Purpose or Case Report: Transabdominal ultrasound (TUS) is a fast, safe, and well-established screening modality for identifying pancreas, liver, and biliary tract pathology in the pediatric population. A subset of patients with findings that are incompletely characterized by ultrasound or who have no sonographic evidence of disease but persistent clinical suspicion may receive magnetic resonance cholangiopancreatography (MRCP). Pediatric inpatients who obtain an MRCP often experience longer inpatient stays, higher costs and delays in management. Relying on the sonographic findings or pursuing more advanced imaging as an outpatient may be a better option. To our knowledge, there have been no studies that have assessed whether inpatient MRCP performed following TUS in pediatric patients resulted in significant changes to additional inpatient treatment rendered. Our group ultimately looks to develop interdepartmental guidelines on when pursuit of an inpatient MRCP after TUS is indicated.
Methods & Materials: Our hospital is a pediatric, tertiary referral, level I trauma center with multiple transplantation services and approximately 80,000 emergency department visits each year. We sought to evaluate imaging data and clinical records for all patients at our hospital who received TUS followed by inpatient MRCP evaluation in 2016. This allowed us to investigate if MRCP studies performed after transabdominal ultrasound changed inpatient clinical management in pediatric patients with suspected pancreatohepatobiliary disease. The change was assessed by either an additional inpatient procedure or new treatment administered based on MRCP findings.
Results: There were a total of 101 inpatient MRCPs performed in 2016, of which 84 had a preceding abdominal ultrasound performed. Of these 84 MRCPs, 28 (33.3%) resulted in additional diagnostic information not seen on the ultrasound. Of these 28 studies, there were only eight cases in which the additional information obtained from the MRCP lead to an additional inpatient procedure or new treatment during the course of the patients hospital stay (Figure 1 and Table 1).
Conclusions: Transabdominal ultrasound is the primary screening modality for pediatric pancreatohepatobiliary disease. For some patients, obtaining ultrasound alone, serial ultrasound evaluations, or outpatient MRCP may be sufficient for evaluation. Inpatient MRCP may be over utilized, as only 8 out of 101 (7.9%) of MRCPs performed lead to a significant change in inpatient clinical management.