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علاقه بعض الحالات المرضيه بالاختلافات التشريحيه للقنوات الصفراويه في العراقيين باستخدام الرنين المغناطيسي الراسم للقنوات الصفراء والبنكرياس == Association of Some Pathological Conditions with the Anatomical Variations of the Biliary System in Iraqi People Using Magnetic Resonance Cholangiopancreatography(MRCP)
Author name:
احمد سعد محسن
Supervisor name:
نوفل خضير ياس الحديثي
General topic:
Medicine
Specific topic:
Anatomy and Histology and Embryos
Degree:
Master
University:
University of Baghdad - Faculty Of Medicine
Language:
English
University location:
Baghdad
First pages:
19T1611 - p.pdf
Abstract:
Anatomic variations of the bile ducts are important to identify beforehepatobiliary surgical procedures as inaccurate determination of existing biliaryanatomic variations may potentiate ligature or section of aberrant ducts, leadingto major complications such as leakage or atrophy of the residual liver.Moreover, abnormal anatomical pattern of the biliary tree may predispose toincreased incidence of certain pathologies like gallstones. Therefore, it isapparent that thorough preoperative knowledge and successful detection andrecognition of such anatomic variations can lead to decreased morbidity andmortality rates during hepatobiliary surgery. Although several methods, like CTor MR Cholangiopancreatograms, have become the modality of choice fornoninvasive evaluation of abnormalities of the biliary tract, they are notroutinely used in preoperative imaging evaluation of patients.Magnetic resonance cholangiopancreatography (MRCP) is a safe, non - invasivediagnostic imaging technique, with added value of imaging post processing,allows accurate identification of biliary anatomy.For this study, ―Yoshida classification‖ was used to classify the anatomicalvariations of the biliary tree by using MRCP, Yoshida divide these variationinto 7 types, Type 1 where the right posterior segmental duct (RPSD) unit withthe right anterior segmental duct (RASD) to form the right hepatic duct (RHD)which unite with the left hepatic duct (LHD) to form the common hepatic duct(CHD) which unite with the cystic duct to form the common bile duct. Type 2in which the RPSD,RASD and the LHD unite together in triple confluence toform the CHD. Type 3 in which the RPSD cross to the left side to unite with theLHD, in Type 4 the RPSD have a lower insertion into the CHD, in Type 5; thereis triple confluence of the RPSD, Left inferior segmental duct (LISD) and Leftsuperior segmental duct (LSSD), while the RASD join the formed RHD to formviiCHD, while in Type 6; the triple confluence is between RASD,RPSD,LSSD andthe LISD drain into the CHD, Finally; Type 7 resemble type 1 except that theLISD an inferior insertion into CHD.Aim of the study : 1. To determine the most common anatomical patterns of the biliary tree inpatients and define the incidence of each pattern and to relate thesedifferent anatomical patterns to the incidence of biliary pathology.2. To measure the length of different branches of the biliary tree and findthe range of length in each branch and to relate the length of differentbranches of the biliary tree to the incidence of biliary tree pathology.Patient and Method : This study was conducted in the X - ray Institute in Baghdad Medical City usingmagnetic resonance cholangiopancreatography (MRCP) to scan patients withrelated biliary pathology.108 patients were taken for the study and the datacollected over 8 months periods from 10th of September 2014 to 28th of April2015. Full history and examination were done to the patients with basicinvestigation. Patients prepared before the scan by fasting and simple sedation.The images were taken both in coronal and transverse section; the resulting scanwas printed on disk and interprets by microDICOM software which hasmultiple functions and facilities, the cases then categorized according to theanatomical pattern and according to the pathological finding, Finally; the resultwere analyzed statistically.Results : Typical biliary tree (Type I) anatomical pattern was found in 64.8%.Anatomicalvariation was found in 35.2% and the most common anatomical variation isviiiwhen the right anterior hepatic duct crosses to the other side to drains into theleft hepatic duct and it is called Type 3 and found in 20.4% of cases while eachof type 2 and 4 was found in 7.4% of cases. The length of different branches ofthe biliary tree was variable and each branch had a wide range of length whichwere being recorded and compared. Pathological changes were found in 90.7%of cases which were mainly Gallstones, strictures and tumors. Gallstones werethe most common pathological finding with incidence of 79.6% while strictures were found in 3.7% and tumors in 7.4%. Relation between the variant anatomical pattern and pathological finding was significant. Also relationbetween the change in the length of the left hepatic duct and incidence of three mentioned pathological finding was significant, and relation between the change of the cystic duct and incidence of tumors in the biliary regions was also significant.Conclusion : MRCP scan of patients with liver related symptoms is of high importance on both surgical and medical methods. It will show us the complete anatomical pattern of the biliary tree and if there are any pathological conditions, additionally; we can take measurement of the branches of the biliary tree. Define the anatomical pattern of the biliary tree can give us a clue about the risk of this patient to develop certain pathological conditions even if the scan was normal. So it is advisable to take MRCP to any patient with liver related problems who underwent other liver specific investigation like US for evaluation and further accurate identification of the biliary tree anatomical pattern and of any existing pathological conditions and also for estimation of developing other pathological conditions in the future.
