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La radiologia medica

, Volume 113, Issue 6, pp 841–859 | Cite as

Congenital anomalies and variations of the bile and pancreatic ducts: magnetic resonance cholangiopancreatography findings, epidemiology and clinical significance

  • M. De FilippoEmail author
  • M. Calabrese
  • S. Quinto
  • A. Rastelli
  • A. Bertellini
  • R. Martora
  • N. Sverzellati
  • D. Corradi
  • M. Vitale
  • G. Crialesi
  • L. Sarli
  • L. Roncoroni
  • G. Garlaschi
  • M. Zompatori
Abdominal Radiology/Radiologia Addominale

Abstract

Purpose

The objective of this paper is to document the magnetic resonance cholangiopancreatography (MRCP) findings and the epidemiology of congenital anomalies and variations of the bile and pancreatic ducts and to discuss their clinical significance.

Materials and methods

Three-hundred and fifty patients of both sexes (150 females, 200 males, age range 0–76 years, average age 38 years) underwent MRCP for clinically suspected lithiasic, neoplastic or inflammatory disease of the bile and pancreatic ducts. Patients were imaged with a 1.5-T superconductive magnet (Magnetom Vision, Siemens, Erlangen, Germany), a four-channel phased-array body coil, breath-hold technique, with multislice T2-weighted half-Fourier acquisition single-shot turbo spin echo (HASTE), MIP reconstructions, and a single-shot T2-weighted turbo-spin-echo sequence rapid acquisition with relaxation enhancement (RARE) with different slice thicknesses. Studies in oncological patients were completed with fat saturation 3D T1 gradient-echo sequences during the intravenous injection of gadolinium diethylene triamine pentaacetate acid (DTPA) (0.2 ml/kg).

Results

MRCP demonstrated recurrent and therefore normal bile and pancreatic ducts in 57% of patients. In the remaining 42.3%, it documented anatomical variants (41%) and congenital anomalies (1.3%). Variants of the intrahepatic bile duct were seen in 21% of cases: crossover anomaly (6.7%), anterior branch of the right hepatic duct draining the IV and VII segments that flow together with the left bile duct (3.1%) and anterior and posterior branches of the right hepatic duct that flow together with the common hepatic duct (3.3%). Variants of the extrahepatic bile ducts were present in 8.8% of patients: low insertion of the cystic duct into the common hepatic duct (4.5%), emptying of the cystic duct into the right hepatic duct (2.7%) and a second-order large branch draining into the cystic duct (1.6%). MRCP identified a double gall bladder in 3% of patients and anatomical variants of the biliopancreatic system in 8.2%: pancreas divisum (5.2%) and a long sphincter of Oddi (3%). Finally, congenital anomalies were diagnosed in 1.3% of cases: bile duct cysts (0.3%), atresia of the bile ducts (0.3%) and multiple biliary hamartomatosis (0.7%).

Conclusions

The congenital anomalies and anatomical variants of the bile and pancreatic ducts present a complex spectrum of frequent alterations, which are worthy of attention in both the clinical and surgical settings and are readily identified by MRCP.

Key words

Bile and pancreatic ducts Anatomical variations Congenital anomalies MRCP 

Varianti ed anomalie congenite delle vie biliari e pancreatiche: aspetti colangiopancreato-RM, epidemiologia e significato clinico

Riassunto

Obiettivo

Documentare gli aspetti colangiopancreato-RM (CPRM), valutare l’epidemiologia e discutere il significato clinico delle varianti e delle anomalie congenite delle vie biliari e pancreatiche.

Materiali e metodi

Trecentocinquanta pazienti di entrambi i sessi (150 F e 200 M; range di età 0-76 anni, età media 38 anni) sono stati sottoposti a CPRM per i sospetti clinici di patologia litiasica, neoplastica e flogistica delle vie biliari e pancreatiche. È stato impiegato un magnete superconduttivo da 1,5 T con bobina body phased-array a quattro canali, tecnica breath-hold, acquisizioni half-fourier con T2-W (HASTE) multislice, ricostruzioni MIP, e single shot T2-W turbo-spin-echo (RARE) con differente spessore di strato. Alcuni esami, in pazienti oncologici, sono stati completati con sequenze gradient echo 3D T1w fat-sat durante somministrazione in vena periferica di mezzo di contrasto gadolinium-DTPA (0,2 ml/kg).

Risultati

La CPRM ha documentato vie biliari e pancreatiche ricorrenti e pertanto considerate normali nel 57,7% dei pazienti; nel restante 42,3% ha rilevato varianti anatomiche (41%) ed anomalie congenite (1,3%). Nel 21% dei casi le varianti interessavano le vie biliari intraepatiche: crossover anomaly (6,7%), dotto bisegmentario anteriore destro confluente nel dotto biliare di sinistra (3,1%), dotto bisegmentario posteriore destro confluente nel dotto epatico sinistro (7,9%) e nel dotto epatico comune (3,3%). La presenza di varianti anatomiche delle vie biliari extraepatiche è stata riscontrata nell’8,8% dei pazienti: bassa inserzione del dotto cistico nel dotto epatico comune (4,5%), sbocco del dotto cistico nel dotto epatico destro (2,7%), grosso ramo di secondo ordine drenante nel dotto cistico (1,6%). La CPRM ha identificato un 3% di pazienti con colecisti doppia ed un 8,2% di pazienti con varianti anatomiche del sistema bilio-pancreatico: pancreas divisum (5,2%) e sfintere di Oddi lungo (3%). Infine anomalie congenite sono state diagnosticate nell’1,3% dei casi: cisti coledocica (0,3%), atresia delle vie biliari (0,3%) ed amartomatosi biliare multipla (0,7%).

Conclusioni

Le anomalie congenite e le varianti anatomiche delle vie biliari e pancreatiche costituiscono uno spettro complesso di frequenti alterazioni, documentabili agevolmente in CPRM e meritevoli di attenzione in ambito sia clinico sia chirurgico.

Parole chiave

Vie biliari e pancreatiche Varianti anatomiche Anomalie congenite CPRM 

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Copyright information

© Springer-Verlag Italia 2008

Authors and Affiliations

  • M. De Filippo
    • 1
    Email author
  • M. Calabrese
    • 1
  • S. Quinto
    • 1
  • A. Rastelli
    • 1
  • A. Bertellini
    • 1
  • R. Martora
    • 1
  • N. Sverzellati
    • 1
  • D. Corradi
    • 2
  • M. Vitale
    • 2
  • G. Crialesi
    • 3
  • L. Sarli
    • 3
  • L. Roncoroni
    • 3
  • G. Garlaschi
    • 4
  • M. Zompatori
    • 1
  1. 1.Dipartimento di Scienze Cliniche, Sezione di Scienze RadiologicheUniversità degli Studi di ParmaParmaItaly
  2. 2.Dipartimento di Anatomia UmanaFarmacologia e Medicina Forense, Sezione di Anatomia Umana, Università degli Studi di ParmaParmaItaly
  3. 3.Dipartimento di Scienze Chirurgiche, Sezione di Chirurgia Generale e Terapia ChirurgicaUniversità degli Studi di ParmaParmaItaly
  4. 4.Università di GenovaGenovaItaly

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