Prospective evaluation of pancreaticobiliary maljunction using high-frequency ultrasonography in children.

BACKGROUND

Ultrasound (US) enables clear visualization of the pancreaticobiliary junction within the pancreatic parenchyma. However, limited studies have evaluated its diagnostic utility for pancreaticobiliary maljunction in pediatrics.

OBJECTIVE

To prospectively assess the diagnostic value of high-frequency ultrasonography for pancreaticobiliary maljunction in suspected pediatric patients.

MATERIALS AND

METHODS

All suspected patients received detailed high-frequency US examination of the gallbladder wall, common bile duct, heterogeneous biliary echoes (including stones, sludge, and protein plugs), pancreatic duct, pancreaticobiliary junction, or common channel. Ultrasound characteristics were compared in patients with versus without pancreaticobiliary maljunction. The areas under receiver operating characteristic curves (AUCs) for different US characteristics in the diagnosis of pancreaticobiliary maljunction were calculated and compared.

RESULTS

The study included 56 pediatric patients (male 19, female 37; median age 38.5 months, interquartile range 12-81). Pancreaticobiliary maljunction was present in 32 patients and absent in 24. High-frequency ultrasonography successfully depicted the pancreaticobiliary junction in 43 patients (76.8%). Higher sensitivities were observed in pancreatic duct dilation (88%) and common bile duct dilation (97%) compared to gallbladder wall thickening (78%) and heterogeneous biliary echoes (75%) for pancreaticobiliary maljunction identification, though specificities were suboptimal (21-63%). The full four-characteristic set achieved optimal results (AUC=0.872, sensitivity=84%, specificity=75%). The subset excluding common bile duct dilation maintained strong efficacy (AUC=0.860, sensitivity=81%, specificity=75%). Of note, among patients with the junction of pancreaticobiliary duct unclear, the common bile duct-excluded subset (thickened gallbladder wall, heterogeneous biliary echoes, pancreatic duct dilation) had a superior discrimination ability (AUC=0.931, sensitivity=100%, specificity=78%).

CONCLUSION

High-frequency ultrasonography enables direct pancreaticobiliary maljunction diagnosis in children via visualization of the abnormal common channel. When junctional anatomy is indeterminate, ultrasound characteristics-particularly thickened gallbladder wall, heterogeneous biliary echoes, and pancreatic duct dilation-serve as highly informative diagnostic indicators.