Skip to main content

Pancreas

  • Chapter
  • First Online:
Pediatric Body MRI

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.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Howard JM, Hess W. History of the 9ancreas: mysteries of a hidden organ. 2nd ed. New York: Springer; 2002.

    Book  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  4. Jaimes C, Gee MS. Strategies to minimize sedation in pediatric body magnetic resonance imaging. Pediatr Radiol. 2016;46(6):926–7.

    Article  Google Scholar 

  5. Semelka RC, Ascher SM. MR imaging of the pancreas. Radiology. 1993;188(3):593–602.

    Article  CAS  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  9. Manfredi R, Pozzi Mucelli R. Secretin-enhanced MR imaging of the pancreas. Radiology. 2016;279(1):29–43.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  11. Sadler TW. Langman’s medical embryology. 11th ed. Philadelphia: Lippincott Williams and Wilkins; 2010.

    Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  14. Sandrasegaran K, Patel A, Fogel E, Zyromski NJ, Pitt HA. Annular pancreas in adults. AJR Am J Roentgenol. 2009;193(2):455–60.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  Google Scholar 

  21. Shukla-Udawatta M, Madani S, Kamat D. An update on pediatric pancreatitis. Pediatr Ann. 2017;46(5):e207–11.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  30. Chung EM, Travis MD, Conran RM. Pancreatic tumors in children: radiologic-pathologic correlation. Radiographics. 2006;26:1211–38.

    Article  Google Scholar 

  31. Shet NS, Cole BL, Iyer RS. Imaging of pediatric pancreatic neoplasms with radiologic histopathologic correlation. AJR Am J Roentgenol. 2014;202:1337–48.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  33. Amodio J, Brodsky JE. Pediatric Burkitt lymphoma presenting as acute pancreatitis: MRI characteristics. Pediatr Radiol. 2010;40(5):770–2.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  35. Sivit CJ. Imaging children with abdominal trauma. AJR Am J Roentgenol. 2009;192(5):1179–89.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Monica Johnson .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Johnson, M., Anupindi, S.A., Gee, M.S. (2020). Pancreas. In: Lee, E., Liszewski, M., Gee, M., Daltro, P., Restrepo, R. (eds) Pediatric Body MRI. Springer, Cham. https://doi.org/10.1007/978-3-030-31989-2_9

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-31989-2_9

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-31988-5

  • Online ISBN: 978-3-030-31989-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics