Acute Pancreatitis and Acute Recurrent Pancreatitis in Children: Imaging Findings and Outcomes.

OBJECTIVE: The prevalence of acute pancreatitis and acute recurrent pancreatitis in children has increased over the years, and there are limited data about imaging findings. This study aimed to reveal the imaging findings of acute pancreatitis and acute recurrent pancreatitis in children at a tertiary care hospital. MATERIALS AND METHODS: The patients with acute pancreatitis and acute recurrent pancreatitis diagnosed between January 2007 and December 2018 were included. Demographic and clinical features, follow-up period, and interventions were noted. Imaging features were evaluated for pancreatic enlargement, peripancreatic fluid, and biliary ducts for initial examination and pancreas parenchymal necrosis, peripancreatic collection, walled-off necrosis, pseudocyst, parenchymal atrophy, and biliary ductal dilatation for follow-up. RESULTS: The study included 74 patients with a mean age of 9 ± 4.9 years. The most common causes of acute pancreatitis and acute recurrent pancreatitis were biliary tract anomalies (n = 21), biliary ductal stones (n = 9), and cystic fibrosis (n = 8). Findings consistent with acute pancreatitis were determined by ultrasound in 40.5% (n = 30/74), whereas by magnetic resonance imaging in 60% (n = 39/65). Forty-one percent of the patients (n = 16) with positive magnetic resonance imaging findings did not show any findings on ultrasound. Acute recurrent pancreatitis was seen in 32 patients (43.2%). Follow-up imaging was performed in 55 patients (74.3%) between 2 months and 11 years. At follow-up, 8 patients had peripancreatic collections (6 walled-off necrosis and 2 pseudocysts). CONCLUSION: Recognizing the imaging findings of acute pancreatitis and its complications is crucial. Magnetic resonance imaging should be preferred as a second option following ultrasound, with the advantages of biliary ductal system delineation and better characterization of complications.

Are the thickness and ADC values reliable to evaluate pancreas in children? A retrospective MRI study.

PURPOSE: To define the pancreatic thickness on the transverse plane and apparent diffusion coefficient (ADC) values at multiple anatomical locations in the normal pancreas of children and to evaluate inter-rater and intra-rater reliability. METHODS: Two reviewers measured the thickness and ADC values of the pancreas at four locations obtained from two different 1,5 Tesla MRI scanners [MAGNETOM Symphony (Siemens Medical Systems, Erlangen, Germany) and Signa HDxt(GE Healthcare, Milwaukee, WI, USA)]. Measurements were made based on 190 retrospective MRI examinations. Patients were distributed among ten age groups for thickness measurements and three age groups for ADC measurements between 0 and 18 years. RESULTS: The thickness measurements from each segment of the pancreas were significantly correlated with patient age, height and weight (p < 0.01). Inter-rater agreement was excellent for pancreatic head (intraclass correlation coefficient (ICC): 0.837) and good for pancreatic neck, body and tail (ICC: 0.646, 0.632 and 0.678, respectively). We also defined the mean ADC values for three age groups. There was significant difference in the mean ADC value of the head and body by both the vendor and age group (p < 0.05). The mean ADC values and mean ranks of the Signa HDxt were significantly higher and the frequencies were lower than those of the MAGNETOM Symphony at all locations (p < 0.001). CONCLUSION: The thickness of the pancreatic head is more reliable than that at other locations. Pancreatic body and tail measurements are not as reliable as head or neck measurements due to discrepancies between published studies and low interobserver agreement. ADC values of the normal pancreas can be significantly different among vendors; therefore, ADC comparison on follow-up should be performed using same MRI machine.

Increased ocular wall thickness and decreased globe volume in children with mucopolysaccharidosis type VI.

PURPOSE lthough clinical ophthalmologic findings have been reported, no study documented magnetic resonance imaging (MRI) findings in mucopolysaccharidosis (MPS) type VI. The aim of this study was to determine the ophthalmologic imaging findings of MPS type VI in the pediatric age group retrospectively. METHODS Brain MRIs of 10 patients with MPS type VI and 49 healthy children were evaluated independently by two pediatric radiologists for the following characteristics: globe volume, ocular wall thickness, and optic nerve sheath diameter for each orbit. The means of the measurement of each group were compared by using an independent t-test. Agreement and bias between reviewers were assessed by intra-class correlation coefficients (ICC). RESULTS A total of 59 children [32 girls (54.23%), 27 boys (45.77%); age range, 4-16 years; mean age, 10.37 ± 3.73 years] were included in the study. Statistical analysis revealed smaller eyeballs and thicker ocular walls of patients with MPS type VI (P < .001 and P < .001, respectively). However, there was no statistically significant difference in terms of optic nerve sheath diameter between the two groups (P=.648). CONCLUSION Patients with MPS type VI displayed reduced globe volumes and increased ocular wall thicknesses compared to the healthy children. Therefore, we recommend that ophthalmologic imaging findings might prove to be an auxiliary tool in the diagnosis of MPS patients.

Influence of direct radiography in decision making during orthopaedic trauma surgery: A prospective study.

Objective: To evaluate the effects of intraoperative direct radiography on the change in the patient's treatment and the reliability of fluoroscopy in orthopaedic trauma surgery operations. Methods: A total of 773 fractures were evaluated prospectively. The surgeons involved in the case were divided into three groups according to their experiences: less than 5 years, 5-10 years and over 10 years. After each case, the fracture classification, whether any interventions were made after the X-ray, and the interventions were recorded. Results: There were 312(40%) intra-articular, 200(26%) metaphyseal, 161(21%) diaphyseal, 81(10%) pelvis-acetabulum, and 19(3%) vertebrae fractures. Surgeons needed to intervene in 71(9.2%) cases after direct-radiography. There was a significant difference between the location of the fracture and the number of interventions (p < 0.001). The most frequent interventions were intra-articular distal radius, acetabulum and intra-articular calcaneus fractures, respectively. Surgeons with more than 10 years of the experience felt the need to make fewer changes, it was statistically significant compared to the other two groups (p = 0.001 for both). Conclusion: It was found that the final evaluation with x-ray images before the operation was completed in trauma surgery affected the surgeon's decision. In particular, intra-articular fractures, acetabular fractures, and vertebral fractures are recommended to evaluate fixation with direct radiography in addition to fluoroscopy images before ending the operation. Level of evidence: LEVEL III.

Imaging findings of benign and malignant pediatric splenic lesions.

Splenic lesions in children have a wide histological spectrum. The majority of pediatric splenic lesions are benign and detected incidentally, and the most common benign lesions are cysts, followed by hemangiomas and lymphatic malformations. Most of the splenic malignancies in children are secondary to leukemia or lymphoma. The purpose of this article is to describe the ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI) features of benign and malignant splenic lesions in the pediatric age group.