Study of the hepatobiliary and pancreatic ductal system abnormalities in children with hepatobiliary pancreatic ductal system disorders
Journal Title: Journal of Medical Sciences - Year 2015, Vol 18, Issue 1
Abstract
BACKGROUND: Hepatobiliary and pancreatic disorders in children are infrequent and include duct malunion (APBD union), Extrahepatic biliary atresia (EHBA), Caroli's disease, primary sclerosing cholangitis, pancreas divisum and pancreatic duct abnormalities. Investigations used for evaluation of these disorders in children range from USG, HIDA Scan, CT, ERCP, Cholangiography and MRCP. Among these MRCP is a non-invasive investigation which has the potential to delineate the hepatobiliary pancreatic ductal system pre-operatively to help surgeon in diagnosis and operative planning AIMS AND OBJECTIVES: The purpose of this study is to determine whether MRCP is feasible in paediatric age group patients and to look for the possible measures to optimize the pediatric MRI. MATERIAL AND METHODS: This study was a prospective and descriptive study between Oct-2012 to Jan-2015. We examined 50 consecutive children (28 boys and 22 girls), who were suspected of having the pancreaticobiliary disease. Besides baseline USG, MRCP was performed in all patients. The findings of MRCP were compared with those of intraoperative cholangiography (IOC). RESULTS: A total of 50 children (7 neonates, 17 infants and 26 older children), 30 children with ductal dilatation and 20 children with cholestatic jaundice. The sensitivity, specificity and accuracy of MRCP were 50%, 75% and 60% respectively in detecting the APBD-union in our series.The sensitivity, specificity, accuracy, Positive predictive value and Negative predictive value of MRCP were 84.61%, 85.71% and 85%, 91.66%, and 75% respectively in detecting biliary atresia. For patients with neonatal cholestasis, biliary atresia was excluded if there was visualization of normal extra-hepatic biliary system at MR cholangiography. Sedation was required in 10 patients for an optimal MRCP. CONCLUSION: MRCP is effective in delineating choledochal cyst type, and helpful in diagnosing related pancreaticobiliary anomalies, such as APBD–union. But more evaluation needs to be done to assess the MRCP ability to detect APBD–union. Furthermore, from our preliminary results, we can conclude that BA can be ruled out if complete extrahepatic bile duct (EHBD) is delineated on MRCP.
Authors and Affiliations
Raashid Hamid, Nisar Ahmad Bhat, Feroze Shaheen, Gulzar GM
Keywords
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