Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC5031, Cincinnati, OH 45229.
Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH.
AJR Am J Roentgenol. 2024 Jul;223(1):e2431347. doi: 10.2214/AJR.24.31347. Epub 2024 Jul 31.
Pancreatic duct (PD) or common bile duct (CBD) dilatation can indicate ductal pathology, but limited data describe normal pediatric duct measurements on routine 2D MRI sequences. The purpose of this study was to characterize the visibility and diameter of the PD and CBD on 2D MR images in children without pancreaticobiliary disease. This retrospective study included patients who underwent abdominal MRI using a rapid protocol (composed of noncontrast axial and coronal 2D SSFSE sequences) to assess for suspected appendicitis or ovarian torsion in the emergency department setting between January 23, 2023, and September 13, 2023, and excluded patients with a pancreatic or hepatobiliary abnormality on MRI or laboratory assessment. Four pediatric radiologists independently reviewed examinations. Reviewers recorded PD visibility in each of four segments (i.e., head, neck, body, and tail) and CBD visibility, and reviewers measured PD diameter in each segment and maximal CBD diameter. Duct measurements by age were characterized by linear regression analyses. The study included 177 patients (112 female patients, 65 male patients; mean age, 12.3 ± 3.4 [SD] years [age range, 5.1-17.7 years]). The observers reported PD visibility in the head in 35.6-94.9% of patients, neck in 18.6-72.3%, body in 22.6-89.8%, and tail in 7.3-26.0% and reported PD visibility in all four segments in 6.2-22.6% of patients. Maximum PD diameter in any segment, as a mean across observers, was 1.8 mm (range across observers, 0.7-3.5 mm). The expected maximal PD diameter in any segment, in terms of the 5th and 95th percentile values of observers' mean measurements, was 1.4-2.3 mm; the prediction interval's upper limit increased from age 5 to age 17 from 2.1 to 2.5 mm. All observers reported CBD visibility in all patients. The mean CBD diameter across observers was 3.1 mm (range across observers, 2.9-3.4 mm). The expected CBD diameter, in terms of the 5th and 95th percentile values of observers' mean measurements, was 2.3-4.9 mm; the prediction interval's upper limit increased from age 5 to age 17 from 3.9 to 5.0 mm. We report expected upper limits for PD and CBD measurements on 2D MR images in children without evidence of pancreaticobiliary disease. These findings may aid radiologists' identification of pancreaticobiliary duct abnormalities on routine abdominal MRI examinations.
胰腺管 (PD) 或胆总管 (CBD) 扩张可能表明存在管腔病理学，但关于在常规 2D MRI 序列上测量儿科正常胆管的相关数据有限。本研究的目的是描述在没有胰胆管疾病的儿童中，2D MRI 图像上 PD 和 CBD 的可见性和直径。本回顾性研究纳入了 2023 年 1 月 23 日至 9 月 13 日期间在急诊科因疑似阑尾炎或卵巢扭转而行腹部 MRI 检查的患者，该 MRI 采用快速方案（由非对比轴向和冠状 2D SSFSE 序列组成），并排除了 MRI 或实验室检查显示存在胰腺或肝胆异常的患者。四位儿科放射科医生独立对检查结果进行了评估。评估者记录了 PD 在四个节段（头部、颈部、体部和尾部）中的可见性以及 CBD 的可见性，并测量了 PD 直径在各个节段和最大 CBD 直径。通过线性回归分析来描述年龄与管腔直径之间的关系。该研究共纳入了 177 名患者（112 名女性，65 名男性；平均年龄为 12.3 ± 3.4 [标准差] 岁[年龄范围为 5.1-17.7 岁]）。观察者报告 PD 在头部的可见性为 35.6%-94.9%，在颈部为 18.6%-72.3%，在体部为 22.6%-89.8%，在尾部为 7.3%-26.0%，4 位观察者中有 6.2%-22.6%的患者 PD 可见于所有四个节段。任何节段的最大 PD 直径为 1.8 毫米（观察者之间的范围为 0.7-3.5 毫米）。任何节段的最大 PD 直径的预期值（以观察者平均测量值的第 5 百分位和第 95 百分位来表示）为 1.4-2.3 毫米；预测区间上限从 5 岁到 17 岁时从 2.1 毫米增加到 2.5 毫米。所有观察者均报告了所有患者的 CBD 可见性。观察者之间 CBD 直径的平均值为 3.1 毫米（观察者之间的范围为 2.9-3.4 毫米）。CBD 直径的预期值（以观察者平均测量值的第 5 百分位和第 95 百分位来表示）为 2.3-4.9 毫米；预测区间上限从 5 岁到 17 岁时从 3.9 毫米增加到 5.0 毫米。我们报告了在没有胰胆管疾病证据的儿童中，2D MRI 图像上 PD 和 CBD 测量的预期上限。这些发现可能有助于放射科医生在常规腹部 MRI 检查中识别胰胆管异常。
