Noninvasive Imaging of Pediatric Pancreatitis

Publication Date: January 1, 2021

Statements and Recommendations

General Imaging

CT should be performed with intravenous contrast material as a single portal venous phase examination unless specific arterial detail is needed. (1C)
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When imaging with MRI, intravenous contrast material is not always needed but contributes to the diagnosis and definition of necrosis, assessment of the vasculature and the diagnosis of autoimmune pancreatitis. (2C)
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Acute Pancreatitis

Transabdominal ultrasound is recommended as a first-line noninvasive imaging modality for suspected AP. (1B)
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If ultrasound is negative for AP and an imaging diagnosis of AP is needed, either CT or MRI is recommended.(1B)
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CT or MRI is recommended for identification and assessment of known or suspected complications of AP. (1C)
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Ultrasound can be used to follow known AP fluid collections for resolution or progression (changes in size). (2C)
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CT or MRI should be used to characterize the degree of organization of collections before intervention. (1C)
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Acute Recurrent Pancreatitis

MRI is recommended to identify structural or obstructive causes for ARP. (1B)
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When clinically indicated, MRI is recommended to follow children with ARP and to assess for progression to CP. (1C)
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In a child who requires sedation for imaging, it is reasonable to alternate MRI with ultrasound or CT for serial monitoring of ARP. (2C)
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Chronic Pancreatitis

MRI is the recommended modality for imaging of suspected CP. (1C)
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When imaging is needed to assess a suspected or known episode of AP in a child with CP, transabdominal ultrasound is the preferred first-line imaging modality. (1B)
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If ultrasound is negative for AP in a child with CP and an imaging diagnosis of AP is needed, either CT or MRI are recommended. (1B)
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CT or MRI are recommended for planning of endoscopic or surgical interventions in a patient with known CP. (2C)
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MRI is recommended for clinically indicated serial imaging of CP. (1B)
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Grading Table
Strength of Recommendation Quality of Evidence
1 Strong A High
2 Weak B Moderate
C Low

Recommendation Grading

Disclaimer

Overview

Title

Noninvasive Imaging of Pediatric Pancreatitis

Authoring Organization

Publication Month/Year

January 1, 2021

Supplemental Implementation Tools

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Female, Male, Child

Health Care Settings

Ambulatory, Childcare center, Emergency care, Hospital

Intended Users

Dietician nutritionist, nurse, nurse practitioner, physician, physician assistant

Scope

Diagnosis, Management

Diseases/Conditions (MeSH)

D010195 - Pancreatitis

Keywords

ultrasound, computed tomography, pediatric pancreatitis, Noninvasive Imaging, magnetic resonance, imaging radiography

Source Citation

Trout AT, Anupindi SA, Freeman AJ, Macias-Flores JA, Martinez JA, Parashette KR, Shah U, Squires JH, Morinville VD, Husain SZ, Abu-El-Haija M. North American Society for Pediatric Gastroenterology, Hepatology and Nutrition and the Society for Pediatric Radiology Joint Position Paper on Noninvasive Imaging of Pediatric Pancreatitis: Literature Summary and Recommendations. J Pediatr Gastroenterol Nutr. 2021 Jan 1;72(1):151-167. doi: 10.1097/MPG.0000000000002964. PMID: 33003171.

Methodology

Number of Source Documents
121
Literature Search Start Date
April 1, 2019
Literature Search End Date
July 1, 2019