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Objective: To analyze the clinical characteristics of chronic pancreatitis (CP) and evaluate its impact on growth of children. Methods: A retrospective study was conducted in 94 children (male 49 cases, female 45 cases) who were diagnosed with CP in the Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from August 2008 to July 2015. Clinical characteristics, such as features of abdominal pain, etiologies, image data, levels of serum amylase and lipase, and physical development data were extracted from electronic medical records. The comparison between groups based on etiology or with normal control was performed with student's t test. Results: The age of first episode was (8.2±3.7) years. There were 61 (65%) children diagnosed with idiopathic CP, and 25 (27%) with anatomic abnormalities. The age of onset in the group with anatomic abnormalities was lower than that in the idiopathic CP group ((6.3±3.5) vs. (8.9±3.4) years, t= 3.211, P= 0.002). There were 51 (54%) patients with serum amylase elevation, 41(44%) patients with lipase elevation, and 35 (37%) with elevation in both. The questionnaire showed that 28 out of 30 children had moderate to severe abdominal pain. The patients' weight standard score (SDS) was significantly lower than the overall average in normal control (-0.4±1.1 vs. 0, t= -3.308, P= 0.001). Meanwhile, the mean level of insulin like growth factor-1 (IGF-1) SDS of 35 children was significantly decreased (-1.8±1.8 vs. 0, t= -6.136, P< 0.01). There were 69% (37/54) patients diagnosed by magnetic resonance cholangiopancreatography (MRCP) combined with magnetic resonance imaging (MRI), higher than that diagnosed by abdominal ultrasound (29%, 27/94). Conclusions: Idiopathic CP and anatomic abnormalities were the two main etiologies. Normal level of serum amylase and lipase or negative finding of ultrasound cannot exclude CP, while MRCP and MRI should be considered to improve CP diagnostic rate. It is noteworthy that growth delay would happen in children with CP history.

Objective: To evaluate the value of MRI 3-dimensional volumetric interpolated breath-hold examination (VIBE) sequence combined with MR cholangiopancreatography (MRCP) in the differential diagnosis of pancreaticobiliary ductal and duodenal union carcinomas (PDDUC)., Methods: Fifty nine patients with PDDUC confirmed by surgical-pathological findings or unequivocal clinical follow-up results were recruited in the study, which included 34 pancreatic head carcinomas, 14 distal common bile duct carcinomas, and 11 ampullary carcinomas. In addition to the routine MRI examinations for the upper abdomen, MRCP and Gadolinium-enhanced 3D-VIBE tri-phase (early arterial phase, late arterial phase and portal venous phase) were performed. The morphological features of the lesions, the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of the lesions were analyzed. The distance between the ends of the dilated pancreaticobiliary duct, the distance from the duodenal lumen to the distal end of the dilated duct, the diameter of the common bile duct and the pancreatic duct were measured., Results: The differences among the carcinomas in max-diameters, locations, edge features and degrees of signal equality of the lesions showed statistical significance (P < 0.05). The percentage of peripancreatic vascular involvement was significantly higher in the pancreatic head carcinoma than in the others. The pancreaticobiliary conjunction angle, the distance between the ends of dilated pancreaticobiliary ducts, the distance from the duodenal lumen to the distal end of dilated duct were larger in the pancreatic head carcinoma than in the distal common bile duct carcinoma and ampullary carcinoma. The pancreatic head carcinoma showed four-segment signs. During portal venous phase, the mean SNR of the distal common bile duct carcinoma was higher than the pancreatic head carcinoma and ampullary carcinoma (P < 0.05), while in the other phases, no statistical significant differences were found (P > 0.05). The signal intensity of distal common bile duct carcinoma was higher than the pancreatic head parenchyma during portal venous phase., Conclusion: MRI 3D-VIBE sequence combined with MRCP can demonstrate the morphologic features and enhancement characteristics of PDDUC, and display the details of abnormalities of pancreaticobiliary duct. It is valuable in the differential diagnosis of pancreatic head carcinoma, distal common bile duct carcinoma and ampullary carcinoma.

Objective: To evaluate the value of oral ferric ammonium citrate solution as a gastrointestinal contrast agent in diagnosing low-level obstructive jaundice., Methods: Thirty-six patients who were suspected of low-level obstructive jaundice were performed with magnetic resonance cholangiopancreatography (MRCP) and conventional MRI before and after the administration of oral ferric ammonium citrate solution. The diagnostic accuracy for evaluating the site and the cause of obstruction was compared with other diagnostic modalities., Results: The image qualities of single-slice and multi-slice MRCP were improved markedly. The accuracy of MRCP for evaluating the site of obstruction was 97.22%, which was superior to US (P<0.05). There were no significant differences among the MRCP, CT, and ERCP., Conclusion: Oral ferric ammonium citrate solution can significantly improve the image quality of MRCP. FAC-MRCP is a simple, safe, and noninvasive technique with excellent accuracy in the diagnosis of low-level obstructive jaundice.