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Imaging of choledochal cysts

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Abstract

Choledochal cysts are rare cystic dilatations of the intrahepatic and/or extrahepatic biliary tree, which may be mistaken for other cystic lesions if their characteristic features are not recognized. The etiology is unknown, and likely multifactorial, and it is uncertain whether they are congenital or acquired. Multiple imaging modalities can be used to diagnose choledochal cysts, including ultrasound, computed tomography, magnetic resonance (MR) cholangiopancreatography (MRCP), endoscopic retrograde cholangiopancreatography, and percutaneous transhepatic cholangiography. MRCP has replaced the more invasive techniques as the gold standard of diagnosis. In addition, MRCP is helpful in detecting an abnormal pancreaticobiliary junction, which is seen in the majority of choledochal cysts. Reaching a correct diagnosis is essential, given the associated risk of complications, including cholangitis, biliary strictures, stones, and malignancy, and accurately assessing the location and length of involvement is important for surgical planning. This review aims to familiarize radiologists with the different types of choledochal cysts and their imaging features according to the Todani classification.

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References

  1. Lee HK, et al. (2009) Imaging features of adult choledochal cysts: a pictorial review. Korean J Radiol 10(1):71–80

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  2. Idrees K, Ahrendt SA (2011) Cystic disorders of the bile ducts. In: Cameron JL, Cameron AM, (eds). Current Surgical Therapy. pp. 353-356

  3. Lipsett PA, et al. (1994) Choledochal cyst disease. A changing pattern of presentation. Ann Surg 220(5):644–652

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  4. O’Neill JA Jr (1992) Choledochal cyst. Curr Probl Surg 29(6):361–410

    PubMed  Google Scholar 

  5. Edil BH, et al. (2008) Choledochal cyst disease in children and adults: a 30-year single-institution experience. J Am Coll Surg 206(5):1000–1005 (discussion 1005–1008)

    Article  PubMed  Google Scholar 

  6. Singham J, Yoshida EM, Scudamore CH (2009) Choledochal cysts: part 1 of 3: classification and pathogenesis. Can J Surg 52(5):434–440

    PubMed Central  PubMed  Google Scholar 

  7. Mabrut JY, et al. (2010) Management of congenital bile duct cysts. Dig Surg 27(1):12–18

    Article  PubMed  Google Scholar 

  8. Summerfield JA, et al. (1986) Hepatobiliary fibropolycystic diseases. A clinical and histological review of 51 patients. J Hepatol 2(2):141–156

    Article  CAS  PubMed  Google Scholar 

  9. Edil BH, Olino K, Cameron JL (2009) The current management of choledochal cysts. Adv Surg 43:221–232

    Article  PubMed  Google Scholar 

  10. Miyano T, Yamataka A (1997) Choledochal cysts. Curr Opin Pediatr 9(3):283–288

    Article  CAS  PubMed  Google Scholar 

  11. Cha SW, et al. (2008) Choledochal cyst and anomalous pancreaticobiliary ductal union in adults: radiological spectrum and complications. J Comput Assist Tomogr 32(1):17–22

    Article  PubMed  Google Scholar 

  12. Levy AD, Rohrmann CA Jr (2003) Biliary cystic disease. Curr Probl Diagn Radiol 32(6):233–263

    Article  PubMed  Google Scholar 

  13. Beltran MA (2012) Current knowledge on pancreaticobiliary reflux in normal pancreaticobiliary junction. Int J Surg 10(4):190–193

    Article  PubMed  Google Scholar 

  14. Sugiyama M, et al. (2004) Biliopancreatic reflux via anomalous pancreaticobiliary junction. Surgery 135(4):457–459

    Article  PubMed  Google Scholar 

  15. Ochiai K, et al. (2004) Activated pancreatic enzyme and pancreatic stone protein (PSP/reg) in bile of patients with pancreaticobiliary maljunction/choledochal cysts. Dig Dis Sci 49(11–12):1953–1956

    Article  PubMed  Google Scholar 

  16. Shimada K, Yanagisawa J, Nakayama F (1991) Increased lysophosphatidylcholine and pancreatic enzyme content in bile of patients with anomalous pancreaticobiliary ductal junction. Hepatology 13(3):438–444

    Article  CAS  PubMed  Google Scholar 

  17. Singham J, Yoshida EM, Scudamore CH (2009) Choledochal cysts: part 2 of 3: diagnosis. Can J Surg 52(6):506–511

    PubMed Central  PubMed  Google Scholar 

  18. Todani T, et al. (2003) Classification of congenital biliary cystic disease: special reference to type Ic and IVA cysts with primary ductal stricture. J Hepatobiliary Pancreat Surg 10(5):340–344

    Article  PubMed  Google Scholar 

  19. She WH, et al. (2009) Management of choledochal cyst: 30 years of experience and results in a single center. J Pediatr Surg 44(12):2307–2311

    Article  PubMed  Google Scholar 

  20. Kim MJ, et al. (2002) Using MR cholangiopancreatography to reveal anomalous pancreaticobiliary ductal union in infants and children with choledochal cysts. AJR Am J Roentgenol 179(1):209–214

    Article  PubMed  Google Scholar 

  21. Kamisawa T, et al. (2007) MRCP of congenital pancreaticobiliary malformation. Abdom Imaging 32(1):129–133

    Article  CAS  PubMed  Google Scholar 

  22. Guo WL, et al. (2012) Imaging findings in 75 pediatric patients with pancreaticobiliary maljunction: a retrospective case study. Pediatr Surg Int 28(10):983–988

    Article  PubMed Central  PubMed  Google Scholar 

  23. Burke C, et al. (2013) the role of hepatocyte-specific contrast agents in hepatobiliary magnetic resonance imaging. Semin Ultrasound, CT MRI 34(1):44–53

    Article  Google Scholar 

  24. Yeh BM, et al. (2009) MR imaging and CT of the biliary tract. Radiographics 29(6):1669–1688

    Article  PubMed  Google Scholar 

  25. Gupta RT, et al. (2010) Dynamic MR imaging of the biliary system using hepatocyte-specific contrast agents. AJR Am J Roentgenol 195(2):405–413

    Article  PubMed  Google Scholar 

  26. Alonso-Lej F, Rever WB Jr, Pessagno DJ (1959) Congenital choledochal cyst, with a report of 2, and an analysis of 94, cases. Int Abstr Surg 108(1):1–30

    CAS  PubMed  Google Scholar 

  27. Todani T, et al. (1977) Congenital bile duct cysts: classification, operative procedures, and review of thirty-seven cases including cancer arising from choledochal cyst. Am J Surg 134(2):263–269

    Article  CAS  PubMed  Google Scholar 

  28. Todani T (1997) Congenital choledochal dilatation: classification, clinical features, and long-term result. J Hepatobiliary Pancreat Surg 4:276–282

    Article  Google Scholar 

  29. Serena Serradel AF, Santamaria Linares E, Herrera Goepfert R (1991) Cystic dilatation of the cystic duct: a new type of biliary cyst. Surgery 109(3 Pt 1):320–322

    CAS  PubMed  Google Scholar 

  30. Nguyen Thanh L, et al. (2010) Laparoscopic repair for choledochal cyst: lessons learned from 190 cases. J Pediatr Surg 45(3):540–544

    Article  PubMed  Google Scholar 

  31. Ziegler KM, et al. (2010) Choledochoceles: are they choledochal cysts? Ann Surg 252(4):683–690

    PubMed  Google Scholar 

  32. Woon CY, et al. (2006) Adult choledochal cysts: an audit of surgical management. ANZ J Surg 76(11):981–986

    Article  PubMed  Google Scholar 

  33. Lefere M, et al. (2011) Caroli disease: review of eight cases with emphasis on magnetic resonance imaging features. Eur J Gastroenterol Hepatol 23(7):578–585

    Article  PubMed  Google Scholar 

  34. Brancatelli G, et al. (2005) Fibropolycystic liver disease: CT and MR imaging findings. Radiographics 25(3):659–670

    Article  PubMed  Google Scholar 

  35. Santiago I, et al. (2012) Congenital cystic lesions of the biliary tree. AJR Am J Roentgenol 198(4):825–835

    Article  PubMed  Google Scholar 

  36. Fulcher AS, Turner MA, Sanyal AJ (2001) Case 38: Caroli disease and renal tubular ectasia. Radiology 220(3):720–723

    Article  CAS  PubMed  Google Scholar 

  37. Shedda S, Robertson A (2007) Caroli’s syndrome and adult polycystic kidney disease. ANZ J Surg 77(4):292–294

    Article  PubMed  Google Scholar 

  38. Levy AD, et al. (2002) Caroli’s disease: radiologic spectrum with pathologic correlation. AJR Am J Roentgenol 179(4):1053–1057

    Article  PubMed  Google Scholar 

  39. Miller WJ, et al. (1995) Imaging findings in Caroli’s disease. AJR Am J Roentgenol 165(2):333–337

    Article  CAS  PubMed  Google Scholar 

  40. Choi BI, et al. (1990) Caroli disease: central dot sign in CT. Radiology 174(1):161–163

    Article  CAS  PubMed  Google Scholar 

  41. Dantey K, Guindi M, Zenali M (2014) Education and imaging. Hepatobiliary and pancreatic: focal Caroli disease mimicking cholangiocarcinoma. J Gastroenterol Hepatol 29(3):420

    Article  CAS  PubMed  Google Scholar 

  42. Lipsett PA, Pitt HA (2003) Surgical treatment of choledochal cysts. J Hepatobiliary Pancreat Surg 10(5):352–359

    Article  PubMed  Google Scholar 

  43. Bode WE, Aust JB (1983) Isolated cystic dilatation of the cystic duct. Am J Surg 145(6):828–829

    Article  CAS  PubMed  Google Scholar 

  44. Loke TK, Lam SH, Chan CS (1999) Choledochal cyst: an unusual type of cystic dilatation of the cystic duct. AJR Am J Roentgenol 173(3):619–620

    Article  CAS  PubMed  Google Scholar 

  45. Goya C, et al. (2014) A rare anomaly of biliary system: MRCP evidence of a cystic duct cyst. Case Rep Radiol 2014:291071

    PubMed Central  PubMed  Google Scholar 

  46. Chan ES, Auyang ED, Hungness ES (2009) Laparoscopic management of a cystic duct cyst. JSLS 13(3):436–440

    PubMed Central  PubMed  Google Scholar 

  47. Venkatanarasimha N, et al. (2011) Imaging features of ductal plate malformations in adults. Clin Radiol 66(11):1086–1093

    Article  CAS  PubMed  Google Scholar 

  48. Liu QY, et al. (2013) MRI manifestations of adult choledochal cysts associated with biliary malignancy: a report of ten cases. Abdom Imaging 38(5):1061–1070

    Article  PubMed  Google Scholar 

  49. Todani T, et al. (1979) Carcinoma arising in the wall of congenital bile duct cysts. Cancer 44(3):1134–1141

    Article  CAS  PubMed  Google Scholar 

  50. Han JK, Choi BI (1996) Carcinoma in a choledochal cyst. Abdom Imaging 21(2):179–181

    Article  CAS  PubMed  Google Scholar 

  51. Cho MJ, et al. (2011) Surgical experience of 204 cases of adult choledochal cyst disease over 14 years. World J Surg 35(5):1094–1102

    Article  PubMed  Google Scholar 

  52. Lee KF, Lai EC, Lai PB (2005) Adult choledochal cyst. Asian J Surg 28(1):29–33

    Article  PubMed  Google Scholar 

  53. Ono S, et al. (2010) Long-term outcomes after hepaticojejunostomy for choledochal cyst: a 10- to 27-year follow-up. J Pediatr Surg 45(2):376–378

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology, Northwestern University Feinberg School of Medicine, 676 North St. Clair, Suite 800, Chicago, IL, 60611, USA

    Vanessa A. Lewis, Sharon Z. Adam, Paul Nikolaidis, Cecil Wood, Vahid Yaghmai & Frank H. Miller

  2. Department of Medicine, Olive View - UCLA Medical Center, 14445 Olive View Dr 2B-182, Sylmar, CA, 91342, USA

    James G. Wu

Authors
  1. Vanessa A. Lewis
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  2. Sharon Z. Adam
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  3. Paul Nikolaidis
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  4. Cecil Wood
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  6. Vahid Yaghmai
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  7. Frank H. Miller
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Correspondence to Frank H. Miller.

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Lewis, V.A., Adam, S.Z., Nikolaidis, P. et al. Imaging of choledochal cysts. Abdom Imaging 40, 1567–1580 (2015). https://doi.org/10.1007/s00261-015-0381-4

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