Diagnosis of PBM and CBD by MRCP

A diagnostic work-up of pancreaticobiliary maljunction (PBM) and con- genital biliary dilatation (CBD) depends on noninvasive imaging modalities rather than direct cholangiography. Magnetic resonance cholangiopancreatography (MRCP) is widely used for hepatobiliary and pancreatic disease and should be con- sidered the first-line imaging test for PBM and CBD after ultrasonography in cur- rent clinical practice. The advantages of MRCP over computed tomography and endoscopic retrograde cholangiopancreatography in such cases include its excellent contrast resolution, low invasiveness, and lack of irradiation. However, it is still challenging to perform high-quality MRCP in children, especially very young chil- dren, due to these patients' small-caliber ducts, a poor signal, and unavoidable patient motion, which creates artifacts. MRCP was able to visualize PBM in only 44.4% of cases, and the minimum age for successful visualization of PBM with MRCP was 1 year and 11 months in the authors' series. Recent technical improve- ments in the image quality may lead to better diagnostic accuracy of MRCP in young patients in the near future.