I mean unfortunately the pancreas can be a little bit difficult to see sometimes. Especially in larger patients and as you say, in patients that are NPO, if you've got a stomach full of gas or if you have an ileus because there's a real inflammatory process going on, all that bowel gas can really affect the penetration of the ultrasound waves and make the pancreas non-visible.
MRI has advantages over CT in terms of the soft tissue contrast that you get with the multiple different MRI sequences, and Going to provide you the best visualization of both parenchymal and duct changes that we see with chronic pancreatitis.
We acquire identical imaging both prior to and following administration of secretin. So there's a question earlier about use of secretin and MRCP. This is our primary means of using Secretin or the main reason that we use Secretin for MRCP.
You take your pre-image, you quantify your fluid on there, you take your post image, quantify your fluid there, subtract pre from post, and you have your secreted fluid volume in response to secretin.
The value of Secretin in our practice really comes, um, and I think in your practice as well will be when you want to look, um, and best characterize a non-dilated pancreatic duct.
clinicalUltrasound is the initial imaging modality for suspected uncomplicated acute pancreatitis in children because it is radiation-free and gives a reasonably good look at the pancreas.↗
▶Ep 1 · 25:33
clinicalThe pancreas can be difficult to visualize on ultrasound in larger patients, in patients who are not NPO (stomach full of gas), or when there is ileus from inflammation; bowel gas affects ultrasound wave penetration.↗
▶Ep 1 · 25:35
quotethe pancreas can be a little bit difficult to see sometimes. Especially in larger patients↗
▶Ep 1 · 28:19
clinicalFor CT imaging of acute pancreatitis, a single portal venous phase is sufficient; multi-phase imaging is not needed in pediatric patients as the goal is to identify complications (venous thrombosis, necrosis, fluid collections), not masses.↗
▶Ep 1 · 28:41
clinicalOral contrast is helpful in CT of pancreatitis to separate fluid-filled bowel loops from pancreatic fluid collections, but a sick patient who cannot tolerate oral contrast can still have an informative CT without it.↗
▶Ep 1 · 29:51
clinicalOn contrast-enhanced CT, absent enhancement in pancreatic tissue is highly concerning for necrosis.↗
▶Ep 1 · 34:03
clinicalIn MRI of the pancreas after acute attacks have resolved, a prominent pancreatic duct (visible as a white stripe) and some atrophy/irregularity of contour may be seen, but these findings alone are not diagnostic of chronic pancreatitis.↗
▶Ep 1 · 42:34
clinicalEvidence for secretin-enhanced MRCP in pediatric pancreatitis is limited; even adult literature shows iffy data on added value, though it may improve visualization of ductal anomalies in some cases.↗
▶Ep 1 · 42:49
quotewhen you have it's. Often in the chronic pancreatitic patients or the acute recurrence that we're doing these MR exams and they've had enough attacks that generally the ducts dilated and you can see it without secretin↗
Acute and Acute Recurrent Pancreatitis: Pancreatic Disease
▶Ep 5 · 3:43
clinicalUltrasound should be the initial imaging modality for suspected uncomplicated acute pancreatitis because it is radiation-free and provides a reasonably good look at the pancreas.↗
▶Ep 5 · 27:42
quoteI mean unfortunately the pancreas can be a little bit difficult to see sometimes. Especially in larger patients and as you say, in patients that are NPO, if you've got a stomach full of gas or if you have an ileus because there's a real inflammatory process going on, all that bowel gas can really affect the penetration of the ultrasound waves and make the pancreas non-visible.↗
▶Ep 5 · 33:31
clinicalFor CT imaging of acute pancreatitis, a single portal venous phase is sufficient; multi-phase imaging is not needed in pediatric patients unless evaluating for masses.↗
▶Ep 5 · 33:50
clinicalOral contrast is helpful in CT for pancreatitis to separate fluid-filled bowel loops from pancreatic fluid collections, but the exam can provide substantial information without it if the patient cannot tolerate oral contrast.↗
▶Ep 5 · 45:01
opinionThe added value of secretin-enhanced MRCP in pediatric pancreatitis is not well established; even adult literature shows limited evidence, though it may improve visualization of ductal anomalies in select cases.↗
Chronic Pancreatitis, Function Tests, & Pain Management: Pancreatic Disease
▶Ep 3 · 29:53
guidelineMR pancreatic function testing acquires identical imaging both prior to and following secretin administration, with about 15 minutes between pre and post imaging↗
▶Ep 3 · 32:00
clinicalMR sequences can be thresholded to quantify the volume of fluid secreted in response to secretin by subtracting pre from post measurements↗
▶Ep 3 · 34:15
opinionIn chronic pancreatitis patients with dilated and abnormal ducts at baseline, it is unclear whether secretin is needed to increase conspicuity of the duct↗
Pancreas Care Updates 2020 - FULL SHOW
▶Ep 7 · 8:05
clinicalFor CT of the pancreas in both chronic and acute pancreatitis, intravenous contrast should always be used because it provides the detail needed for imaging pancreatic parenchyma and vessels.↗
▶Ep 7 · 8:25
clinicalA single phase portal venous phase CT is almost always sufficient for pancreatic imaging; non-contrast phase is not needed as calcific pancreatitis is uncommon in pediatrics.↗
▶Ep 7 · 9:20
quoteMRCP is just a single sequence, um, or maybe even a couple of sequences. It's part of a broader MRI exam in a patient with pancreatitis.↗
▶Ep 7 · 10:20
quoteThe value of Secretin in our practice really comes, um, and I think in your practice as well will be when you want to look, um, and best characterize a non-dilated pancreatic duct.↗
▶Ep 7 · 10:55
clinicalMRI provides the best combination of parenchymal and duct detail for pancreas imaging and is the cross-sectional test of choice.↗
▶Ep 7 · 11:25
clinicalSecretin administration during MRI improves conspicuity of pancreas divisum and is most helpful in patients with non-dilated ducts for characterizing ductal abnormalities.↗
▶Ep 7 · 12:46
clinicalUltrasound is the first line test of choice in acute pancreatitis, but is only moderately sensitive; CT or MRI should be used when complications are suspected or diagnosis cannot be confirmed.↗
▶Ep 7 · 13:05
clinicalCross-sectional imaging for suspected complications in acute pancreatitis is typically obtained several days to at least a week after initial presentation when a patient is not improving as expected.↗
▶Ep 7 · 30:50
clinicalMRI with secretin can provide non-invasive measurement of exocrine function by quantifying duodenal and jejunal fluid secretion in response to secretin, compared to normative ranges established in 50 healthy children.↗
Acute Pancreatitis
▶Ep 8 · 2:09
clinicalUltrasound is the initial imaging modality for suspected uncomplicated acute pancreatitis; it is radiation-free and gives a reasonably good look at the pancreas, but is limited for evaluating complications.↗
▶Ep 8 · 28:19
clinicalFor pediatric pancreatitis CT, a portal venous phase is sufficient (no multi-phase needed); oral contrast helps separate fluid-filled bowel from pancreatic fluid collections but is not a deal-breaker if patient cannot tolerate it.↗
▶Ep 8 · 29:51
quotewhen we see absent enhancement like that, that's highly concerning for necrosis within the. Pancreas.↗
▶Ep 8 · 29:51
clinicalAbsent enhancement on contrast-enhanced CT is highly concerning for pancreatic necrosis.↗
▶Ep 8 · 42:34
opinionSecretin-enhanced MRCP has unclear added value in pediatric pancreatitis; adult literature data is 'iffy.' In acute recurrent or chronic pancreatitis patients, ducts are often dilated enough to visualize without secretin.↗
Andrew's statements about Acute Recurrent Pancreatitis43 statements
Acute and Acute Recurrent Pancreatitis: Pancreatic Disease
▶Ep 5 · 3:43
clinicalUltrasound should be the initial imaging modality for suspected uncomplicated acute pancreatitis because it is radiation-free and provides a reasonably good look at the pancreas.↗
▶Ep 5 · 27:42
quoteI mean unfortunately the pancreas can be a little bit difficult to see sometimes. Especially in larger patients and as you say, in patients that are NPO, if you've got a stomach full of gas or if you have an ileus because there's a real inflammatory process going on, all that bowel gas can really affect the penetration of the ultrasound waves and make the pancreas non-visible.↗
▶Ep 5 · 33:31
clinicalFor CT imaging of acute pancreatitis, a single portal venous phase is sufficient; multi-phase imaging is not needed in pediatric patients unless evaluating for masses.↗
▶Ep 5 · 33:50
clinicalOral contrast is helpful in CT for pancreatitis to separate fluid-filled bowel loops from pancreatic fluid collections, but the exam can provide substantial information without it if the patient cannot tolerate oral contrast.↗
▶Ep 5 · 45:01
opinionThe added value of secretin-enhanced MRCP in pediatric pancreatitis is not well established; even adult literature shows limited evidence, though it may improve visualization of ductal anomalies in select cases.↗
Function Tests & Pain Management: Pancreatic Disease
▶Ep 3 · 5:07
quoteWhat we're trying to do here at Cincinnati Children's with the MRPFTs or MR pancreatic function testing is to non-invasively accomplish or at least simulate what's going on with the endoscopic pancreatic function testing.↗
▶Ep 3 · 5:18
clinicalMR pancreatic function testing acquires identical imaging pre- and post-secretin to quantify the volume of fluid secreted into the gastrointestinal tract.↗
▶Ep 3 · 6:27
clinicalThe delay between pre- and post-secretin MR imaging is about 15 minutes to allow fluid accumulation.↗
▶Ep 3 · 7:38
clinicalMR-PFT can threshold images and quantify secreted fluid volume by subtracting pre-secretin from post-secretin fluid volume.↗
▶Ep 3 · 8:13
clinicalPhantom studies have proven that MR can accurately quantitate fluid volume.↗
▶Ep 3 · 8:13
quoteWe've proven that we can accurately quantitate fluid by measuring phantoms, so you can put phantoms in the MR scanner and you can prove that you can actually quantitate the fluid.↗
▶Ep 3 · 8:28
clinicalPreliminary data in about 35 patients are examining correlation between MR-PFT and endoscopic pancreatic function testing.↗
▶Ep 3 · 8:49
opinionQualitative MR exocrine assessment appears different between pediatric and adult patients, suggesting possible size or weight dependency.↗
▶Ep 3 · 8:49
quoteThe qualitative assessment seems to be different between pediatric and adult patients, at least in my gestalt, and so it may be that there's a size dependency, a weight dependency.↗
▶Ep 3 · 9:41
opinionIn chronic or acute recurrent pancreatitis patients with ductal changes, the pancreatic duct is often dilated and abnormal at baseline, so secretin may not be needed to visualize the duct.↗
Chronic Pancreatitis, Function Tests, & Pain Management: Pancreatic Disease
▶Ep 6 · 29:42
clinicalMR pancreatic function testing (MRPFT) acquires identical fluid-sensitive imaging pre- and post-secretin, then quantifies the volume of fluid secreted into the gastrointestinal tract.↗
▶Ep 6 · 29:42
quoteWhat we're trying to do here at Cincinnati Children's with the MRPFTs or MR pancreatic function testing, is to noninvasively accomplish or at least simulate what's going on with the endoscopic pancreatic function testing.↗
▶Ep 6 · 29:53
quoteWe acquire identical imaging both prior to and following administration of secretin. So there's a question earlier about use of secretin and MRCP. This is our primary means of using Secretin or the main reason that we use Secretin for MRCP.↗
▶Ep 6 · 31:02
quoteThe way our protocol is set up, it's about 15 minutes between pre and post. You give the amount, about 15 minutes for that fluid to accumulate.↗
▶Ep 6 · 31:02
clinicalIn the MRPFT protocol, there is about a 15-minute delay between pre- and post-secretin imaging to allow fluid accumulation.↗
▶Ep 6 · 32:13
quoteYou take your pre-image, you quantify your fluid on there, you take your post image, quantify your fluid there, subtract pre from post, and you have your secreted fluid volume in response to secretin.↗
▶Ep 6 · 32:13
clinicalMRPFT can threshold images and quantify secreted fluid volume by subtracting pre-secretin fluid from post-secretin fluid.↗
▶Ep 6 · 32:43
clinicalCorrelation between MRPFT volumetric analysis and endoscopic pancreatic function testing is under study in about 35 patients.↗
▶Ep 6 · 32:43
quoteWe are looking at that right now. That's, that's the big question. So we've done several steps to get ourselves on the way here. We've proven that we can accurately quantitate fluid.↗
▶Ep 6 · 33:03
quoteWe have some preliminary data in about 35 patients where we have been looking at the correlation between the secretin function, the endoscopic pancreatic function testing.↗
▶Ep 6 · 33:24
quoteThe qualitative assessment seems to be different between pediatric and adult patients, at least in my gestalt. And so it may be that there's a size dependency, a weight dependency, and so we're still figuring those sorts of things out.↗
▶Ep 6 · 33:24
opinionQualitative assessment of exocrine function by MRPFT may differ between pediatric and adult patients, possibly due to size or weight dependency.↗
▶Ep 6 · 34:15
opinionIn chronic pancreatitis patients with dilated and abnormal ducts at baseline, secretin may not add diagnostic value for duct visualization, though it is used primarily for exocrine assessment.↗
▶Ep 6 · 34:46
quoteIn a patient with an abnormal duct, does that dilation add anything? I get it. I think there is a subset of patients where it probably does and there's a subset of patients where it probably doesn't, and that still needs to be teased and figured out.↗
Pancreas Care Updates 2020 - FULL SHOW
▶Ep 7 · 8:05
clinicalFor CT of the pancreas in both chronic and acute pancreatitis, intravenous contrast should always be used because it provides the detail needed for imaging pancreatic parenchyma and vessels.↗
▶Ep 7 · 8:25
clinicalA single phase portal venous phase CT is almost always sufficient for pancreatic imaging; non-contrast phase is not needed as calcific pancreatitis is uncommon in pediatrics.↗
▶Ep 7 · 9:20
quoteMRCP is just a single sequence, um, or maybe even a couple of sequences. It's part of a broader MRI exam in a patient with pancreatitis.↗
▶Ep 7 · 10:20
quoteThe value of Secretin in our practice really comes, um, and I think in your practice as well will be when you want to look, um, and best characterize a non-dilated pancreatic duct.↗
▶Ep 7 · 10:55
clinicalMRI provides the best combination of parenchymal and duct detail for pancreas imaging and is the cross-sectional test of choice.↗
▶Ep 7 · 11:25
clinicalSecretin administration during MRI improves conspicuity of pancreas divisum and is most helpful in patients with non-dilated ducts for characterizing ductal abnormalities.↗
▶Ep 7 · 12:46
clinicalUltrasound is the first line test of choice in acute pancreatitis, but is only moderately sensitive; CT or MRI should be used when complications are suspected or diagnosis cannot be confirmed.↗
▶Ep 7 · 13:05
clinicalCross-sectional imaging for suspected complications in acute pancreatitis is typically obtained several days to at least a week after initial presentation when a patient is not improving as expected.↗
▶Ep 7 · 30:50
clinicalMRI with secretin can provide non-invasive measurement of exocrine function by quantifying duodenal and jejunal fluid secretion in response to secretin, compared to normative ranges established in 50 healthy children.↗
Acute Pancreatitis
▶Ep 8 · 2:09
clinicalUltrasound is the initial imaging modality for suspected uncomplicated acute pancreatitis; it is radiation-free and gives a reasonably good look at the pancreas, but is limited for evaluating complications.↗
▶Ep 8 · 28:19
clinicalFor pediatric pancreatitis CT, a portal venous phase is sufficient (no multi-phase needed); oral contrast helps separate fluid-filled bowel from pancreatic fluid collections but is not a deal-breaker if patient cannot tolerate it.↗
▶Ep 8 · 29:51
clinicalAbsent enhancement on contrast-enhanced CT is highly concerning for pancreatic necrosis.↗
▶Ep 8 · 29:51
quotewhen we see absent enhancement like that, that's highly concerning for necrosis within the. Pancreas.↗
▶Ep 8 · 42:34
opinionSecretin-enhanced MRCP has unclear added value in pediatric pancreatitis; adult literature data is 'iffy.' In acute recurrent or chronic pancreatitis patients, ducts are often dilated enough to visualize without secretin.↗
Andrew's statements about Chronic Pancreatitis30 statements
Function Tests & Pain Management: Pancreatic Disease
▶Ep 1 · 5:07
quoteWhat we're trying to do here at Cincinnati Children's with the MRPFTs or MR pancreatic function testing is to non-invasively accomplish or at least simulate what's going on with the endoscopic pancreatic function testing.↗
▶Ep 1 · 5:18
clinicalMR pancreatic function testing acquires identical imaging pre- and post-secretin to quantify the volume of fluid secreted into the gastrointestinal tract.↗
▶Ep 1 · 6:27
clinicalThe delay between pre- and post-secretin MR imaging is about 15 minutes to allow fluid accumulation.↗
▶Ep 1 · 7:38
clinicalMR-PFT can threshold images and quantify secreted fluid volume by subtracting pre-secretin from post-secretin fluid volume.↗
▶Ep 1 · 8:13
clinicalPhantom studies have proven that MR can accurately quantitate fluid volume.↗
▶Ep 1 · 8:13
quoteWe've proven that we can accurately quantitate fluid by measuring phantoms, so you can put phantoms in the MR scanner and you can prove that you can actually quantitate the fluid.↗
▶Ep 1 · 8:28
clinicalPreliminary data in about 35 patients are examining correlation between MR-PFT and endoscopic pancreatic function testing.↗
▶Ep 1 · 8:49
opinionQualitative MR exocrine assessment appears different between pediatric and adult patients, suggesting possible size or weight dependency.↗
▶Ep 1 · 8:49
quoteThe qualitative assessment seems to be different between pediatric and adult patients, at least in my gestalt, and so it may be that there's a size dependency, a weight dependency.↗
▶Ep 1 · 9:41
opinionIn chronic or acute recurrent pancreatitis patients with ductal changes, the pancreatic duct is often dilated and abnormal at baseline, so secretin may not be needed to visualize the duct.↗
Chronic Pancreatitis, Function Tests, & Pain Management: Pancreatic Disease
▶Ep 2 · 29:42
quoteWhat we're trying to do here at Cincinnati Children's with the MRPFTs or MR pancreatic function testing, is to noninvasively accomplish or at least simulate what's going on with the endoscopic pancreatic function testing.↗
▶Ep 2 · 29:42
clinicalMR pancreatic function testing (MRPFT) acquires identical fluid-sensitive imaging pre- and post-secretin, then quantifies the volume of fluid secreted into the gastrointestinal tract.↗
▶Ep 2 · 29:53
quoteWe acquire identical imaging both prior to and following administration of secretin. So there's a question earlier about use of secretin and MRCP. This is our primary means of using Secretin or the main reason that we use Secretin for MRCP.↗
▶Ep 2 · 31:02
clinicalIn the MRPFT protocol, there is about a 15-minute delay between pre- and post-secretin imaging to allow fluid accumulation.↗
▶Ep 2 · 31:02
quoteThe way our protocol is set up, it's about 15 minutes between pre and post. You give the amount, about 15 minutes for that fluid to accumulate.↗
▶Ep 2 · 32:13
quoteYou take your pre-image, you quantify your fluid on there, you take your post image, quantify your fluid there, subtract pre from post, and you have your secreted fluid volume in response to secretin.↗
▶Ep 2 · 32:13
clinicalMRPFT can threshold images and quantify secreted fluid volume by subtracting pre-secretin fluid from post-secretin fluid.↗
▶Ep 2 · 32:43
clinicalCorrelation between MRPFT volumetric analysis and endoscopic pancreatic function testing is under study in about 35 patients.↗
▶Ep 2 · 32:43
quoteWe are looking at that right now. That's, that's the big question. So we've done several steps to get ourselves on the way here. We've proven that we can accurately quantitate fluid.↗
▶Ep 2 · 33:03
quoteWe have some preliminary data in about 35 patients where we have been looking at the correlation between the secretin function, the endoscopic pancreatic function testing.↗
▶Ep 2 · 33:24
quoteThe qualitative assessment seems to be different between pediatric and adult patients, at least in my gestalt. And so it may be that there's a size dependency, a weight dependency, and so we're still figuring those sorts of things out.↗
▶Ep 2 · 33:24
opinionQualitative assessment of exocrine function by MRPFT may differ between pediatric and adult patients, possibly due to size or weight dependency.↗
▶Ep 2 · 34:15
opinionIn chronic pancreatitis patients with dilated and abnormal ducts at baseline, secretin may not add diagnostic value for duct visualization, though it is used primarily for exocrine assessment.↗
▶Ep 2 · 34:46
quoteIn a patient with an abnormal duct, does that dilation add anything? I get it. I think there is a subset of patients where it probably does and there's a subset of patients where it probably doesn't, and that still needs to be teased and figured out.↗
Chronic Pancreatitis - Pancreatic Pathologies by Cincinnati Children's Pancreas Care Center
▶Ep 8 · 2:15
clinicalFor CT imaging of chronic pancreatitis, a single phase with portal venous contrast is adequate.↗
▶Ep 8 · 2:19
clinicalMRI has advantages over CT in terms of soft tissue contrast from multiple different MRI sequences, providing the best visualization of both parenchymal and duct changes in chronic pancreatitis.↗
▶Ep 8 · 2:19
quoteMRI has advantages over CT in terms of the soft tissue contrast that you get with the multiple different MRI sequences, and Going to provide you the best visualization of both parenchymal and duct changes that we see with chronic pancreatitis.↗
▶Ep 8 · 2:50
quoteAnd non-contrast CT is essentially never needed in a child with pancreatitis.↗
▶Ep 8 · 2:50
clinicalNon-contrast CT is essentially never needed in a child with pancreatitis because calcifications can be seen on post-contrast phases of imaging.↗
▶Ep 8 · 3:13
clinicalThe key MRI sequences for chronic pancreatitis are the 3D MRCP sequence to characterize the duct and its relationship to the bile duct, and a T1 weighted sequence to understand parenchymal health.↗
Andrew's statements about Hirschsprung disease29 statements
clinicalUltrasound is the initial imaging modality for suspected uncomplicated acute pancreatitis in children because it is radiation-free and gives a reasonably good look at the pancreas.↗
▶Ep 12 · 25:33
clinicalThe pancreas can be difficult to visualize on ultrasound in larger patients, in patients who are not NPO (stomach full of gas), or when there is ileus from inflammation; bowel gas affects ultrasound wave penetration.↗
▶Ep 12 · 25:35
quotethe pancreas can be a little bit difficult to see sometimes. Especially in larger patients↗
▶Ep 12 · 28:19
clinicalFor CT imaging of acute pancreatitis, a single portal venous phase is sufficient; multi-phase imaging is not needed in pediatric patients as the goal is to identify complications (venous thrombosis, necrosis, fluid collections), not masses.↗
▶Ep 12 · 28:41
clinicalOral contrast is helpful in CT of pancreatitis to separate fluid-filled bowel loops from pancreatic fluid collections, but a sick patient who cannot tolerate oral contrast can still have an informative CT without it.↗
▶Ep 12 · 29:51
clinicalOn contrast-enhanced CT, absent enhancement in pancreatic tissue is highly concerning for necrosis.↗
▶Ep 12 · 34:03
clinicalIn MRI of the pancreas after acute attacks have resolved, a prominent pancreatic duct (visible as a white stripe) and some atrophy/irregularity of contour may be seen, but these findings alone are not diagnostic of chronic pancreatitis.↗
▶Ep 12 · 42:34
clinicalEvidence for secretin-enhanced MRCP in pediatric pancreatitis is limited; even adult literature shows iffy data on added value, though it may improve visualization of ductal anomalies in some cases.↗
▶Ep 12 · 42:49
quotewhen you have it's. Often in the chronic pancreatitic patients or the acute recurrence that we're doing these MR exams and they've had enough attacks that generally the ducts dilated and you can see it without secretin↗
Function Tests & Pain Management: Pancreatic Disease
▶Ep 15 · 5:07
quoteWhat we're trying to do here at Cincinnati Children's with the MRPFTs or MR pancreatic function testing is to non-invasively accomplish or at least simulate what's going on with the endoscopic pancreatic function testing.↗
▶Ep 15 · 5:07
quoteWhat we're trying to do here at Cincinnati Children's with the MRPFTs or MR pancreatic function testing is to non-invasively accomplish or at least simulate what's going on with the endoscopic pancreatic function testing.↗
▶Ep 15 · 5:18
clinicalMR pancreatic function testing acquires identical imaging pre- and post-secretin to quantify the volume of fluid secreted into the gastrointestinal tract.↗
▶Ep 15 · 5:18
clinicalMR pancreatic function testing acquires identical imaging pre- and post-secretin to quantify the volume of fluid secreted into the gastrointestinal tract.↗
▶Ep 15 · 6:27
clinicalThe delay between pre- and post-secretin MR imaging is about 15 minutes to allow fluid accumulation.↗
▶Ep 15 · 6:27
clinicalThe delay between pre- and post-secretin MR imaging is about 15 minutes to allow fluid accumulation.↗
▶Ep 15 · 7:38
clinicalMR-PFT can threshold images and quantify secreted fluid volume by subtracting pre-secretin from post-secretin fluid volume.↗
▶Ep 15 · 7:38
clinicalMR-PFT can threshold images and quantify secreted fluid volume by subtracting pre-secretin from post-secretin fluid volume.↗
▶Ep 15 · 8:13
clinicalPhantom studies have proven that MR can accurately quantitate fluid volume.↗
▶Ep 15 · 8:13
quoteWe've proven that we can accurately quantitate fluid by measuring phantoms, so you can put phantoms in the MR scanner and you can prove that you can actually quantitate the fluid.↗
▶Ep 15 · 8:13
quoteWe've proven that we can accurately quantitate fluid by measuring phantoms, so you can put phantoms in the MR scanner and you can prove that you can actually quantitate the fluid.↗
▶Ep 15 · 8:13
clinicalPhantom studies have proven that MR can accurately quantitate fluid volume.↗
▶Ep 15 · 8:28
clinicalPreliminary data in about 35 patients are examining correlation between MR-PFT and endoscopic pancreatic function testing.↗
▶Ep 15 · 8:28
clinicalPreliminary data in about 35 patients are examining correlation between MR-PFT and endoscopic pancreatic function testing.↗
▶Ep 15 · 8:49
opinionQualitative MR exocrine assessment appears different between pediatric and adult patients, suggesting possible size or weight dependency.↗
▶Ep 15 · 8:49
opinionQualitative MR exocrine assessment appears different between pediatric and adult patients, suggesting possible size or weight dependency.↗
▶Ep 15 · 8:49
quoteThe qualitative assessment seems to be different between pediatric and adult patients, at least in my gestalt, and so it may be that there's a size dependency, a weight dependency.↗
▶Ep 15 · 8:49
quoteThe qualitative assessment seems to be different between pediatric and adult patients, at least in my gestalt, and so it may be that there's a size dependency, a weight dependency.↗
▶Ep 15 · 9:41
opinionIn chronic or acute recurrent pancreatitis patients with ductal changes, the pancreatic duct is often dilated and abnormal at baseline, so secretin may not be needed to visualize the duct.↗
▶Ep 15 · 9:41
opinionIn chronic or acute recurrent pancreatitis patients with ductal changes, the pancreatic duct is often dilated and abnormal at baseline, so secretin may not be needed to visualize the duct.↗
Andrew's statements about Pancreatitis84 statements
clinicalUltrasound is the initial imaging modality for suspected uncomplicated acute pancreatitis in children because it is radiation-free and gives a reasonably good look at the pancreas.↗
▶Ep 2 · 25:33
clinicalThe pancreas can be difficult to visualize on ultrasound in larger patients, in patients who are not NPO (stomach full of gas), or when there is ileus from inflammation; bowel gas affects ultrasound wave penetration.↗
▶Ep 2 · 25:35
quotethe pancreas can be a little bit difficult to see sometimes. Especially in larger patients↗
▶Ep 2 · 28:19
clinicalFor CT imaging of acute pancreatitis, a single portal venous phase is sufficient; multi-phase imaging is not needed in pediatric patients as the goal is to identify complications (venous thrombosis, necrosis, fluid collections), not masses.↗
▶Ep 2 · 28:41
clinicalOral contrast is helpful in CT of pancreatitis to separate fluid-filled bowel loops from pancreatic fluid collections, but a sick patient who cannot tolerate oral contrast can still have an informative CT without it.↗
▶Ep 2 · 29:51
clinicalOn contrast-enhanced CT, absent enhancement in pancreatic tissue is highly concerning for necrosis.↗
▶Ep 2 · 34:03
clinicalIn MRI of the pancreas after acute attacks have resolved, a prominent pancreatic duct (visible as a white stripe) and some atrophy/irregularity of contour may be seen, but these findings alone are not diagnostic of chronic pancreatitis.↗
▶Ep 2 · 42:34
clinicalEvidence for secretin-enhanced MRCP in pediatric pancreatitis is limited; even adult literature shows iffy data on added value, though it may improve visualization of ductal anomalies in some cases.↗
▶Ep 2 · 42:49
quotewhen you have it's. Often in the chronic pancreatitic patients or the acute recurrence that we're doing these MR exams and they've had enough attacks that generally the ducts dilated and you can see it without secretin↗
Acute and Acute Recurrent Pancreatitis: Pancreatic Disease
▶Ep 6 · 3:43
clinicalUltrasound should be the initial imaging modality for suspected uncomplicated acute pancreatitis because it is radiation-free and provides a reasonably good look at the pancreas.↗
▶Ep 6 · 3:43
clinicalUltrasound should be the initial imaging modality for suspected uncomplicated acute pancreatitis because it is radiation-free and provides a reasonably good look at the pancreas.↗
▶Ep 6 · 27:42
quoteI mean unfortunately the pancreas can be a little bit difficult to see sometimes. Especially in larger patients and as you say, in patients that are NPO, if you've got a stomach full of gas or if you have an ileus because there's a real inflammatory process going on, all that bowel gas can really affect the penetration of the ultrasound waves and make the pancreas non-visible.↗
▶Ep 6 · 27:42
quoteI mean unfortunately the pancreas can be a little bit difficult to see sometimes. Especially in larger patients and as you say, in patients that are NPO, if you've got a stomach full of gas or if you have an ileus because there's a real inflammatory process going on, all that bowel gas can really affect the penetration of the ultrasound waves and make the pancreas non-visible.↗
▶Ep 6 · 33:31
clinicalFor CT imaging of acute pancreatitis, a single portal venous phase is sufficient; multi-phase imaging is not needed in pediatric patients unless evaluating for masses.↗
▶Ep 6 · 33:31
clinicalFor CT imaging of acute pancreatitis, a single portal venous phase is sufficient; multi-phase imaging is not needed in pediatric patients unless evaluating for masses.↗
▶Ep 6 · 33:50
clinicalOral contrast is helpful in CT for pancreatitis to separate fluid-filled bowel loops from pancreatic fluid collections, but the exam can provide substantial information without it if the patient cannot tolerate oral contrast.↗
▶Ep 6 · 33:50
clinicalOral contrast is helpful in CT for pancreatitis to separate fluid-filled bowel loops from pancreatic fluid collections, but the exam can provide substantial information without it if the patient cannot tolerate oral contrast.↗
▶Ep 6 · 45:01
opinionThe added value of secretin-enhanced MRCP in pediatric pancreatitis is not well established; even adult literature shows limited evidence, though it may improve visualization of ductal anomalies in select cases.↗
▶Ep 6 · 45:01
opinionThe added value of secretin-enhanced MRCP in pediatric pancreatitis is not well established; even adult literature shows limited evidence, though it may improve visualization of ductal anomalies in select cases.↗
Function Tests & Pain Management: Pancreatic Disease
▶Ep 3 · 5:07
quoteWhat we're trying to do here at Cincinnati Children's with the MRPFTs or MR pancreatic function testing is to non-invasively accomplish or at least simulate what's going on with the endoscopic pancreatic function testing.↗
▶Ep 3 · 5:07
quoteWhat we're trying to do here at Cincinnati Children's with the MRPFTs or MR pancreatic function testing is to non-invasively accomplish or at least simulate what's going on with the endoscopic pancreatic function testing.↗
▶Ep 3 · 5:18
clinicalMR pancreatic function testing acquires identical imaging pre- and post-secretin to quantify the volume of fluid secreted into the gastrointestinal tract.↗
▶Ep 3 · 5:18
clinicalMR pancreatic function testing acquires identical imaging pre- and post-secretin to quantify the volume of fluid secreted into the gastrointestinal tract.↗
▶Ep 3 · 6:27
clinicalThe delay between pre- and post-secretin MR imaging is about 15 minutes to allow fluid accumulation.↗
▶Ep 3 · 6:27
clinicalThe delay between pre- and post-secretin MR imaging is about 15 minutes to allow fluid accumulation.↗
▶Ep 3 · 7:38
clinicalMR-PFT can threshold images and quantify secreted fluid volume by subtracting pre-secretin from post-secretin fluid volume.↗
▶Ep 3 · 7:38
clinicalMR-PFT can threshold images and quantify secreted fluid volume by subtracting pre-secretin from post-secretin fluid volume.↗
▶Ep 3 · 8:13
clinicalPhantom studies have proven that MR can accurately quantitate fluid volume.↗
▶Ep 3 · 8:13
clinicalPhantom studies have proven that MR can accurately quantitate fluid volume.↗
▶Ep 3 · 8:13
quoteWe've proven that we can accurately quantitate fluid by measuring phantoms, so you can put phantoms in the MR scanner and you can prove that you can actually quantitate the fluid.↗
▶Ep 3 · 8:13
quoteWe've proven that we can accurately quantitate fluid by measuring phantoms, so you can put phantoms in the MR scanner and you can prove that you can actually quantitate the fluid.↗
▶Ep 3 · 8:28
clinicalPreliminary data in about 35 patients are examining correlation between MR-PFT and endoscopic pancreatic function testing.↗
▶Ep 3 · 8:28
clinicalPreliminary data in about 35 patients are examining correlation between MR-PFT and endoscopic pancreatic function testing.↗
▶Ep 3 · 8:49
opinionQualitative MR exocrine assessment appears different between pediatric and adult patients, suggesting possible size or weight dependency.↗
▶Ep 3 · 8:49
quoteThe qualitative assessment seems to be different between pediatric and adult patients, at least in my gestalt, and so it may be that there's a size dependency, a weight dependency.↗
▶Ep 3 · 8:49
opinionQualitative MR exocrine assessment appears different between pediatric and adult patients, suggesting possible size or weight dependency.↗
▶Ep 3 · 8:49
quoteThe qualitative assessment seems to be different between pediatric and adult patients, at least in my gestalt, and so it may be that there's a size dependency, a weight dependency.↗
▶Ep 3 · 9:41
opinionIn chronic or acute recurrent pancreatitis patients with ductal changes, the pancreatic duct is often dilated and abnormal at baseline, so secretin may not be needed to visualize the duct.↗
▶Ep 3 · 9:41
opinionIn chronic or acute recurrent pancreatitis patients with ductal changes, the pancreatic duct is often dilated and abnormal at baseline, so secretin may not be needed to visualize the duct.↗
Chronic Pancreatitis, Function Tests, & Pain Management: Pancreatic Disease
▶Ep 4 · 29:42
clinicalMR pancreatic function testing (MRPFT) acquires identical fluid-sensitive imaging pre- and post-secretin, then quantifies the volume of fluid secreted into the gastrointestinal tract.↗
▶Ep 4 · 29:42
quoteWhat we're trying to do here at Cincinnati Children's with the MRPFTs or MR pancreatic function testing, is to noninvasively accomplish or at least simulate what's going on with the endoscopic pancreatic function testing.↗
▶Ep 4 · 29:42
quoteWhat we're trying to do here at Cincinnati Children's with the MRPFTs or MR pancreatic function testing, is to noninvasively accomplish or at least simulate what's going on with the endoscopic pancreatic function testing.↗
▶Ep 4 · 29:42
clinicalMR pancreatic function testing (MRPFT) acquires identical fluid-sensitive imaging pre- and post-secretin, then quantifies the volume of fluid secreted into the gastrointestinal tract.↗
▶Ep 4 · 29:53
quoteWe acquire identical imaging both prior to and following administration of secretin. So there's a question earlier about use of secretin and MRCP. This is our primary means of using Secretin or the main reason that we use Secretin for MRCP.↗
▶Ep 4 · 29:53
quoteWe acquire identical imaging both prior to and following administration of secretin. So there's a question earlier about use of secretin and MRCP. This is our primary means of using Secretin or the main reason that we use Secretin for MRCP.↗
▶Ep 4 · 31:02
quoteThe way our protocol is set up, it's about 15 minutes between pre and post. You give the amount, about 15 minutes for that fluid to accumulate.↗
▶Ep 4 · 31:02
clinicalIn the MRPFT protocol, there is about a 15-minute delay between pre- and post-secretin imaging to allow fluid accumulation.↗
▶Ep 4 · 31:02
quoteThe way our protocol is set up, it's about 15 minutes between pre and post. You give the amount, about 15 minutes for that fluid to accumulate.↗
▶Ep 4 · 31:02
clinicalIn the MRPFT protocol, there is about a 15-minute delay between pre- and post-secretin imaging to allow fluid accumulation.↗
▶Ep 4 · 32:13
clinicalMRPFT can threshold images and quantify secreted fluid volume by subtracting pre-secretin fluid from post-secretin fluid.↗
▶Ep 4 · 32:13
quoteYou take your pre-image, you quantify your fluid on there, you take your post image, quantify your fluid there, subtract pre from post, and you have your secreted fluid volume in response to secretin.↗
▶Ep 4 · 32:13
clinicalMRPFT can threshold images and quantify secreted fluid volume by subtracting pre-secretin fluid from post-secretin fluid.↗
▶Ep 4 · 32:13
quoteYou take your pre-image, you quantify your fluid on there, you take your post image, quantify your fluid there, subtract pre from post, and you have your secreted fluid volume in response to secretin.↗
▶Ep 4 · 32:43
quoteWe are looking at that right now. That's, that's the big question. So we've done several steps to get ourselves on the way here. We've proven that we can accurately quantitate fluid.↗
▶Ep 4 · 32:43
clinicalCorrelation between MRPFT volumetric analysis and endoscopic pancreatic function testing is under study in about 35 patients.↗
▶Ep 4 · 32:43
quoteWe are looking at that right now. That's, that's the big question. So we've done several steps to get ourselves on the way here. We've proven that we can accurately quantitate fluid.↗
▶Ep 4 · 32:43
clinicalCorrelation between MRPFT volumetric analysis and endoscopic pancreatic function testing is under study in about 35 patients.↗
▶Ep 4 · 33:03
quoteWe have some preliminary data in about 35 patients where we have been looking at the correlation between the secretin function, the endoscopic pancreatic function testing.↗
▶Ep 4 · 33:03
quoteWe have some preliminary data in about 35 patients where we have been looking at the correlation between the secretin function, the endoscopic pancreatic function testing.↗
▶Ep 4 · 33:24
opinionQualitative assessment of exocrine function by MRPFT may differ between pediatric and adult patients, possibly due to size or weight dependency.↗
▶Ep 4 · 33:24
quoteThe qualitative assessment seems to be different between pediatric and adult patients, at least in my gestalt. And so it may be that there's a size dependency, a weight dependency, and so we're still figuring those sorts of things out.↗
▶Ep 4 · 33:24
quoteThe qualitative assessment seems to be different between pediatric and adult patients, at least in my gestalt. And so it may be that there's a size dependency, a weight dependency, and so we're still figuring those sorts of things out.↗
▶Ep 4 · 33:24
opinionQualitative assessment of exocrine function by MRPFT may differ between pediatric and adult patients, possibly due to size or weight dependency.↗
▶Ep 4 · 34:15
opinionIn chronic pancreatitis patients with dilated and abnormal ducts at baseline, secretin may not add diagnostic value for duct visualization, though it is used primarily for exocrine assessment.↗
▶Ep 4 · 34:15
opinionIn chronic pancreatitis patients with dilated and abnormal ducts at baseline, secretin may not add diagnostic value for duct visualization, though it is used primarily for exocrine assessment.↗
▶Ep 4 · 34:46
quoteIn a patient with an abnormal duct, does that dilation add anything? I get it. I think there is a subset of patients where it probably does and there's a subset of patients where it probably doesn't, and that still needs to be teased and figured out.↗
▶Ep 4 · 34:46
quoteIn a patient with an abnormal duct, does that dilation add anything? I get it. I think there is a subset of patients where it probably does and there's a subset of patients where it probably doesn't, and that still needs to be teased and figured out.↗
Acute Pancreatitis
▶Ep 12 · 2:09
clinicalUltrasound is the initial imaging modality for suspected uncomplicated acute pancreatitis; it is radiation-free and gives a reasonably good look at the pancreas, but is limited for evaluating complications.↗
▶Ep 12 · 28:19
clinicalFor pediatric pancreatitis CT, a portal venous phase is sufficient (no multi-phase needed); oral contrast helps separate fluid-filled bowel from pancreatic fluid collections but is not a deal-breaker if patient cannot tolerate it.↗
▶Ep 12 · 29:51
quotewhen we see absent enhancement like that, that's highly concerning for necrosis within the. Pancreas.↗
▶Ep 12 · 29:51
clinicalAbsent enhancement on contrast-enhanced CT is highly concerning for pancreatic necrosis.↗
▶Ep 12 · 42:34
opinionSecretin-enhanced MRCP has unclear added value in pediatric pancreatitis; adult literature data is 'iffy.' In acute recurrent or chronic pancreatitis patients, ducts are often dilated enough to visualize without secretin.↗
Chronic Pancreatitis - Pancreatic Pathologies by Cincinnati Children's Pancreas Care Center
▶Ep 20 · 2:15
clinicalFor CT imaging of chronic pancreatitis, a single phase with portal venous contrast is adequate.↗
▶Ep 20 · 2:15
clinicalFor CT imaging of chronic pancreatitis, a single phase with portal venous contrast is adequate.↗
▶Ep 20 · 2:19
clinicalMRI has advantages over CT in terms of soft tissue contrast from multiple different MRI sequences, providing the best visualization of both parenchymal and duct changes in chronic pancreatitis.↗
▶Ep 20 · 2:19
quoteMRI has advantages over CT in terms of the soft tissue contrast that you get with the multiple different MRI sequences, and Going to provide you the best visualization of both parenchymal and duct changes that we see with chronic pancreatitis.↗
▶Ep 20 · 2:19
quoteMRI has advantages over CT in terms of the soft tissue contrast that you get with the multiple different MRI sequences, and Going to provide you the best visualization of both parenchymal and duct changes that we see with chronic pancreatitis.↗
▶Ep 20 · 2:19
clinicalMRI has advantages over CT in terms of soft tissue contrast from multiple different MRI sequences, providing the best visualization of both parenchymal and duct changes in chronic pancreatitis.↗
▶Ep 20 · 2:50
quoteAnd non-contrast CT is essentially never needed in a child with pancreatitis.↗
▶Ep 20 · 2:50
clinicalNon-contrast CT is essentially never needed in a child with pancreatitis because calcifications can be seen on post-contrast phases of imaging.↗
▶Ep 20 · 2:50
quoteAnd non-contrast CT is essentially never needed in a child with pancreatitis.↗
▶Ep 20 · 2:50
clinicalNon-contrast CT is essentially never needed in a child with pancreatitis because calcifications can be seen on post-contrast phases of imaging.↗
▶Ep 20 · 3:13
clinicalThe key MRI sequences for chronic pancreatitis are the 3D MRCP sequence to characterize the duct and its relationship to the bile duct, and a T1 weighted sequence to understand parenchymal health.↗
▶Ep 20 · 3:13
clinicalThe key MRI sequences for chronic pancreatitis are the 3D MRCP sequence to characterize the duct and its relationship to the bile duct, and a T1 weighted sequence to understand parenchymal health.↗
