Common and Uncommon Anatomical Variants of Intrahepatic Bile Ducts in Magnetic Resonance Cholangiopancreatography and its Clinical Implication.
BACKGROUND
Preoperative knowledge of intrahepatic bile duct (IHD) anatomy is critical for planning liver resections, liver transplantations and complex biliary reconstructive surgery. The purpose of our study was to demonstrate the imaging features of various anatomical variants of IHD using magnetic resonance cholangio-pancreatography (MRCP) and their prevalence in our population.


METHODS
This observational clinical evaluation study included 224 patients who were referred for MRCP. MRCP was performed in a 1.5-Tesla magnet (Philips) with SSH MRCP 3DHR and SSHMRCP rad protocol. A senior radiologist assessed the biliary passage for anatomical variations.


RESULTS
The branching pattern of the right hepatic duct (RHD) was typical in 55.3% of subjects. The most common variant was right posterior sectoral duct (RPSD) draining into the left hepatic duct (LHD) in 27.6% of subjects. Trifurcation pattern was noted in 9.3% of subjects. In 4% of subjects, RPSD was draining into the common hepatic duct (CHD) and in 0.8% of subjects into the cystic duct. Other variants were noted in 2.6% of subjects. In 4.9% of cases there was an accessory duct. The most common type of LHD branching pattern was a common trunk of segment 2 and 3 ducts joining the segment 4 duct in 67.8% of subjects. In 23.2% of subjects, segment 2 duct united with the common trunk of segment 3 and 4 and in 3.4% of subjects segment 2, 3, and 4 ducts united together to form LHD. Other uncommon branching patterns of LHD were seen in 4.9% of subjects.


CONCLUSIONS
Intrahepatic bile duct anatomy is complex with many common and uncommon variations. MRCP is a reliable non-invasive imaging method for demonstration of bile duct morphology, which is useful to plan complex surgeries and to prevent iatrogenic injuries.
Department of Radiodiagnosis, People's College of Medical Sciences and Research Center, Bhopal, India.
Radha
R
Sarawagi
Department of Radiodiagnosis, Mahatma Gandhi Medical College and Research Institute, Puducherry, India.
Shyam
S
Sundar
Department of Radiodiagnosis, People's College of Medical Sciences and Research Center, Bhopal, India.
Sameer
S
Raghuvanshi
Department of Community Medicine, RKDF Medical College Hospital and Research Centre, Bhopal, India.
Sanjeev Kumar
SK
Gupta
Department of Radiodiagnosis, Mahatma Gandhi Medical College and Research Institute, Puducherry, India.
Gopal
G
Jayaraman
Anatomic Variation; Bile Ducts, Intrahepatic; Cholangiopancreatography, Magnetic Resonance