Our purpose was to investigate the anatomic variants of the biliary tree using MRCP in a
large cohort of Sicilian patients and evaluate in how many cases they had been reported

Amico, M.

Galfano, M.

Galia, M.

Lo Re, G.

Midiri, M.

Picone, D.

Salerno, S.

Serraino, S.

Vernuccio, F.

Our purpose was to investigate the anatomic variants of the biliary tree using MRCP in a
large cohort of Sicilian patients and evaluate in how many cases they had been reported

PICONE, Dario

VERNUCCIO, Federica

AMICO, Maria

SERRAINO, Salvatore

GALIA, Massimo

SALERNO, Sergio

MIDIRI, Massimo

Archivio istituzionale della ricerca - Università di Palermo

Page 1 of 8Anatomic variants of the biliary tree at MRCP: still too rarelyreported!Poster No.: C-1053Congress: ECR 2015Type: Scientific ExhibitAuthors: D. Picone, G. Lo Re, F. Vernuccio, M. Amico, S. Serraino, M.Galia, M. C. Galfano, S. Salerno, M. Midiri; Palermo/ITKeywords: Abdomen, MR, Cholangiography, CongenitalDOI: 10.1594/ecr2015/C-1053Any information contained in this pdf file is automatically generated from digital materialsubmitted to EPOS by third parties in the form of scientific presentations. Referencesto any names, marks, products, or services of third parties or hypertext links to third-party sites or information are provided solely as a convenience to you and do not inany way constitute or imply ECR's endorsement, sponsorship or recommendation of thethird party, information, product or service. ECR is not responsible for the content ofthese pages and does not make any representations regarding the content or accuracyof material in this file.As per copyright regulations, any unauthorised use of the material or parts thereof aswell as commercial reproduction or multiple distribution by any traditional or electronicallybased reproduction/publication method ist strictly prohibited.You agree to defend, indemnify, and hold ECR harmless from and against any and allclaims, damages, costs, and expenses, including attorneys' fees, arising from or relatedto your use of these pages.Please note: Links to movies, ppt slideshows and any other multimedia files are notavailable in the pdf version of presentations.www.myESR.orgPage 2 of 8Aims and objectivesMagnetic resonance cholangiopancreatography (MRCP) is a non-invasive and fastmethod for evaluating requiring neither the use of contrast medium injection nor anybiliary intervention. It is actually indicated for the direct visualization of the intrahepaticand extrahepatic biliary ducts and the pancreatic duct. MRCP images allow also torecord many different anatomic abnormalities as anatomic variants of biliary tree. For thisreason, MRCP is increasingly used for preoperative planning, as in donor candidates forliving related liver transplantation, since anatomic variants of biliary tree may increasethe complexity of hepatic surgical procedures and biliary interventions.In normal anatomy, which is present in about 58% of the population, the right hepatic ductdrains the segments of the right liver lobe and has two major branches: the right posteriorduct draining the posterior segments, VI and VII, and the right anterior duct draining theanterior segments, V and VIII. The right posterior duct usually runs posterior to the rightanterior duct and fuses it from a left approach to form the right hepatic duct. The lefthepatic duct is formed by segmental tributaries draining segments II-IV. The commonhepatic duct is formed by fusion of the right hepatic duct and the left hepatic duct. Thebile duct draining the caudate lobe usually joins the origin of the left or right hepatic duct.The cystic duct classically joins the common hepatic duct below the confluence of theright and left hepatic ducts.However, as demonstrated in different studies, there is great variability in the anatomyof the hepatic biliary tree, gallbladder, and pancreatic ducts, since biliary tract structureshows racial and ethnic variation. In approximately 30% of the general population, twosegmental ducts drain the right hepatic lobe and separately join with the left hepatic duct,cystic duct, or common bile duct. Rarely, the cystic duct is absent or duplicated. Thelength and course of the cystic duct are frequently anomalous and in about 5%-15%of the population, the common bile duct and main pancreatic duct enter the duodenumseparately.Our purpose was to investigate the anatomic variants of the biliary tree using MRCP in alarge cohort of Sicilian patients and evaluate in how many cases they had been reported.Methods and materialsWe reviewed both reports and images of MRCP performed in 516 patients (60,9±15,6years) who had been submitted to diagnostic MRCP from June 2009 to May 2013 in orderto identify the type of biliary tree variants. All patients had been submitted an MRCP witha 1.5 Tesla super-conducting magnet with surface or 8-channel phased-array coils.Page 3 of 8All exams had been performed acquiring a Fat-saturated axial FIESTA sequence (TR3600, TE min, FOV 38, thickness 6mm Nex 1), Dual Phase FSPGR (TR 150, FA 80, NEX1, thickness 1mm, matrix 256x192), axial T2 SSFSE (TE180, TR 827, thickness 7mm,matrix 384x224) and a MRCP radial sequence (TR 10000, TE min, FOV 36, thickness0.4mm).The MRCP had been performed after oral administration of 400 ml of a solution ofsuperparamagnetic iron oxide particles with silicone coating. All images were reviewedand common variations of the biliary tract were divided into the following types: type 1,2, 3a, 3b, 3c, 4, 5a, 5b, 6 as shown in Figure 1.Images for this section:Fig. 1: Figure 1. Schematic drawing of Biliary ductal anatomic variants.Page 4 of 8ResultsIn less than 1% of the MRCP reports it was specified the presence of an anatomicalvariant of the biliary tree. On the other hand the imaging findings showed that around 23%of the patients had anatomical variants of the biliary tree (see Figures 2-4). Type 3a wasthe most common variant. The distribution of the different percentage of the anatomicvariants according to Yoshida classification is shown in Figure 5.Images for this section:Fig. 2: Figure 2. MRCP showing type 1 anatomic variant of the biliary tree.Fig. 3: Figure 3. MRCP shows type 3a anatomic variant of the biliary tree.Page 5 of 8Fig. 4: Figure 4. MRCP shows a type 5a anatomic variant of the biliary tree.Page 6 of 8Fig. 5: Figure 5. Distribution of the common variants of biliary tree in our population.Page 7 of 8ConclusionAnatomical variants of the biliary tree present a complex spectrum of frequent alterations,which can be easily identified by MRCP. Knowledge of the presence of these variantscan be useful for both the clinician and the surgeon. Preoperative imaging of the biliarybranching pattern proves to be a succesful method to diagnose these variants. However,in our experience, comparing reports and imaging analyses it merges that in most ofthe cases the presence of anatomical variants of the biliary tree is not reported by theradiologist.Personal informationDario Picone, dariopicone@hotmail.itGiuseppe Lo Re, giuseppe.lore12@gmail.comFederica Vernuccio, federicavernuccio@gmail.comReferences1. Mortelé KJ, Ros PR. Anatomic variants of the biliary tree: MR cholangiographic findingsand clinical applications. AJR Am J Roentgenol. 2001;177:389-94.2. Yoshida J, Chijiiwa K, Yamaguchi K, Yokohata K, Tanaka M. Practical classificationof the branching types of the biliary tree: an analysis of 1094 consecutive directcholangiograms. J Am Coll Surg 1996; 182: 37-403. Lee CM, Chen HC, Leung TK, Chen YY. Magnetic resonancecholangiopancreatography of anatomical variants of the biliary tree in Taiwanese. JFormos Med Assoc 2004; 103: 155-1594. Silva AC, Friese JL, Hara AK, Liu PT. MR cholangiopancreatography: improved ductaldistention with intravenous morphine administration. Radiographics. 2004;24:677-87.5. De Filippo M, Calabrese M, Quinto S, Rastelli A, Bertellini A, Martora R, SverzellatiN, Corradi D, Vitale M, Crialesi G, Sarli L, Roncoroni L, Garlaschi G, ZompatoriM. Congenital anomalies and variations of the bile and pancreatic ducts: magneticresonance cholangiopancreatography findings, epidemiology and clinical significance.Radiol Med. 2008;113:841-59.Page 8 of 8

ANATOMIC VARIANTS OF THE BILIARY TREE AT MRCP: STILL TOO RARELY REPORTED!

https://iris.unipa.it/retrieve/handle/10447/120798/180113/ECR2015_C-1053.pdf

ANATOMIC VARIANTS OF THE BILIARY TREE AT MRCP: STILL TOO RARELY REPORTED!

Abstract

Similar works

Full text

Available Versions

Archivio istituzionale della ricerca - Università di Palermo