Validation of threshold values for pancreas thickness and T1-weighted signal intensity ratio in the pediatric pancreas

Abstract

Background

Pancreas atrophy and the loss of T1-weighted signal intensity by magnetic resonance imaging (MRI) are findings of chronic pancreatitis.

Objective

The purpose of this study was to test published normal values and cutoffs for pancreas thickness and the pancreas:spleen T1-weighted signal intensity ratio in children without pancreatic disease.

Materials and methods

This was a secondary analysis of prospectively collected MRI data for 50 children (range: 6.3–15.9 years; 27 female) with no history of pancreatic disease. Two observers (R1, R2) measured linear pancreas thickness on axial T1-weighted, fat-saturated gradient recalled echo images and placed regions of interest in the pancreas and spleen to calculate the T1-weighted signal intensity ratio. Measurements were compared to published pediatric normal values (computed tomography [CT], ultrasound [US]) and adult cutoffs (CT, MRI).

Results

Compared to published pediatric values for CT, 68% (R1: 34/50) or 40% (R2: 22/50) of participants had ≥1 pancreas segment with thickness below the normal range. No participant had a thickness value below the normal range published for US. Compared to cutoff values in adults, 84% (R1: 42/50) or 80% (R2: 40/50) of participants met the criteria for pancreas atrophy. Mean T1-weighted signal intensity ratio was 1.33±0.15 (R1) and 1.32±0.16 (R2). Twelve (R1: 24.5% of 49) or 11/49 (R2: 22.4%) participants had a T1-weighted signal intensity ratio below the threshold associated with exocrine insufficiency in adults.

Conclusion

Previously defined thresholds for pancreas thickness and pancreas:spleen T1-weighted signal intensity ratio appear too restrictive for a pediatric population. Further study is needed to define optimal quantitative metrics for findings of chronic pancreatitis in children.

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References

  1. 1.

    Kim DH, Pickhardt PJ (2007) Radiologic assessment of acute and chronic pancreatitis. Surg Clin North Am 87:1341–1358

    Article  Google Scholar 

  2. 2.

    Morinville VD, Husain SZ, Bai H et al (2012) Definitions of pediatric pancreatitis and survey of present clinical practices. J Pediatr Gastroenterol Nutr 55:261–265

  3. 3.

    Remer EM, Baker ME (2002) Imaging of chronic pancreatitis. Radiol Clin North Am 40:1229–1242

  4. 4.

    Siddiqi AJ, Miller F (2007) Chronic pancreatitis: ultrasound, computed tomography, and magnetic resonance imaging features. Semin Ultrasound CT MR 28:384–394

    Article  Google Scholar 

  5. 5.

    Djuric-Stefanovic A, Masulovic D, Kostic J et al (2012) CT volumetry of normal pancreas: correlation with the pancreatic diameters measurable by the cross-sectional imaging, and relationship with the gender, age, and body constitution. Surg Radiol Anat 34:811–817

    CAS  Article  Google Scholar 

  6. 6.

    Gilbeau JP, Poncelet V, Libon E et al (1992) The density, contour, and thickness of the pancreas in diabetics: CT findings in 57 patients. AJR Am J Roentgenol 159:527–531

    CAS  Article  Google Scholar 

  7. 7.

    Heuck A, Maubach PA, Reiser M et al (1987) Age-related morphology of the normal pancreas on computed tomography. Gastrointest Radiol 12:18–22

    CAS  Article  Google Scholar 

  8. 8.

    Trout AT, Preet-Singh K, Anton CG et al (2018) Normal pancreatic parenchymal thickness by CT in healthy children. Pediatr Radiol 48:1600–1605

    Article  Google Scholar 

  9. 9.

    Tirkes T, Fogel EL, Sherman S et al (2017) Detection of exocrine dysfunction by MRI in patients with early chronic pancreatitis. Abdom Radiol (NY) 42:544–551

    Article  Google Scholar 

  10. 10.

    Trout AT, Serai SD, Fei L et al (2018) Prospective assessment of normal pancreatic secretory function measured by MRI in a cohort of healthy children. Am J Gastroenterol 113:1385

    Article  Google Scholar 

  11. 11.

    Siegel MJ, Martin KW, Worthington JL (1987) Normal and abnormal pancreas in children: US studies. Radiology 165:15–18

    CAS  Article  Google Scholar 

  12. 12.

    Tirkes T, Shah ZK, Takahashi N et al (2019) Reporting standards for chronic pancreatitis by using CT, MRI, and MR cholangiopancreatography: the consortium for the study of chronic pancreatitis, diabetes, and pancreatic cancer. Radiology 290:207–215

    Article  Google Scholar 

  13. 13.

    Haycock GB, Schwartz GJ, Wisotsky DH (1978) Geometric method for measuring body surface area: a height-weight formula validated in infants, children, and adults. J Pediatr 93:62–66

    CAS  Article  Google Scholar 

  14. 14.

    Saisho Y, Butler AE, Meier JJ et al (2007) Pancreas volumes in humans from birth to age one hundred taking into account sex, obesity, and presence of type-2 diabetes. Clin Anat 20:933–942

    CAS  Article  Google Scholar 

  15. 15.

    McCleary BM, Trout AT, Fei L et al (2020) Healthy pancreatic parenchymal volume and its relationship to exocrine function. Pediatr Radiol 50:684–688

    Article  Google Scholar 

  16. 16.

    Gilligan LA, Dillman JR, Tkach JA et al (2019) Magnetic resonance imaging T1 relaxation times for the liver, pancreas and spleen in healthy children at 1.5 and 3 tesla. Pediatr Radiol 49:1018–1024

    Article  Google Scholar 

Download references

Acknowledgments

Funding was received from the National Pancreas Foundation with in-kind support from ChiRhoClin Inc.

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Correspondence to Andrew T. Trout.

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Drs. Trout and Abu-El-Haija receive funding from the National Pancreas Foundation and in-kind support from ChiRhoClin Inc.

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McCleary, B.M., Trout, A.T., Dillman, J.R. et al. Validation of threshold values for pancreas thickness and T1-weighted signal intensity ratio in the pediatric pancreas. Pediatr Radiol (2020). https://doi.org/10.1007/s00247-020-04733-x

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Keywords

  • Children
  • Computed tomography
  • Magnetic resonance imaging
  • Pancreas
  • Pancreatitis