MRCP: A Reliable, Non Invasive Method for Staging Chronic Pancreatitis in Pediatrics

Introduction/Methods: Pancreatic fibrosis is the end stage of chronic pancreatitis (CP),
which leads to loss of acinar volume and secretory capacity, and ultimately pancreatic
insufficiency (PI). CP and congenital PI affect the pediatric population, and are both
increasingly recognized in children. PI has serious negative implications on a child's
growth and health but, if diagnosed early, PI can be treated, minimizing the detrimental
effects of PI. Currently, direct pancreatic function testing (PFT) via collection of
pancreatic fluid is the "gold standard" for diagnosis of PI but it is an invasive testing
that may require sedation or general anesthesia. Magnetic resonance cholangiopancreatography
(MRCP) with secretin administration (MR-PFT) and MR elastography (MRE) may allow
non-invasive, and potentially early diagnosis of CP and PI. Currently, however, normative
data with which to compare MR-PFT and MRE results in pediatric patients with suspected CP/PI
is not available.

Aims: The investigators propose to determine the normal range for secreted pancreatic fluid
volume in response to secretin administration and determine the normal range for pancreatic
parenchymal stiffness in a pediatric population that is not affected by pancreatic disease.
To date, the investigators have validated their MRCP technique and have successfully
performed both MR-PFT and MRE in CP patients; however normative data is essential for
validation of our non-invasive technique.

Inclusion Criteria:

1. Subjects between the ages of 6 and 15.9 years.

2. Subjects without a documented history of (or suggestive of) pancreatic disease

Exclusion Criteria:

1. History of pancreatic disease, liver disease, intra-abdominal neoplasm, abdominal
inflammatory process such as inflammatory bowel disease (IBD), or systemic illness
that may affect pancreatic state (e.g. cystic fibrosis).

2. Subjects with surgical hardware/implanted devices making them ineligible for MRI
(e.g. pacemaker or other implanted medical device not approved for MRI).

3. Subjects who require any form of sedation or general anesthesia for MRI.

4. Subjects unable to breath-hold for the required 15-20 second imaging sequence.

5. Subjects who are pregnant or less than 12 months post-partum.