. J Pediatr Surg 53:146–151

    Article  Google Scholar 

  6. 6.

    Cirillo RL Jr, Koniaris LG (2002) Detecting blunt pancreatic injuries. J Gastrointest Surg Off J Soc Surg Aliment Tract 6(4):587–598

    Article  Google Scholar 

  7. 7.

    Gupta A, Stuhlfaut JW, Fleming KW, Lucey BC, Soto JA (2004) Blunt trauma of the pancreas and biliary tract: a multimodality imaging approach to diagnosis. Radiogr Rev Publ Radiol Soc N Am Inc 24(5):1381–1395

    Google Scholar 

  8. 8.

    Venkatesh SK, Wan JM (2008) CT of blunt pancreatic trauma: a pictorial essay. Eur J Radiol 67(2):311–320

    Article  PubMed  Google Scholar 

  9. 9.

    Rekhi S, Anderson SW, Rhea JT, Soto JA (2010) Imaging of blunt pancreatic trauma. Emerg Radiol 17(1):13–19

    Article  PubMed  Google Scholar 

  10. 10.

    Bradley EL III, Young PR Jr, Chang MC, Allen JE, Baker CC, Meredith W et al (1998) Diagnosis and initial management of blunt pancreatic trauma: guidelines from a multiinstitutional review. Ann Surg 227(6):861–869

    Article  PubMed  PubMed Central  Google Scholar 

  11. 11.

    Ilahi O, Bochicchio GV, Scalea TM (2002) Efficacy of computed tomography in the diagnosis of pancreatic injury in adult blunt trauma patients: a single-institutional study. Am Surg 68(8):704–707 (discussion 7–8)

    PubMed  Google Scholar 

  12. 12.

    Panda A, Kumar A, Gamanagatti S, Bhalla AS, Sharma R, Kumar S et al (2015) Evaluation of diagnostic utility of multidetector computed tomography and magnetic resonance imaging in blunt pancreatic trauma: a prospective study. Acta Radiol (Stockholm, Sweden: 1987) 56(4):387–396

    Google Scholar 

  13. 13.

    Phelan HA, Velmahos GC, Jurkovich GJ, Friese RS, Minei JP, Menaker JA et al (2009) An evaluation of multidetector computed tomography in detecting pancreatic injury: results of a multicenter AAST study. J Trauma 66(3):641–646 discussion 6–7.

    Article  PubMed  Google Scholar 

  14. 14.

    Wallnoefer AM, Herrmann KA, Beuers U, Zech CJ, Gourtsoyianni S, Reiser MF et al (2005) Comparison of 2D and 3D sequences for MRCP. Clinical value of the different techniques. Der Radiol 45(11):993-4, 6–1003

    Article  CAS  Google Scholar 

  15. 15.

    Nandalur KR, Hussain HK, Weadock WJ, Wamsteker EJ, Johnson TD, Khan AS et al (2008) Possible biliary disease: diagnostic performance of high-spatial-resolution isotropic 3D T2-weighted MRCP. Radiology 249(3):883–890

    Article  PubMed  Google Scholar 

  16. 16.

    Hekimoglu K, Ustundag Y, Dusak A, Erdem Z, Karademir B, Aydemir S et al (2008) MRCP vs. ERCP in the evaluation of biliary pathologies: review of current literature. J Dig Dis 9(3):162–169

    Article  PubMed  Google Scholar 

  17. 17.

    Kinner S, Dechene A, Ladd SC, Zopf T, de Dechene EM, Gerken G et al (2010) Comparison of different MRCP techniques for the depiction of biliary complications after liver transplantation. Eur Radiol 20(7):1749–1756

    Article  PubMed  Google Scholar 

  18. 18.

    Romagnuolo J, Bardou M, Rahme E, Joseph L, Reinhold C, Barkun AN (2003) Magnetic resonance cholangiopancreatography: a meta-analysis of test performance in suspected biliary disease. Ann Intern Med 139(7):547–557

    Article  PubMed  Google Scholar 

  19. 19.

    Taylor AC, Little AF, Hennessy OF, Banting SW, Smith PJ, Desmond PV (2002) Prospective assessment of magnetic resonance cholangiopancreatography for noninvasive imaging of the biliary tree. Gastrointest Endosc 55(1):17–22

    Article  PubMed  Google Scholar 

  20. 20.

    Guibaud L, Bret PM, Reinhold C, Atri M, Barkun AN (1995) Bile duct obstruction and choledocholithiasis: diagnosis with MR cholangiography. Radiology 197(1):109–115

    Article  PubMed  CAS  Google Scholar 

  21. 21.

    Moon JH, Cho YD, Cha SW, Cheon YK, Ahn HC, Kim YS et al (2005) The detection of bile duct stones in suspected biliary pancreatitis: comparison of MRCP, ERCP, and intraductal US. Am J Gastroenterol 100(5):1051–1057

    Article  PubMed  Google Scholar 

  22. 22.

    Varghese JC, Farrell MA, Courtney G, Osborne H, Murray FE, Lee MJ (1999) A prospective comparison of magnetic resonance cholangiopancreatography with endoscopic retrograde cholangiopancreatography in the evaluation of patients with suspected biliary tract disease. Clin Radiol 54(8):513–520

    Article  PubMed  CAS  Google Scholar 

  23. 23.

    Becker CD, Grossholz M, Becker M, Mentha G, de Peyer R, Terrier F (1997) Choledocholithiasis and bile duct stenosis: diagnostic accuracy of MR cholangiopancreatography. Radiology 205(2):523–530

    Article  PubMed  CAS  Google Scholar 

  24. 24.

    Calvo MM, Bujanda L, Calderon A, Heras I, Cabriada JL, Bernal A et al (2002) Comparison between magnetic resonance cholangiopancreatography and ERCP for evaluation of the pancreatic duct. Am J Gastroenterol 97(2):347–353

    Article  PubMed  Google Scholar 

  25. 25.

    Gillams AR, Kurzawinski T, Lees WR (2006) Diagnosis of duct disruption and assessment of pancreatic leak with dynamic secretin-stimulated MR cholangiopancreatography. AJR Am J Roentgenol 186(2):499–506

    Article  PubMed  CAS  Google Scholar 

  26. 26.

    Drake LM, Anis M, Lawrence C (2012) Accuracy of magnetic resonance cholangiopancreatography in identifying pancreatic duct disruption. J Clin Gastroenterol 46(8):696–699

    Article  PubMed  Google Scholar 

  27. 27.

    Fulcher AS, Turner MA, Yelon JA, McClain LC, Broderick T, Ivatury RR et al (2000) Magnetic resonance cholangiopancreatography (MRCP) in the assessment of pancreatic duct trauma and its sequelae: preliminary findings. J Trauma 48(6):1001–1007

    Article  PubMed  CAS  Google Scholar 

  28. 28.

    Sheikh F, Fallon S, Bisset G, Podberesky D, Zheng J, Orth R et al (2015) Image-guided prediction of pseudocyst formation in pediatric pancreatic trauma. J Surg Res 193(2):513–518

    Article  PubMed  Google Scholar 

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This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Correspondence to Eric H. Rosenfeld.

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Rosenfeld, E.H., Vogel, A., Russell, R.T. et al. Comparison of diagnostic imaging modalities for the evaluation of pancreatic duct injury in children: a multi-institutional analysis from the Pancreatic Trauma Study Group. Pediatr Surg Int 34, 961–966 (2018).

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