Prevalence of Different Hepatobiliary Tree Variants on Magnetic Resonance Cholangiopancreatography in Patients Visiting a Tertiary Care Teaching Hospital in Karachi

Naeem, Muhammad; Ahmed, Muhammad Saad; Hamid, Kamran S.; Shazlee, Muhammad Kashif; Qureshi, Farheen; Ullah, Muhammad Asad

doi:10.7759/cureus.12329

Cited by 8 publications

(7 citation statements)

References 26 publications

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“…Regarding variations in biliary anatomy, we reported a prevalence of 34% among the 400 living donors who underwent MRCP preoperatively. Our result was similar to numerous other studies [15,20], including a regional study on 342 patients using MRCP [21]. In this study, Naeem et al revealed a frequency of 34.2% for nonconventional biliary anatomy, thus strengthening our data [21].…”

Section: Discussionsupporting

confidence: 92%

Anatomical variations in living donors for liver transplantation—prevalence and relationship

Khalid,

Saleem,

Ihsan-ul-Haq

et al. 2023

Langenbecks Arch Surg

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Living donor liver transplantation (LDLT) is a widely accepted option to address the lack of a deceased liver program for transplantation. Understanding vascular and biliary anatomy and their variants is crucial for successful and safe graft harvesting. Anatomic variations are common, particularly in the right hepatic lobe. To provide evidence for screening potential liver transplant donors, the presence of vascular and biliary anatomic variations in the preoperative assessment of transplantation donor candidates in Pakistan were explored. Methods:The was a retrospective cross-sectional study to evaluate the hepatic artery, portal vein, hepatic vein, and biliary variations in living liver donors. The study included 400 living liver donors, and data was collected from March 2019 to March 2023. We used a CT scan and MRCP to assess the anatomical variations. Results:The study examined 400 liver donors aged 18 to 53 years. Conventional arterial anatomy was the most common (65.8%), followed by replaced right hepatic artery (16%) and replaced left hepatic artery (10.8%).Conventional type 1 biliary anatomy was seen in 65.8% of cases. The dominant right hepatic vein was found in 13.3% donors. There was a signi cant association between the prevalence of variant portal venous anatomy with variant biliary anatomy. Conclusion:There was high variability in hepatic venous anatomy and a similar prevalence of variant hepatic arterial anatomy to other studies. A strong relationship between variant portal venous and biliary anatomy was found. These ndings can aid in selecting suitable candidates and improving surgical planning for liver transplantation.

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Section: Discussionsupporting

confidence: 92%

Anatomical variations in living donors for liver transplantation—prevalence and relationship

Khalid,

Saleem,

Ihsan-ul-Haq

et al. 2023

Langenbecks Arch Surg

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“…With the recent advancements in imaging techniques, non‐invasive mapping of the biliary anatomy can be easily performed. An understanding of the anatomy of the biliary tree and its main variations is essential for many reasons, such as providing precise pre‐operative information for surgeons in order to reduce the rate of procedure‐related complications (Farias et al, 2013; Naeem et al, 2020; Sureka et al, 2016). Moreover, accurate knowledge of the biliary system is also required for radiologists since its variations can be associated with biliary tract pathologies and both staging and localization of intrahepatic liver neoplasms and bile duct tumours are based on its segmental anatomy (Medisoglu et al, 2021; Mortelé & Ros, 2001; Mosconi, Solaini, et al, 2021; Renzulli, Brocchi, et al, 2021).…”

Section: Discussionmentioning

confidence: 99%

Association between anatomic variations of extrahepatic and intrahepatic bile ducts: Do look up!

et al. 2023

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Biliary anatomic variations are usually asymptomatic, but they may cause problems in diagnostic investigations and interventional and surgical procedures, increasing both their technical difficulty and their postoperative complication rates. The aim of the present study was to evaluate the prevalence of anatomic variations in the intrahepatic biliary ducts (IHBD) in relation to demographical and clinical characteristics in a large study population requiring magnetic resonance cholangiopancreatography (MRCP) for various clinical conditions. The possible association between IHBD and extrahepatic biliary ducts (EHBD) variants was then explored. From January 2017 to May 2019, 1004 patients underwent MRCP. Demographical and clinical data were collected. IHBD and EHBD anatomy were recorded and the EHBD anatomy was classified using both qualitative and quantitative classifications. The presence of a type 3 EHBD variant (an abnormal proximal cystic duct [CD] insertion) in both qualitative and quantitative classifications and an intrapancreatic CD were associated with the presence of IHBD variants at univariate analysis (p = 0.008, p = 0.019, and p = 0.001, respectively). The presence of a posterior or medial insertion of the CD into the EHBD was a strong predictive factor of the presence of IHBD variants both at uni-and multivariate analysis (p = 0.002 and p = 0.003 for posterior insertion and p = 0.002 and p = 0.002 for medial insertion, respectively). The presence of gallstones on MRCP resulted in a strong predictor of the presence of an anatomical variant of the IHBD both at uni-and multivariate analysis (p = 0.027 and p = 0.046, respectively). In conclusion, the presence of a type 3 variant of the EHBD, an intrapancreatic CD and, especially, a posterior/medial CD insertion into the EHBD represent predictive factors of the concomitant presence of IHBD variants, thus radiologists must be vigilant when encountering these EHBD configurations and always remember to "look up" at the IHBD.Finally, the presence of an IHBD variant is a strong predictive factor of gallstones.

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“…Basaran et al evaluated 40 potential liver donors and found standard biliary anatomy in 67.5% of donors [ 17 ]. Naeem et al, in their study of 369 patients, identified conventional standard anatomy in 65.8% [ 18 ]. Higher numbers for standard biliary anatomy were seen in the studies by Basasran et al and Naeem et al compared to our study.…”

Section: Discussionmentioning

confidence: 99%

Our Experience in Tracking the Tract: Normal Biliary Anatomy and Variants on Magnetic Resonance Cholangiopancreatography in Living Donor Liver Transplantation

Jaganathan¹,

Ray²,

Velaga³

2023

Cureus

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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.

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Prevalence of Different Hepatobiliary Tree Variants on Magnetic Resonance Cholangiopancreatography in Patients Visiting a Tertiary Care Teaching Hospital in Karachi

Cited by 8 publications

References 26 publications

Anatomical variations in living donors for liver transplantation—prevalence and relationship

Anatomical variations in living donors for liver transplantation—prevalence and relationship

Association between anatomic variations of extrahepatic and intrahepatic bile ducts: Do look up!

Our Experience in Tracking the Tract: Normal Biliary Anatomy and Variants on Magnetic Resonance Cholangiopancreatography in Living Donor Liver Transplantation

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