For a study, researchers sought to evaluate the effectiveness of magnetic resonance cholangiopancreatography (MRCP) vs. endoscopic retrograde cholangiopancreatography (ERCP) in identifying pancreatic duct variations in children. They used ERCP to identify children with a pancreatic duct mutation and then searched the MRCP database for comparable variants. Patients who had a paired ERCP-MRCP were evaluated. Three radiologists were requested to independently assess the MRCP data and identify the pancreatic duct architecture while blinded to the ERCP and MRCP findings. These blinded reviewers also rated the quality of the magnetic resonance imaging examination.

There were 74 pairings of ERCP-MRCP exams found. The most common ductal variation observed was the pancreas divisum (73%). The radiology reviewers were mostly in accord with the magnetic resonance imaging studies (Fleiss Kappa agreement). The reviewers’ agreement with the ERCP was moderate for the precise diagnosis, moderate for the presence of pancreatic divisum, and medium for agreement on the existence of any duct variation. The level of agreement among reviewers was moderate for the precise diagnosis, normal vs. abnormal, and considerable for the existence of pancreatic divisum. When comparing MRCP to the gold reference standard of ERCP, diagnostic limitations remain, particularly when examining pancreatic duct variations in youngsters.