David S. Vitale

Objectives: Magnetic resonance imaging (MRI) with secretin stimulation allows non-invasive assessment of pancreatic secretion in vivo. Software (PFTquant) can facilitate quantification of secretory response. Our objective was to quantify secretory response for a clinical sample of pediatric patients and compare quantitative to qualitative assessment. Methods: Two hundred one examinations of 169 patients (< 21 years of age) were processed using PFTquant and manually refined by human observers. Fluid volumes were characterized as normal or abnormal based on 5th percentile values by body surface area (BSA) and age and were compared to qualitative assessment of secretory response. Results: The mean patient age was 12.1 ± 4.9 (0–20) years and 106 (52.7%) were female. The most common diagnoses were acute recurrent ( n = 54, 26.9%), chronic ( n = 53, 26.4%), and acute ( n = 29, 14.4%) pancreatitis. Based on human-refined segmentation, secretory response was abnormal in 70 (34.8%; by BSA) and 62 (30.8%; by age) patients, including 48.3% (14/29) of patients with acute pancreatitis. Clinical reports characterized secretory response as qualitatively abnormal in 26/201 (12.9%) examinations. Compared to quantitative analysis, qualitative assessment was falsely positive in 12 cases and falsely negative in 50 (BSA) or 55 (age) cases. Conclusion: In a clinical sample of pediatric and young adult patients, abnormal pancreatic secretory response was present in 30.8 to 34.8% of patients and was most common in patients with acute pancreatitis. Quantiative assessment identifies more patients with abnormal secretory response than qualitative assessment.

Objectives: Liver biopsy is the gold standard for diagnosing and staging liver diseases. Endoscopic ultrasound‐guided liver biopsy (EUS‐LB) has been reported in adults with equivalent or better safety profiles than percutaneous liver biopsies. The aim of this study was to retrospectively assess the safety and efficacy of EUS‐LB in pediatric patients.Methods: This was a retrospective chart review of consecutive pediatric patients undergoing EUS‐LB at Cincinnati Children's Hospital Medical Center from March 2020 to April 2023. Patients ≤21 years old were included. EUS‐LB was performed via fine‐needle biopsy technique with transduodenal and/or transgastric approach. Histology was independently reviewed by one of two expert pathologists, including length (cm) and complete portal tract (CPT) number per the American Association for the Study of Liver Diseases (AASLD) adequacy criteria. Demographics, clinical data, technical information, diagnostic success, and adverse events were recorded.Results: Eighty‐three patients were included in the analysis, with various indications that required liver biopsy. All biopsies achieved diagnostic and technical success, with 77 (93%) meeting both AASLD criteria for adequacy. Most patients (57, 69%) underwent biopsy of both hepatic lobes, with an overall median of two needle passes. Total specimen length was a median of 7.9 cm (interquartile range [IQR] 5.2–10.3), and the median maximum intact specimen was 4.2 cm (IQR 3.1–5.4). The median CPT number was 24 (IQR 17–32) per patient. Four mild adverse events (5%) occurred; none involved bleeding.Conclusions: EUS‐LB was well tolerated and yielded samples that were technically and diagnostically successful in a pediatric population, with comparable safety to percutaneous liver biopsy.

Purpose: Our primary purpose was to understand the correlation between pancreas T1-weighted signal intensity ratio (SIR) and T1 relaxation time in children. We also sought to characterize differences in T1 SIR between children without and with pancreatitis. Methods: Retrospective study of patients < 18-years-old. SIR-pancreas:spleen (SIR-PS) and SIR-pancreas:paraspinal muscle (SIR-PM) were generated from T1-weighted gradient recalled echo images. Subdivided by field strength, T1 SIR was correlated (Spearman’s) with T1 relaxation time. Results: 220 participants were included, 144 imaged at 1.5T (mean: 11.4 ± 4.2 years) and 76 imaged at 3T (mean: 10.9 ± 4.5 years). At 1.5T, SIR-PS (rho=-0.62, 95% CI: -0.71 to -0.51, p < 0.0001) and SIR-PM (rho=-0.57, 95% CI: -0.67 to -0.45, p < 0.0001) moderately negatively correlated with T1 relaxation time. At 3T, correlations between T1 SIR and T1 relaxation time were moderate (rho=-0.40 to -0.43, p ≤ 0.0003). SIR-PS was significantly different between patient groups at 1.5T (p < 0.0001) with pairwise differences between: normal vs. acute on chronic pancreatitis (1.52 vs. 1.13; p < 0.0001). SIR-PM was also significantly different between groups at 1.5T (p < 0.0001) with differences between: normal vs. acute pancreatitis (1.65 vs. 1.40; p = 0.0006), normal vs. acute on chronic pancreatitis (1.65 vs. 1.18; p < 0.0001), and normal vs. chronic pancreatitis (1.65 vs. 1.52; p = 0.0066). A SIR-PS cut-off of ≤ 1.31 had 44% sensitivity and 95% specificity and SIR-PM cut-off of ≤ 1.53 had 69% sensitivity and 70% specificity for pancreatitis. At 3T, SIR-PS was significantly different between groups (p = 0.033) but without significant pairwise differences. Conclusion: At 1.5T pancreas T1 SIR moderately to strongly correlates with estimated T1 relaxation time and is significantly lower in children with pancreatitis.