Anatomic variants of the biliary tree at MRCP: still too rarely reported! (original) (raw)
Related papers
Role of MRCP in assessment of biliary variants in living donor liver transplantation
The Egyptian Journal of Radiology and Nuclear Medicine, 2013
Introduction: Liver transplantation can be done by three different methods: Cadaveric, heterotopic and living donor liver transplantation (LDLT). In LDLT usually the right lobe of a donor liver is transplanted into the patient after proper volumetric studies. The native patient bile ducts are connected to the biliary tree of the transplanted liver segment. Patients and methods: From January 2010 to August 2011, 50 potential LDLT donors were evaluated with preoperative MRCP. Results: The radiologist evaluated the visualization of the common duct, right and left intra-hepatic ducts, and insertion of the right posterior lobe duct. The data were classified according to Huang and Hakki classifications. According to the more detailed classification of Hakki 13 patients (26%) were Type K1; 15 patients (30%) were Type K2a; three patients (6%) were Type K2b; 11 patients (22%) Type K3a; four patients (8%) were Type K3b; two patients (4%) were Type K4 and no patients were Type K5. Two patients with unclassified anatomical biliary pattern were encountered. In conclusion, this study has shown an extremely high accuracy of MRCP in preoperative assessment of live hepatic donors, which aided in the style and procedure of the operation and ultimately to a high success rate of the transplantation procedures.
Liver Transplantation, 2004
Accurate preoperative depiction of biliary anatomy is not always adequately accomplished by imaging techniques in living donor liver transplantation (LDLT). We present the results of a prospective study designed to evaluate the ability of mangafodipir trisodium (Mn-DPDP)-enhanced magnetic resonance (MR) cholangiography (MRC) for this purpose in a series of 25 adult living liver donors (LLDs). We also analyze if a simple or a more complex surgical procedure can be preoperatively suggested for biliary reconstruction in the recipients. Findings on MRC were compared with operative cholangiography (OC). A conventional distribution with a right hepatic duct (RHD) longer than 1 cm anticipated a simple procedure (duct-to-duct anastomosis or hepaticojejunostomy [HJ]). A shorter RHD or any variant were predictors of a more complex surgery (bench ductoplasty or multiple anastomoses). Agreement between MRC and OC in assessing the biliary anatomy was measured using the statistic, and differences between the kind of surgery predicted at MRC and the biliary anastomosis performed were evaluated with Fisher's exact test. Normal variants were present in 16 / 25 donors (64%). MRC was accurate in depicting the pattern of bile duct distribution observed at OC in 22 / 25 (88%) donors (؍ .831), and correctly predicted the complexity of biliary anastomosis in the recipient in 22 / 25 (88%) donors. No significant differences were observed between complexity of biliary surgery proposed at MRC and the final surgery performed (P ؍ .002). In conclusion, Mn-DPDP-enhanced MRC is highly accurate in depicting the biliary duct anatomy and can be used preoperatively for surgical planning in LDLT.
Cureus, 2023
Biliary anatomy is of paramount importance for hepatobiliary pancreatic surgeons for operative planning. Preoperative assessment with magnetic resonance cholangiopancreatography (MRCP) to evaluate the biliary anatomy plays a vital role, especially for prospective liver donors in living donor liver transplantation (LDLT). Our objective was to evaluate the diagnostic accuracy of MRCP in assessing the anatomical variations of the biliary system and the frequency of biliary variation in the donors of LDLT. Materials and Methods Sixty-five donors of living donor liver transplantation in the age range of 20 to 51 years were studied retrospectively to evaluate the anatomical variations of the biliary tree. As a part of the pre-transplantation donor workup, MRI with MRCP was performed in a 1.5T machine for all these candidates. MRCP source data sets were processed with maximum intensity projections, surface shading, and multi-planar reconstructions. Images were reviewed by two radiologists, and the classification system of Huang et al. was utilized to evaluate the biliary anatomy. The results were compared with the intraoperative cholangiogram, considered the gold standard. Results We identified standard biliary anatomy in 34 candidates (52.3%), and variant biliary anatomy was observed in 31 candidates (47.7%) on MRCP. An intraoperative cholangiogram showed standard anatomy in 36 candidates (55.4%) and biliary variation in 29 candidates (44.6%). Our study showed a sensitivity of 100% and a specificity of 94.5% for identifying biliary variant anatomy on MRCP in comparison with the gold standard intraoperative cholangiogram. The accuracy of MRCP in detecting the variant biliary anatomy in our study was 96.9%. The most common biliary variation was the right posterior sectoral duct draining into the left hepatic duct, Huang type A3. Conclusion The frequency of biliary variations is high in potential liver donors. MRCP is sensitive and highly accurate in identifying the biliary variations of surgical significance.
The Egyptian Journal of Radiology and Nuclear Medicine, 2012
Living donor liver transplantation is increasingly being used to help compensate for the increasing shortage of cadaveric liver grafts. However, the extreme variability of the hepatic vascular and biliary systems can impede this surgical procedure. The aim of the study is to demonstrate the role of MR cholangiopancreatography (MRCP) in the evaluation of anatomical biliary variants in potential living donors for liver transplantation. Methods: The study included 20 liver donors in pre-operative assessment before liver transplantation. MR cholangiopancreatography (MRCP) was performed for all donors. Results: The study included 20 donors (16 men and 4 women) ranging in age from 29 to 52 years. 16 (80%) donors demonstrate normal biliary branching anatomy. One donor has trifurcation biliary branching pattern (5%). Two donors have their right posterior ducts draining into the left hepatic duct (10%). One donor has low insertion of the right posterior duct into the main duct (5%). Conclusion: MR cholangiopancreatography (MRCP) provides important information in evaluation of potential living donors for liver transplantation.
Diagnostics
Despite significant advances in hepatobiliary surgery, biliary injury and leakage remain typical postoperative complications. Thus, a precise depiction of the intrahepatic biliary anatomy and anatomical variant is crucial in preoperative evaluation. This study aimed to evaluate the precision of 2D and 3D magnetic resonance cholangiopancreatography (MRCP) in exact mapping of intrahepatic biliary anatomy and its variants anatomically in subjects with normal liver using intraoperative cholangiography (IOC) as a reference standard. Thirty-five subjects with normal liver activity were imaged via IOC and 3D MRCP. The findings were compared and statistically analyzed. Type I was observed in 23 subjects using IOC and 22 using MRCP. Type II was evident in 4 subjects via IOC and 6 via MRCP. Type III was observed equally by both modalities (4 subjects). Both modalities observed type IV in 3 subjects. The unclassified type was observed in a single subject via IOC and was missed in 3D MRCP. Accu...
Gastrointestinal Endoscopy, 2002
Background: Traditionally, ERCP has been the only reliable method for imaging the biliary tree, but it is invasive and carries a risk of complications. Magnetic resonance cholangiopancreatography (MRCP) is a noninvasive method for imaging the biliary tree. The aim of this study was to prospectively assess the accuracy of MRCP in a large number of patients. Methods: Consecutive patients referred to a teaching hospital for ERCP were eligible for study entry. MRCP was performed within 24 hours before ERCP. MRCP findings were compared with ERCP findings or, when the initial ERCP was unsuccessful, with results of repeat ERCP, percutaneous transhepatic cholangiography, or surgery. Results: One hundred forty-six patients underwent 149 ERCP/MRCP procedures, of which 129 were evaluable with successful MRCP and ERCP or an ERCP-equivalent study. Diagnoses included choledocholithiasis in 46 and biliary stricture in 12 patients. The sensitivity, specificity, positive, and negative predictive values for MRCP in the diagnosis of choledocholithiasis were 97.9%, 89.0%, 83.6%, and 98.6%, respectively. All 12 strictures were diagnosed by MRCP (sensitivity 100%, specificity 99.1%). Conclusions: MRCP is an accurate, noninvasive alternative to ERCP for imaging the biliary tree. Choledocholithiasis and biliary strictures can be reliably diagnosed or excluded by MRCP. MRCP should be used increasingly in patients with suspected biliary obstruction to select those who require a therapeutic procedure.
Euromediterranean Biomedical Journal, 2020
The twofold purpose of this study was firstly to analyse the imaging features of various anatomical variants of the intra-hepatic biliary tree using magnetic resonance cholangio-pancreatography (MRCP) and to document the prevalence of each type in our population. The second aim was to perform a systematic review in order to evaluate the prevalence of anatomic variations of the intrahepatic biliary system in different studies and with different imaging methods. Patients who underwent MRCP between January 2009 and December 2011 were included and analyzed. All examinations were obtained using 1.5 Tesla MRI and 8 channel phased-array coil. In order to compare data coming from the present study and different series published by other authors, a comprehensive literature search using the MEDLINE and Pubmed databases was performed, covering the period from January 1980 to December 2017. Among 534 patients, normal morphology of the intrahepatic biliary system (Type 1) was found in 55% of cas...
Diagnostic and Interventional Radiology, 2016
I ntrahepatic bile duct (IHBD) anatomy can show many variations causing biliary complications after liver transplantation (1). Biliary tract complications after orthotopic liver transplantations are reported in 10%-25% of subjects, and fatal complications can be observed in up to 10% of patients in complicated cases. In addition, although laparoscopic surgery is a less invasive surgical method, the limited visual field and errors of misperception occasionally result in biliary complications such as bile leakage and injury to the contralateral biliary ducts (approximately 0.5% of cases) (2). It is very important to preoperatively delineate the anatomy of the biliary system in an accurate and reliable manner. Inadequate characterization of the IHBD anatomy can cause not only perioperative but also postoperative complications that can adversely affect the prognosis. With the technological developments in recent years, it has become possible to noninvasively depict biliary structures using imaging modalities such as magnetic resonance cholangiopancreatography (MRCP), contrast-enhanced magnetic resonance cholangiography, and computed tomography cholangiography. Noninvasive imaging modalities have emerged as invaluable alternatives for endoscopic retrograde cholangiopancreatography and perioperative cholangiography. MRCP is the foremost noninvasive imaging method of the biliary system. Maximum-intensity projection (MIP) images obtained using MRCP enable the assessment of small biliary tracts. Furthermore, MRCP is not associated with radiation exposure and does not require a contrast material (3-5). Despite many different IHBD variations reported, the most comprehensive classification is the Yoshida classification (6). This classification describes seven different IHBD variations. Cystohepatic duct is accepted as the eighth type in this study. In the literature, there are many case reports on different variations that were not presented in the Yoshida classifica-489
MRCPvsERCP in the evaluation of biliary pathologies: Review of current literature
Journal of Digestive Diseases, 2008
OBJECTIVE: Recently developed magnetic resonance (MR) techniques permit fast and correct imaging of the entire biliary tree with a high spatial resolution. The aim of this study was to compare the diagnostic potential of one of these new MR sequences in magnetic resonance cholangiopancreatography (MRCP) procedure and endoscopic retrograde cholangiopancreatography (ERCP) with review of current literatures. METHODS: A total of 295 patients were enrolled in this study prospectively. Of these, 11 were excluded from the study due to inadequate MRCP image quality and 15 more were excluded due to unsuccessful cannulation during ERCP. Thus, finally 269 patients (124 men and 145 women with a mean age of 57 years; range: 23-92 years) were included. The MRCP procedure was performed before the ERCP in all cases. All MRCP studies were performed with recently developed new MR technique using a heavily T2-weighted turbo spin echo (TSE) sequence. This TSE sequence is currently one of the most widely used multiplanar 3-D MR technique, having a high spatial resolution and fast imaging capacity. RESULTS: The study participants were classified into four main groups; normal into group I, stone disease into group II, tumor into group III and others into group IV. Group I consisted of 228 patients who had a normal pancreaticobiliary tree on both the MRCP and ERCP examinations. In group II there were 18 patients, for whom the MRCP had a 88.9% sensitivity and a 100% specificity for diagnosing biliary stone disease. Its positive predictive value (PPV), negative predictive value (NPV) and accuracy rates were 100%, 99.2% and 99.2%, respectively. The MRCP had a 100% sensitivity and a 100% specificity for 20 patients in group III. It also had 100% PPV, 100% NPV, and 100% total accuracy rates in this group. In three patients in group IV, the MRCP had a 100% sensitivity and specificity, respectively. Its PPV, NPV and accuracy were 100%, 100% and 100%, respectively. CONCLUSION: MRCP is used with increasing frequency as a non-invasive alternative to ERCP and the diagnostic results of MRCP with a heavily T2-weighted TSE MR sequence and ERCP are comparable with high accuracy in various hepatobiliary pathologies.
British Journal of Surgery, 2022
The aim of this project was to examine world literature to establish the various types and frequencies of anatomical variants within the extrahepatic biliary tree, thereby contributing to the body of information available to anatomists, surgeons, and radiologists. Knowledge of the notoriously variable anatomy of the extrahepatic biliary tree is of greater importance than ever, given the increased occurrence and complexity of hepatobiliary and laparoscopic surgeries. Method: A database search of MEDLINE, EMBASE and PubMed was conducted in June 2021 and returned 3440 articles, of which 29 were deemed eligible for inclusion. Results: A rare malposition, the left-sided gallbladder, was observed in 0.04-0.60% across five studies. A normal cystic artery origin, that is, from the right hepatic artery was observed in 73.3-92% with variations being seen from the left hepatic artery (1-1.9%), gastroduodenal artery (1-7.5%) and the aberrant right hepatic artery (3-12.1%). It was also noted that in 3.6-32% of subjects the course of the cystic artery lay extraneous to Calot's triangle. Michels' and Hiatt's classification systems were used to define the anatomical variations of the hepatic arteries: studies using Michels' Type III reported a prevalence from 6.4-15%, Michels' Type VI from 0.6-7% and Hiatt's Type III recorded an incidence ranging from 9.7-14.8%. Conclusion: The most obvious finding to emerge from this project was the widely variable anatomy of the extrahepatic biliary tract and the contrasting reported data. Surgeons should therefore anticipate such complexities and adapt techniques to avoid biliary and arterial injuries and associated intra-and postoperative complications.