Anatomic Variations of Biliary Ducts: Magnetic Resonance Cholangiopancreatography Findings of 1041 Consecutive Patients

Abstract

Background It is important for surgical purposes to know the biliary tract anatomy and its variations in detail. The aim of the study was to evaluate the frequency of anatomical variations of the biliary tract at hepatic bifurcation level and also at cystic duct level using magnetic resonance cholangiopancreatography (MRCP). Methods A total of 1041 patients (between 16 and 102 years of age, 600 women 441 men with mean age of 60.6) were included in the study. The MRCP imaging was carried out with a 1.5 Tesla magnetic resonance imaging (MRI) device by using heavily T2-weighted sequences. Results Among the 1041 patients included in the study, 424 (40.7 %) showed anatomical variations at different levels of the biliary tree, and 12 of these patients (1.15 %) had two anatomical variations. Typical anatomy was present in 57.2 % of the females and 62.1 % males. The highest incidence of variation at the level of bifurcation was trifurcation with 133 patients (12.8 %) and at the level of cystic duct was the medial cystic duct insertion with 56 patients (5.37 %). Conclusions Trifurcation and medial cystic duct insertion seem to be more frequent in females compared to males. It is necessary to have the knowledge of these variations to avoid possible complications and also help to achieve the most effective result. MRCP

Anatomic variations of the intra-hepatic biliary tree in the Caribbean: A systematic review

“…Although uncommon, this variation has been reported before. Adatepe et al [ 47 ] reported a quadrification in 0.38% of 1,041 persons, which was similar to the prevalence in our population (0.65%). The clinical significance of this variation is probably similar to that of a Huang A2 variant.…”

Anatomic variations of the pancreatic duct and their relevance with the Cambridge classification system: MRCP findings of 1158 consecutive patients

“…7 Magnetic resonance cholangiopancreatography (MRCP) is becoming more commonly used in the noninvasive evaluation of the pancreatic and the biliary ducts. 1–8 MRCP detects pancreatic ductal system and also these variations with similar accuracy as the invasive technique of endoscopic retrograde cholangiopancreatography (ERCP). 3, 9 In MRCP, heavily T2 weighted sequences are used to image fluid filled structures without using contrast agent.…”

Biliary Anatomy

“…The intrahepatic biliary system is composed of bile ductules that join to form segmental ducts, while the extrahepatic system is composed of the corresponding extrahepatic biliary ducts and the gallbladder. 1,2…”

“…7 The right hepatic duct drains the right liver lobe's segments V to VIII and is composed of two major branches, the right posterior duct and the right anterior duct. 2,5,8 The right posterior duct is responsible for the drainage of the posterior segments, VI and VII, and the right anterior duct is responsible for drainage of anterior segments, V and VIII. 2,4,8 Conversely, the left hepatic duct is formed from several segmented branches which are responsible for drainage of segments II, III, and IV.…”

“…2,5,8 The right posterior duct is responsible for the drainage of the posterior segments, VI and VII, and the right anterior duct is responsible for drainage of anterior segments, V and VIII. 2,4,8 Conversely, the left hepatic duct is formed from several segmented branches which are responsible for drainage of segments II, III, and IV. 2,4,8 In classic biliary anatomy, the posterior right hepatic Keywords ► biliary anatomy ► biliary variants ► hepatic segments…”