Predictive Power of Imaging: Assessing Parenchymal Fibrosis in Pediatric Chronic Pancreatitis.

OBJECTIVES: The primary aim is to identify pancreatic parenchymal imaging markers of fibrosis in children with chronic pancreatitis (CP). Secondary aims include describing the pattern of histopathologic fibrosis in different pancreatic regions and examining the impact of fibrosis on exocrine pancreatic insufficiency (EPI) and baseline glycemic status. METHODS: Single center cross-sectional study that included children aged 0-21 years who underwent total pancreatectomy islet auto-transplantation (TPIAT) prior to December 2022. Those with prior pancreatic surgeries, missing imaging, or missing histology were excluded. RESULTS: Ninety-five patients (56% female, median age 13.3 y) were included. Multiple parenchymal imaging variables were significantly associated with histologic pancreatic fibrosis. A 5 mL decrease in segmented pancreas volume (odds ratio (OR)=1.2, 95% confidence interval (CI): 1.1-1.4, P<0.05) and 0.1 unit decrease in T1 signal intensity ratio (SIR) pancreas/spleen (P/s) (OR=1.7, 95% CI: 1.2-2.2, P<0.05) had increased fibrosis odds. A multivariable model with pancreas volume and T1 SIRp/s predicted severe fibrosis with an area under the receiver operating characteristic curve (AUROC) of 0.8 (95% CI:0.7-0.9). Histologic fibrosis scores showed substantial agreement between pancreatic sampling locations (kappa=0.7, 95% CI: 0.6-0.9). EPI by fecal elastase (FE-1) was associated with increased odds of severe fibrosis (OR=11.7, 95% CI: 2.5-54.1, P<0.05) and higher Ammann scores were seen in participants with prediabetes and diabetes (9.0, interquartile range (IQR): 8.0-12.0, P=0.08). CONCLUSIONS: The pancreatic parenchyma provides insights into pediatric CP through fibrosis assessment, which correlates with pancreatic function. A predictive model using pancreas volume and T1 SIR shows promise for forecasting pancreatic parenchymal fibrosis in children with CP.