title: Use of preoperative, 3-dimensional magnetic resonance cholangiopancreatography in pediatric choledochal cysts.
abstract: BACKGROUND
  Standard choledochal cyst (CC) operations involve dilated extrahepatic bile duct excision followed by biloenterostomy. However, biliary variants and associated intrahepatic bile duct (IHBD) stenoses or dilatations triggering postoperative sequelae require additional procedures. The usefulness of preoperative 3-dimensional magnetic resonance cholangiopancreatography (3D MRCP) and virtual cholangioscopy (VES) for observing biliary morphology and pancreaticobiliary maljunction (PBM) was evaluated.
  
  
  METHODS
  In 16 pediatric CC patients (age range, 4 months to 9 years; median, 3 years), visualization of PBM and aberrant bile duct anatomy and IHBD morphology at the hepatic hilum (HH), umbilical portion (UP), and posterior branch (POST) were compared between 3D-MRCP and intraoperative cholangiography (IOC). VES and intraoperative cholangioscopy (IOS) findings were compared.
  
  
  RESULTS
  HH, UP, and POST visualization rates were 100%, 94%, and 94%, respectively, by 3D-MRCP, and 100%, 69%, and 69%, respectively, by IOC. IHBD stenosis detection rates at each region were 38%, 13%, and 13%, respectively, by 3D-MRCP, and 25%, 0%, and 9%, respectively, by IOC. IHBD dilatation detection rates at each part were 75%, 47%, and 60%, respectively, by 3D-MRCP, and 88%, 82%, and 91%, respectively, by IOC. PBM was confirmed in 56% and 93% of cases on 3D-MRCP and IOC, respectively. Both 3D-MRCP and IOC showed biliary variants in 5 cases (31%). VES showed membranous strictures at HH, UP, and POST in 6, 2, and 2 cases, respectively, whereas IOS did so at HH in 4 cases and POST in 2.
  
  
  CONCLUSIONS
  Preoperative 3D-MRCP and VES accurately depict biliary morphology, allowing concrete operative planning in pediatric CC patients, complementing IOC and IOS.
authors.affiliation: Department of Pediatric Surgery (E6), Graduate School of Medicine, Chiba University, Chiba, Japan. takk@faculty.chiba-u.jp
authors.forename: Takeshi
authors.initials: T
authors.lastname: Saito
authors.forename: Tomoro
authors.initials: T
authors.lastname: Hishiki
authors.forename: Keita
authors.initials: K
authors.lastname: Terui
authors.forename: Yoshiharu
authors.initials: Y
authors.lastname: Sato
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Mitsunaga
authors.forename: Elena
authors.initials: E
authors.lastname: Terui
authors.forename: Mitsuyuki
authors.initials: M
authors.lastname: Nakata
authors.forename: Ayako
authors.initials: A
authors.lastname: Takenouchi
authors.forename: Gen
authors.initials: G
authors.lastname: Matsuura
authors.forename: Eriko
authors.initials: E
authors.lastname: Yahata
authors.forename: Sachie
authors.initials: S
authors.lastname: Ohno
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Sato
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Yanagawa
authors.forename: Yoshitada
authors.initials: Y
authors.lastname: Masuda
authors.forename: Hideo
authors.initials: H
authors.lastname: Yoshida
mesh_terms: D002648:Child; D002675:Child, Preschool; D049448:Cholangiopancreatography, Magnetic Resonance; D015529:Choledochal Cyst / Q000175:diagnosis*; D003251:Constriction, Pathologic / Q000175:diagnosis; D004108:Dilatation, Pathologic / Q000175:diagnosis; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D007223:Infant; D008297:Male; D011300:Preoperative Care