Jaganathan Sriram, Ray Brijesh, Velaga Jyotirmayi
Radiology, Global Hospitals, Bengaluru, IND.
Radiology, Aster Medcity, Kochi, IND.
Cureus. 2023 Feb 6;15(2):e34695. doi: 10.7759/cureus.34695. eCollection 2023 Feb.
Objective 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.
目的 胆道解剖结构对于肝胆胰外科医生进行手术规划至关重要。术前通过磁共振胰胆管造影（MRCP）评估胆道解剖结构起着至关重要的作用，尤其是对于活体肝移植（LDLT）中的潜在肝脏供体。我们的目的是评估MRCP在评估胆道系统解剖变异方面的诊断准确性以及LDLT供体中胆道变异的发生率。材料与方法 回顾性研究了65例年龄在20至51岁之间的活体肝移植供体，以评估胆管树的解剖变异。作为移植前供体检查的一部分，所有这些候选者均在1.5T机器上进行了带有MRCP的MRI检查。MRCP源数据集采用最大强度投影、表面阴影显示和多平面重建进行处理。两名放射科医生对图像进行了评估，并采用黄氏等人的分类系统来评估胆道解剖结构。将结果与术中胆管造影（被视为金标准）进行比较。结果 我们在34例候选者（52.3%）中发现了标准胆道解剖结构，在31例候选者（47.7%）的MRCP上观察到了变异胆道解剖结构。术中胆管造影显示36例候选者（55.4%）为标准解剖结构，29例候选者（44.6%）存在胆道变异。与金标准术中胆管造影相比，我们的研究显示MRCP识别胆道变异解剖结构的敏感性为100%，特异性为94.5%。在我们的研究中，MRCP检测变异胆道解剖结构的准确性为96.9%。最常见的胆道变异是右后叶段胆管汇入左肝管，即黄氏A3型。结论 潜在肝脏供体中胆道变异的发生率较高。MRCP在识别具有手术意义的胆道变异方面敏感且高度准确。
