TABLE 4:

Interpretation Pearls and Pitfalls

Factor	Considerations
Imaging modality	Findings of interstitial edematous pancreatitis by ultrasound can be very subtle; ultrasound may be particularly insensitive for chemotherapy-induced pancreatitis
Abnormal pancreas	A pancreatic duct, visible in its entirety in a child, is generally abnormal; any visible common biliary and pancreatic duct channel should be considered abnormal; a normal liver serves as an internal reference for pancreas parenchymal signal by MRI; on Tl-weighted MRI, the pancreas should be the brightest organ in the upper abdomen
Acute pancreatitis	Fat-saturated T2-weighted imaging highlights subtle parenchymal and peripancreatic edema; interstitial edematous pancreatitis can result in heterogeneous enhancement on CT or MRI that can be difficult to distinguish from limited or early necrosis; evolution on follow-up imaging can confirm a diagnosis
Fluid collections	Fluid collections within the pancreas, even if simple, are necrotic collections; 4 wk is a useful estimate of the timeline for organization of collections but the maturity of the investing wall, not the timeline, defines the degree of organization
Abuse	In young (< 3 y of age) or developmentally delayed children, abuse must be considered as a possible cause of acute pancreatitis