Onder Hakan, Ozdemir Muhammed Sıddık, Tekbaş Güven, Ekici Faysal, Gümüş Hatice, Bilici Aslan
Department of Radiology, Dicle University Medical Faculty, Diyarbakır, 21280, Turkey.
Surg Radiol Anat. 2013 Mar;35(2):161-7. doi: 10.1007/s00276-012-1021-0. Epub 2012 Sep 13.
The gallbladder and the biliary tract are structures in close connection with the adjacent organs and may show a number of variations and anomalies. It is therefore important for surgical purposes to know their anatomy and variations in detail. Various methods are used in the imaging of the variations of the biliary tract and its pathologies, including ultrasonography, computed tomography; direct cholangiographic methods like endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiography, intravenous cholangiography and T-tube cholangiography, as well as indirect methods like magnetic resonance cholangiopancreatography (MRCP) or cholescintigraphy. The aim of this study is to investigate the frequency of the anatomic variations of the biliary tract using 3-T MRCP and to compare the findings with the data in the literature.
For the purposes of this study, patients who underwent MRCP at our hospital (Dicle University Hospital) between November 2009 and February 2012 were investigated retrospectively. A total of 590 patients (between 6 and 88 years of age; mean age: 51 ± 9 years) were included in the study. The MRCP imaging was carried out with an magnetic resonance imaging (MRI) device supplied with 3-T magnetic power and by obtaining T2-weighted images through the single-shot fast spin echo technique using the standard body coil. The axial and coronal source images and the reformatted images were evaluated together in terms of the possible anatomic variations.
Among the 590 patients included in the study, of 233 (39.5 %) showed anatomic variations at different levels in the intra- and extrahepatic biliary tracts. Among these variations, a right posterior hepatic duct insertion to the left hepatic duct at the level of the bifurcation has been observed in 71 patients (12.1 %), trifurcation was observed in 30 patients (5.1 %) and insertion into the main hepatic duct at the proximal aspect of the cystic duct was observed in 18 patients (3.1 %). At the level of the cystic duct, medial insertion of the cystic duct was viewed in 58 patients (9.8 %), distal medial insertion was seen in 40 patients (6.8 %), a short cystic duct was detected in 10 patients (1.7 %), pancreatobiliary junction anomaly was viewed in two patients (0.4 %) and duplicate anatomic variations have been observed in 42 patients (7.2 %).
MRCP studies conducted using 3-T MRI devices may reveal similar or greater numbers of variations when compared to the existing MRCP studies in the literature. 3-T MRI shows a couple of variations. Pointing out these anatomical variations before the surgical intervention may prevent possible iatrogenic traumas. Donors with unsuitable variations for liver transplant may be spotted out at an early phase through the MRCP and certain operations with a high morbidity rate may thus be avoided.
胆囊和胆道是与相邻器官紧密相连的结构，可能存在多种变异和异常情况。因此，从手术角度详细了解其解剖结构和变异情况非常重要。在胆道变异及其病变的成像中使用了多种方法，包括超声检查、计算机断层扫描；直接胆管造影方法，如内镜逆行胰胆管造影、经皮经肝胆管造影、静脉胆管造影和T管胆管造影，以及间接方法，如磁共振胰胆管造影（MRCP）或胆闪烁造影。本研究的目的是使用3-T MRCP研究胆道解剖变异的频率，并将结果与文献数据进行比较。
为进行本研究，对2009年11月至2012年2月在我院（狄克莱大学医院）接受MRCP检查的患者进行回顾性研究。共有590例患者（年龄在6至88岁之间；平均年龄：51±9岁）纳入研究。使用配备3-T磁功率的磁共振成像（MRI）设备进行MRCP成像，并通过使用标准体线圈的单次快速自旋回波技术获得T2加权图像。对轴向和冠状源图像以及重组图像一起进行评估，以确定可能的解剖变异。
在纳入研究的590例患者中，233例（39.5%）在肝内和肝外胆道的不同水平显示解剖变异。在这些变异中，71例患者（12.1%）观察到右后肝管在分叉水平插入左肝管，30例患者（5.1%）观察到三叉分支，18例患者（3.1%）观察到在胆囊管近端插入肝总管。在胆囊管水平，58例患者（9.8%）观察到胆囊管内侧插入，40例患者（6.8%）观察到远端内侧插入，10例患者（1.7%）检测到短胆囊管，2例患者（0.4%）观察到胰胆管连接异常，42例患者（7.2%）观察到重复解剖变异。
与文献中现有的MRCP研究相比，使用3-T MRI设备进行的MRCP研究可能揭示相似或更多数量的变异。3-T MRI显示了一些变异。在手术干预前指出这些解剖变异可能预防可能的医源性创伤。通过MRCP可以早期发现肝移植变异不合适的供体，从而避免某些发病率高的手术。
