Düşünceli Ebru, Erden Ayşe, Erden Ilhan
Ankara Universitesi Tip Fakültesi, Radyodiagnostik Anabilim Dali, Ankara, Turkey.
Tani Girisim Radyol. 2004 Dec;10(4):296-303.
Anatomic variations of intra or extrahepatic bile ducts may be problematic during surgical procedures. Besides iatrogenic trauma of the bile ducts during cholecystectomy, formation of bile duct stones, recurrent pancreatitis, cholangitis and biliary malignancies can be seen. The aim of this study was to evaluate the frequency of anatomic variations of the biliary tree and to present the magnetic resonance cholangiopancreatography (MRCP) findings.
Between July 2000 and April 2004, 581 patients suspected to have pancreatobiliary disease, were referred to our MR unit. Four hundred and seventy-five patients with ages ranging from 22 to 88 (median: 56) were included in the study retrospectively. MRCP was performed on a 1 Tesla MR unit, using phased-array coil for signal detection. Heavily T2 weighted images were obtained with SSFSE technique. Axial and coronal source images and reformatted images were all evaluated together for the possibility of any anatomic variation.
Anatomic variations at different levels of biliary tree were found in 115 patients (24.2%). MRCP showed an aberrant right hepatic duct in 23 patients (4.8%), a right posterior hepatic duct in 27 patients (5.7%), trifurcation in 4 patients (0.8%), a long cystic duct in 8 patients (1.7%), a medial cystic duct insertion in 3 patients (0.63%), a low medial cystic duct insertion in 18 patients (3.8%), a short cystic duct in 1 patient (0.2%), a high localized gallbladder in 5 patients (1%), a vascular compression of common hepatic duct in 12 patients (2.5%), a pancreatobiliary junction anomaly in 3 patients (0.63%). Eleven patients had more than one anatomic variation (2.3%).
MRCP is a useful, rapid, and non-invasive method for demonstrating the anatomy and the variations of the biliary tree. Diagnosis of these anatomic variations prior to surgical procedures may prevent iatrogenic injury to bile ducts.
肝内或肝外胆管的解剖变异在外科手术过程中可能会引发问题。除了胆囊切除术期间胆管的医源性创伤外，还可见胆管结石形成、复发性胰腺炎、胆管炎和胆道恶性肿瘤。本研究的目的是评估胆管树解剖变异的发生率，并展示磁共振胰胆管造影（MRCP）的结果。
2000年7月至2004年4月期间，581例疑似患有胰胆疾病的患者被转诊至我们的磁共振科室。回顾性纳入了475例年龄在22至88岁（中位数：56岁）之间的患者。在1台1特斯拉的磁共振设备上进行MRCP检查，使用相控阵线圈进行信号检测。采用SSFSE技术获取重T2加权图像。对轴向和冠状位源图像以及重组图像一起进行评估，以确定是否存在任何解剖变异。
115例患者（24.2%）在胆管树的不同水平发现了解剖变异。MRCP显示23例患者（4.8%）存在右肝管异常，27例患者（5.7%）存在右后肝管，4例患者（0.8%）存在三叉分支，8例患者（1.7%）存在长胆囊管，3例患者（0.63%）存在胆囊管内侧插入，18例患者（3.8%）存在胆囊管内侧低位插入，1例患者（0.2%）存在短胆囊管，5例患者（1%）存在高位局限性胆囊，12例患者（2.5%）存在肝总管血管压迫，3例患者（0.63%）存在胰胆管连接异常。11例患者有不止一种解剖变异（2.3%）。
MRCP是一种用于显示胆管树解剖结构及其变异的有用、快速且无创的方法。在外科手术前诊断这些解剖变异可预防胆管的医源性损伤。
