Prevalence of Anatomical Variations of Biliary Tree on MRCP among Patients in Srinagarind Hospital

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Wannaporn Soontrapa
Julaluck Promsorn
Nittaya Chamadol

Abstract

Background and Objective:  The growing recognition and awareness of hepatobiliary disease as led to increase the number of surgical procedures being conducted. Appropriate knowledge of biliary tract anatomic variants is crucial in order to reduce bile duct injuries during surgery. This study aimed to  the variations in biliary anatomy in the general population of northeast Thailand using magnetic resonance cholangiopancreatography (MRCP).


Method: Three hundred and eighty-seven patients were examined by MRCP at Srinagarind Hospital between Nov 2nd, 2012 and Nov 5th, 2013.  All MRCP images were reviewed and the biliary anatomy was classified by two radiologists according to the Couinaud classification system. The interobserver agreement was analyzed using a Kappa agreement score.


Result: The prevalence of typical duct anatomy (type A) was 74.4% (n=288), and that of variation from the conventional pattern was 25.6% (n=99). Type B (or trifurcation) was found in 34 patients (8.8 %). The frequencies of other types were as follows: type C1, 0.3 % (n= 1); type C2, 3.1% (n=12); type D1, 6.2% (n= 24); type D2,1.3% (n=5); type E1, 0% (n=0); type E2, 0.5 % (n=2); and type F, 0% (n=0). The remaining 21 patients (5.4 %), all of whom had accessory hepatic ducts, were classified as “other variations.” The Kappa agreement of MRCP readings by two radiologists was 0.431 (p value <0.001).


Conclusion: There was variation from the typical pattern in 25.6% of cases. This study showed that MRCP is a non-invasive tool that can be used to evaluate anatomical variations of the intraheptatic ducts before surgical procedures.

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