Imaged periductal infiltration: Diagnostic and prognostic role in intrahepatic mass-forming cholangiocarcinoma.

Purpose: This study examines periductal infiltration in intrahepatic mass-forming cholangiocarcinoma (IMCC), focusing on its importance for differentiating hepatic tumors and its influence on post-surgical survival in IMCC patients. Methods: Eighty-three consecutive patients with IMCC (n = 43) and liver cancer whose preoperative images showed intrahepatic bile duct dilatation adjacent to the tumor for differential diagnosis from hepatocellular carcinoma (HCC) [n = 21], metastatic liver cancer (MLC) [n = 16] and combined hepatocellular-cholangiocarcinoma (cHCC-CC) [n = 3] were enrolled. CT and MRI findings of simple bile duct compression, imaged periductal infiltration, and imaged intrabiliary growth adjacent to the main tumor were reviewed. Clinicopathological and imaging features were compared in each group. The sensitivity, specificity, and odds ratio were calculated for each imaging finding of IMCC versus the other tumor groups. Overall survival was compared between cases of IMCC with and without imaged periductal infiltration. Results: Simple bile duct compression and imaged intrabiliary growth were more frequently observed in HCC than in the others (p < 0.0001 and 0.040, respectively). Imaged periductal infiltration was observed more often in histopathologically confirmed large-duct type IMCC than in the small-duct type IMCC (p = 0.034). Multivariable analysis demonstrated that only imaged periductal infiltration (odds ratio, 50.67) was independently correlated with IMCC. Patients with IMCC who had imaged periductal infiltration experienced a poorer prognosis than those without imaged periductal infiltration (p = 0.0034). Conclusion: Imaged periductal infiltration may serve as a significant marker for differentiating IMCC from other liver cancers. It may also have the potential to predict post-surgical outcomes in patients with IMCC.

Association between intrahepatic bile duct alterations and liver fibrosis / 临床肝胆病杂志

Liver cirrhosis is a liver disease caused by various factors and is characterized by diffuse fibrous hyperplasia, lobular structural damage, and pseudolobule formation. Bile duct proliferation has been observed in a variety of animal models of liver cirrhosis and patients with liver cirrhosis caused by different etiologies, and it is regulated by signaling pathways with the involvement of multiple regulatory factors such as neuropeptides, neurotransmitters, and hormones. Moreover, the proliferated bile ducts promote the formation of liver fibrosis by mediating the proliferation and activation of hepatic stellate cells. This article summarizes the changes of the intrahepatic bile duct system in liver cirrhosis and its influence on the process of liver fibrosis, various signaling pathways associated with cholangiocyte proliferation and liver fibrosis, and the value of the dynamic evolution of bile duct structure in predicting the degree of liver fibrosis. It is pointed out that bile duct proliferation may become a potential target for the intervention of liver fibrosis, which provides new ideas and methods for early treatment and reversal of liver fibrosis.

Immunotherapy research progress of intrahepatic cholangiocarcinoma / 国际外科学杂志

Intrahepatic cholangiocarcinoma is a primary hepatic malignant tumor with high malignancy and poor prognosis. In addition to surgical resection, there are no clear studies showing that there are other effective treatments. In recent years, with the deepening of the research on the immune mechanism of various malignant tumors, immunotherapy has been gradually attached importance to various anti-solid tumor treatments, and has also become an important direction in the treatment of intrahepatic cholangiocarcinoma. The important role of tumor microenvironment in the immunotherapy of malignant tumors is gradually recognized. In this paper, the characteristics of immune microenvironment in intrahepatic cholangiocarcinoma has been summarized, and the application of immunotherapy in intrahepatic cholangiocarcinoma has been reviewed, with emphasis on the development of immune checkpoint inhibitors, cancer vaccines and adoptive cellular immunotherapy.

Diagnosis, treatment and prevention of biliary hemorrhage after percutaneous transhepatic choledochoscopic lithotomy / 中国医师杂志

Objective:To explore the diagnosis, treatment and prevention of biliary hemorrhage after percutaneous transhepatic choledochoscopic lithotomy(PTCSL).Methods:Retrospective summary and analysis were made on 48 cases of PTCSL completed by the hepatobiliary surgery department of Hunan Provincial People′s Hospital (the First Affiliated Hospital of Hunan Normal University) from January 2016 to December 2020.Results:Biliary hemorrhage occurred in 3 cases after operation, of which 1 case was considered to have a small amount of biliary mucosa bleeding, and the bleeding was stopped after blood transfusion, hemostatic agents and appropriate fluid rehydration. In the other case, a small amount of blood oozing around the T-tube sinus canal was accompanied by a small amount of bloody fluid in the T-tube, which was considered to cause arterioles or venules accompanied by bile duct bleeding during sinus expansion during operation, and the bleeding stopped after compression. Another patient underwent a short time drainage of hemorrhagic fluid ≥100 ml in T tube 15 days after operation, and was prepared for interventional therapy while receiving blood transfusion products and conservative treatment. Celiac arteriography was performed, and pseudoaneurysm was found in the right anterior lobe of the liver. Embolization was performed later and the patient discharged 10 days after embolization.Conclusions:Biliary hemorrhage is one of the more common complications after PTCSL. Increasing the understanding of this complication provides a guarantee for the safety of surgery and has clinical significance for patients with accelerated postoperative recovery.

RASAL3 promotes the proliferation of intrahepatic cholangiocarcinoma cells by up regulating the expression of FXYD6 / 中华普通外科杂志

Objective:To investigate the expression of RASAL3 in intrahepatic cholangiocarcinoma (iCCA) and the mechanism of promoting iCCA development.Methods:Tumor and paracancerous tissues were collected from 185 iCCA patients, the expression of RASAL3 was detected by immunohistochemistry, RT-qPCR and Western blot. The expression of RASAL3 and FXYD6 mRNA and protein in human cholangiocarcinoma cell line and human bile duct epithelial cells were detected with RT-qPCR and Western blot, the cell proliferation was detected with CCK-8 assay, and the activity of Na +-K +-ATPase was also detected. Results:RASAL3 was highly expressed in cholangiocarcinoma tissues and cell lines; Survival analysis showed that RASAL3 overexpression was associated with poor prognosis of cholangiocarcinoma( P<0.05) and knockdown of RASAL3 inhibits the proliferation of cholangiocarcinoma cells; Silencing RASAL3 decreases the expression of FXYD6 inhibiting the activity of Na +-K +-ATPase. Conclusion:RASAL3 is up-regulated in human cholangiocarcinoma, which can promote the occurrence and development of cholangiocarcinoma by activating FXYD6 and affecting Na +-K +-ATPase activity.

Prognostic value of several immune and inflammatory indices after curative-intent resection for intrahepatic cholangiocarcinoma / 临床肝胆病杂志

Objective To investigate the value of different immune and inflammatory indices in predicting the survival outcome of patients with intrahepatic cholangiocarcinoma (ICC) after curative-intent resection. Methods A retrospective analysis was performed for the case data of 122 patients with ICC who underwent curative-intent resection in Affiliated Hospital of Weifang Medical University and Tianjin Medical University Cancer Institute and Hospital from January 2012 to December 2017 to analyze the correlation of neutrophil-lymphocyte ratio (NLR), lymphocyte-monocyte ratio (LMR), systemic immune-inflammation index (SII), prognostic inflammation index (PII), inflammation score (IS), and systemic inflammation score (SIS) with the disease-free survival (DFS) and overall survival of ICC patients after surgery, and the value of the above indices in predicting prognosis was evaluated. The chi-square test or the Fisher's exact test was used for comparison of categorical data between groups. The Kaplan-Meier method was used to plot survival curves, and the Log-rank test was used for comparison between groups; the Cox regression model was used for univariate and multivariate analyses, and hazard ratio ( HR ) and 95% confidence interval [ CI ] were calculated. Results The univariate survival analysis showed that NLR ( HR =2.212, P =0.004), LMR ( HR =0.403, P =0.012), PII ( HR =3.013, P < 0.001), prognostic nutritional index (PNI) ( HR =0.530, P =0.019), IS ( HR =1.809, P =0.001), SII ( HR =2.107, P =0.002), and SIS ( HR =2.225, P < 0.001) were predictive factors for postoperative DFS of patients with ICC, and NLR ( HR =2.416, P =0.009), LMR ( HR =0.297, P =0.008), PII ( HR =3.288, P < 0.001), PNI ( HR =0.292, P =0.003), IS ( HR =2.048, P =0.002), SII ( HR =1.839, P =0.049), and SIS ( HR =2.335, P < 0.001) were predictive factors for postoperative OS of patients with ICC. The multivariate survival analysis showed that high levels of PII ( HR =2.146, P =0.035) and SIS ( HR =2.511, P < 0.001) were independent influencing factors for postoperative DFS of ICC patients, and high levels of PII ( HR =2.981, P =0.009), PNI ( HR =0.261, P =0.002), and SIS ( HR =2.294, P =0.010) were independent influencing factors for postoperative OS. The patients with a high level of PII tended to have advanced tumor T stage ( χ 2 =8.777, P =0.003) and M stage ( P =0.029), and the patients with high-grade SIS tended to have advanced N stage ( χ 2 =9.985, P =0.030) and M stage ( χ 2 =8.574, P =0.012). Conclusion Among the various inflammation indices, PII and SIS are recommended for preoperative stratification and prediction of the outcome of ICC patients after curative-intent resection.

Survival outcomes of patients with intrahepatic cholangiocarcinoma undergoing surgical resection / 中华普通外科杂志

Objective:To investigate the clinical outcomes of patients with intrahepatic cholangiocarcinoma (ICC) undergoing surgical resection.Methods:Patients who undergoing radical surgical resection for ICC from Jan 2015 to Apr 2021 at the Department of General Surgery, the First Affiliated Hospital of Anhui Medical University were included in this retrospective cohort study.Results:There were 67 patients in the final analysis, The median follow-up duration was 14 months (range: 1-60 months). Firty three patients (79.1%) had tumor recurrence, 52 patients (77.6%) died, Among them, 49 patients (73.1%) died from tumor recurrence. The 1-、2-、and 3-year accumulated disease-free and overall survival rate were 35.6%, 19.6%, 16.8% and 53.7%, 32.4%, 20.8%. respectively. The overall survival rate of the group without microvascular invasion was significantly better than those of the group with microvascular invasion ( χ2=5.916, P=0.015). CA19-9≥1 000 U/ml was the only independent risk factor for the disease-free survival. CA19-9≥1 000 U/ml、blood loss≥600 ml、microvascular invasion and tumor recurrence were the independent risk factors for the overall survival. Conclusion:For ICC patients with single tumor, when the tumor diameter is less than 5 cm and has no microvascular invasion, surgical resection is recommended, and a satisfactory prognosis could be achieved.

Association of primary intrahepatic lithiasis with the polymorphisms of the cystic fibrosis transmembrane conductance regulator gene / 临床肝胆病杂志

Objective To investigate the association of common polymorphism loci of the cystic fibrosis transmembrane conductance regulator (CFTR) gene with the onset of primary intrahepatic lithiasis (PIL) in the Chinese Han population. Methods A total of 104 patients with PIL who attended The 900th Hospital of PLA Joint Logistics Support Force from June to November 2018 were enrolled as PIL group, and 120 healthy controls who underwent physical examination during the same period of time were enrolled as control group. Sanger sequencing was used to detect the alleles and genotypes at the M470V, TG-repeats, and Poly-T loci of the CFTR gene. The two groups were compared in terms of age, sex ratio, age of onset, and allele and genotype frequencies, and the association of the above three polymorphism loci of the CFTR gene with the risk of PIL was analyzed. The K-S test was used to determine the normality of continuous variables. The independent samples t -test was used for comparison of normally distributed continuous data between two groups, and the chi-square test was used to compare categorical data and allele/genotype frequencies and analyze Hardy-Weinberg equilibrium. A binary logistic regression analysis was used to investigate the association of genotypes and alleles with the risk of the disease. The association of the loci deviating from Hardy-Weinberg equilibrium with the risk of PIL was expressed as adjusted odds ratio ( OR ). Results There were significant differences between the PIL group and the control group in the distribution of alleles ( χ 2 =15.139, P 0.05). The PIL group had a significantly higher frequency of G allele at the M470V locus than the control group (60.1% vs 41.67%, P < 0.01). Compared with the individuals with AA genotype, the individuals with GG and AG genotypes had a significant increase in the risk of PIL ( OR =4.680 and 2.500, both P < 0.01). As for the TG-repeats locus, the individuals with 12TG/13TG genotype had a significantly higher risk of PIL than those with 11TG/12TG genotype ( OR =11.002, P =0.042), and as for the Poly-T locus, the individuals with 7T/5T genotype had a significantly lower risk of PIL than those with 7T/7T genotype ( OR =0.079, P =0.047). Conclusion The M470V polymorphism of the CFTR gene is independently associated with the risk of PIL in the Chinese Han population, and G allele is a high-risk mutation for the onset of PIL.

[Surgical and comprehensive treatment for intrahepatic cholangiocarcinoma patients from the perspective of tumor heterogeneity].

Intrahepatic cholangiocarcinoma(ICC) is generally found late along with extremely poor prognosis and lack of effective and standardized treatment. Tremendous heterogeneities exist in onset factors, geographic distribution, clinical manifestation, and biological characteristics of ICC patients. However, the relevant causes and mechanisms have not been clearly illustrated. Recent studies indicate that the diverse celluar origins of ICC, including liver cells, bile duct epithelial cells, glandular cells around the duct, and liver stem cells, etc. Besides, the tumorigenesis, progression and metastasis of ICC are closed related to metabolism such as glucose, lipid metabolism. It can be inferred that the varieties of biological characteristics and clinical manifestation of ICC patients are possibly closely linked with heterogeneous cellular origins, multiple metabolic mechanisms or pathways. Therefore, it's necessary to conduct research with regard to the connection between cellular origins, cell metabolism and clinical manifestation, biological characteristics, and make further classifications. Based on the accurate classification, surgeons can exert corresponding surgical and comprehensive treatment strategies on ICC patients, attaining the goal of individualized and standardized treatment, ultimately, improving prognosis and prolonging survival time.

Laparoscopic hepatectomy in the treatment of recurrent hepatolithiasis / 中华普通外科杂志

Objective To explore the safety and effectiveness of laparoscopic hepatectomy in the treatment of recurrent hepatolithiasis.Methods The clinical data of recurrent hepatolithiasis patients treated by laparoscopic hepatectomy were studied.Results Among the 17 patients of recurrent hepatolithiasis patients,5 received hepatic segmentectomy (lobectomy),12 cases received hepatic segmenteetomy (lobectomy),exploration of the comnon bile duct and T-tube drainage,1 case received hepatic segmenteetomy (lobectomy) plus exploration of the common bile duct.The mean operation time and operative blood loss were (236 ± 86) min and (430 ± 101) ml,respectively.The time of gastrointestinal function recovery and postoperative hospital stay were (2.5 ± 0.9) d and (12.3 ± 3.9) d.Postoperative complications included postoperative sub-phrenic hydrops in 3 cases,liver margin infection in 2 cases,incision infection in 1 case,residual stone in 2 cases,bile leak in 2 cases,the pulmonary infection in 2 cases pleural effusion in 3 cases.All were cured by non-surgical treatment.Postoperatively 15 were followed up for 2-24 months.Conclusions It is safe and feasible for laparoscopic hepatectomy to treat recurrent hepatolithiasis.

Surgical and comprehensive treatment for intrahepatic cholangiocarcinoma patients from the perspective of tumor heterogeneity / 中华外科杂志

Intrahepatic cholangiocarcinoma(ICC) is generally found late along with extremely poor prognosis and lack of effective and standardized treatment. Tremendous heterogeneities exist in onset factors, geographic distribution, clinical manifestation, and biological characteristics of ICC patients. However, the relevant causes and mechanisms have not been clearly illustrated. Recent studies indicate that the diverse celluar origins of ICC, including liver cells, bile duct epithelial cells, glandular cells around the duct, and liver stem cells, etc. Besides, the tumorigenesis, progression and metastasis of ICC are closed related to metabolism such as glucose, lipid metabolism. It can be inferred that the varieties of biological characteristics and clinical manifestation of ICC patients are possibly closely linked with heterogeneous cellular origins, multiple metabolic mechanisms or pathways. Therefore, it′s necessary to conduct research with regard to the connection between cellular origins, cell metabolism and clinical manifestation, biological characteristics, and make further classifications. Based on the accurate classification, surgeons can exert corresponding surgical and comprehensive treatment strategies on ICC patients, attaining the goal of individualized and standardized treatment, ultimately, improving prognosis and prolonging survival time.

Predicting IDH mutation status of intrahepatic cholangiocarcinomas based on contrast-enhanced CT features.

OBJECTIVES: To explore the difference in contrast-enhanced computed tomography (CT) features of intrahepatic cholangiocarcinomas (ICCs) with different isocitrate dehydrogenase (IDH) mutation status. METHODS: Clinicopathological and contrast-enhanced CT features of 78 patients with 78 ICCs were retrospectively analysed and compared based on IDH mutation status. RESULTS: There were 11 ICCs with IDH mutation (11/78, 14.1%) and 67 ICCs without IDH mutation (67/78, 85.9%). IDH-mutated ICCs showed intratumoral artery more often than IDH-wild ICCs (p = 0.023). Most ICCs with IDH mutation showed rim and internal enhancement (10/11, 90.9%), while ICCs without IDH mutation often appeared diffuse (26/67, 38.8%) or with no enhancement (4/67, 6.0%) in the arterial phase (p = 0.009). IDH-mutated ICCs showed significantly higher CT values, enhancement degrees and enhancement ratios in arterial and portal venous phases than IDH-wild ICCs (all p < 0.05). The CT value of tumours in the portal venous phase performed best in distinguishing ICCs with and without IDH mutation, with an area under the curve of 0.798 (p = 0.002). CONCLUSIONS: ICCs with and without IDH mutation differed significantly in arterial enhancement mode, and the tumour enhancement degree on multiphase contrast-enhanced CT was helpful in predicting IDH mutation status. KEY POINTS: • IDH mutation occurred frequently in ICCs. • ICCs with and without IDH mutation differed significantly in arterial enhancement mode. • ICCs with IDH mutation enhanced more than those without IDH mutation. • Enhancement ratio and tumour CT value can predict IDH mutation status.

Focal Biliary System Obstruction and Atypical Liver Mass: Intrabiliary Ruptured Cyst Hydatid Case Report.

BACKGROUND: Hydatid disease can involve any part of the body, but the liver is the most frequently affected organ. Intrabiliary rupture is one of the most serious complications of a hepatic hydatid cyst. Radiological findings, especially magnetic resonance imaging and magnetic resonance cholangiopancreatography (MRI/MRCP), are helpful in the diagnosis of hydatid disease. CASE REPORT: We present a 48-year-old female patient with complaints of abdominal pain and jaundice. Radiological examination showed a heterogeneous lesion that contained cystic-solid components and millimetric calcifications in the liver. Adjacent intrahepatic bile ducts were dilated. CONCLUSIONS: In geographical areas endemic for hydatid disease, cyst rapture into the bile ducts should be included in the differential diagnosis even in seronegative cases, although it is not typical for hydatid cyst to be found as a mass lesion in the liver on US in patients with right upper quadrant pain and jaundice.Detailed imaging by MRI/MRCP should be done.

Diagnosis and treatment of intrahepatic stone complicated with atrophy-hypertrophy complex / 中华普通外科杂志

Objective To explore the typing and surgical methods on intrahepatic stone complicated with atrophy-hypertrophy complex.Methods The clinical data of 32 cases of intrahepatic stone complicated with atrophy-hypertrophy complex from January 2014 to December 2015 in Hunan Province Peopole's Hospital were retrospectively analysed.Results These 32 cases of atrophy-hypertrophy complex accounted for 1.9％ of admitted hepatolith patients.We divided the intrahepatic stone complicated with atrophy-hypertrophy syndrome into 5 types,and type-Ⅱ the most common.We performed operation combined with fiber choledochoscope to examine,smash and remove the stone.This methods could reduce the rate of residual stone to 6％.The liver will be partly atrophy with stones inside it,and the residual liver will become hypertrophy.Stones of intrahepatic bile duct lead to the change of the position of porta hepatis and straitness of primary bile duct,and the bile cannot smooth out.there will be lithogenesis and relapsing cholangitis.Patients were treated by intrahepatic biliary double-opening drainage,and followed-up for 12-36 months.There were no death cases,and the total effective rate was 94％.Conclusions Intrahepatic stones complicated with atrophy-hypertrophy complex could be diagnosed by CT scan.Selecting proper operation method to treat atrophy-hypertrophy complex may decrease residual stones and improve the quality of life.

Clinical characteristics and prognostic factors of patients with hepatolithiasis associated with intrahepatic cholangiocarcinoma / 肿瘤研究与临床

Objective To explore the clinical characteristics and prognostic factors of patients with hepatolithiasis associated with intrahepatic cholangiocarcinoma. Methods The clinical data of 39 patients with hepatolithiasis associated with intrahepatic cholangiocarcinoma in the First Affiliated Hospital of Chongqing Medical University from Jan 2006 to Jun 2013 was retrospectively analyzed. Results The main clinical manifestations of hepatolithiasis associated with intrahepatic cholangiocarcinoma included recurrent fever, abdominal pain, jaundice and hepatic percussion pain. Among the 39 cases, the patients older than 60 years accounted for 69.2 % (27/39), and the duration of hepatolithiasis more than 10 years accounted for 76.9 % (30/39). Remarkable differences were found in serum CA19-9 and surgery methods (both P< 0.05). Conclusions Recurrent fever, abdominal pain, jaundice and hepatic percussion pain are the main clinical manifestations for the patients who are diagnosed with hepatolithiasis associated with intrahepatic cholangiocarcinoma. Advanced age and longer duration of the disease may be the high risk factors. Serum CA19-9 levels and surgical methods are the important prognostic factors.

Total laparoscopic radical resection for Bismuth type Ⅲa hilar cholangiocarcinoma / 中华普通外科杂志

Objective To explore the feasibility and safety of total laparoscopic radical resection for a patient of Bismuth type Ⅲ a hilar cholangiocarcinoma.Methods This patient underwent right hemihepatectomy combined caudate lobectomy,radical regional lymphadenectomy and Roux-en-Y hepaticojejunostomy under total laparoscopic techniques.Preoperatively the volume of future liver remnant estimated by CT scan was 46％,and indocyanine green retention rate at 15 min (ICG R15) was 6.0％.Results The total laparoscopic surgery was carried out successfully with operation time of 540 min and intraoperative blood loss 300 ml,without blood transfusion.The results of pathological examination showed well-differentiated adenocarcinoma of hilar bile duct with negative tumor margins and no regional lymph node metastasis(0/13).The postoperative recovery was uneventful with hospital stay time of 10 days and without any complications.Conclusion At experienced hands,total laparoscopic radical resection of Bismuth type Ⅲ a hilar cholangiocarcinoma is feasible and safe for selected patients.

Clinical effect of laparoscopic left lateral hepatectomy in treatment of intrahepatic bile duct stones / 临床肝胆病杂志

Objective To investigate the surgical method,safety,and clinical effect of laparoscopic left lateral hepatectomy in the treatment of intrahepatic bile duct stones.Methods A total of 30 patients with intrahepatic bile duct stones who were admitted to our hospital from January 2015 to December 2016 were enrolled,and according to the surgical procedure,these patients were divided into conventional group (15 patients) and laparoscopic group (15 patients).The patients in the conventional group were treated with open left lateral hepatectomy,and those in the laparoscopic group were treated with minimally invasive laparoscopic left lateral hepatectomy.Surgical indices were observed,and postoperative complications and liver function parameters were compared between the two groups.The t-test was used for comparison of normally distributed continuous data,and the Wilcoxon rank sum test was used for comparison of non-normally distributed continuous data.The chi-square test was used for comparison of categorical data.Results The laparoscopic group had significant reductions in the time to passage of gas by anus (1.02 ± 0.51 d vs 1.98 ± 0.36 d,t =5.956,P ＜0.001) and length of postoperative hospital stay (8.83 ±0.81 d vs 11.83 ± 0.42 d,t =5.830,P ＜ 0.001) compared with the conventional group.Compared with the conventional group,the laparoscopic group had a significantly lower alanine aminotransferase level (125.8 ± 91.9 U/L vs 214.1 ± 99.6 U/L,t =2.52,P =0.02) and a significantly higher serum albumin level (33.2 ± 3.7 g/L vs 28.9 ± 4.3 g/L,t =2.94,P =0.01) at 5 days after surgery.Conclusion Compared with conventional open surgery,laparoscopic left lateral hepatectomy has the features of litde trauma,rapid postoperative recovery,and little influence on liver function in the treatment of intrahepatic bile duct stones and has a marked clinical effect.Therefore,it holds promise for clinical application.

Coronal 2D MR cholangiography overestimates the length of the right hepatic duct in liver transplantation donors.

PURPOSE: To compare the length of the right hepatic duct (RHD) measured on rotatory coronal 2D MR cholangiography (MRC), rotatory axial 2D MRC, and reconstructed 3D MRC. MATERIALS AND METHODS: Sixty-seven donors underwent coronal and axial 2D projection MRC and 3D MRC. RHD length was measured and categorized as ultrashort (≤1 mm), short (>1-14 mm), and long (>14 mm). The measured length, frequency of overestimation, and the degree of underestimation between two 2D MRC sets were compared to 3D MRC. RESULTS: The length of the RHD from 3D MRC, coronal 2D MRC, and axial 2D MRC showed significant difference (p < 0.05). RHD was frequently overestimated on the coronal than on axial 2D MRC (61.2 % vs. 9 %; p < .0001). On coronal 2D MRC, four (6 %) with short RHD and one (1.5 %) with ultrashort RHD were over-categorized as long RHD. On axial 2D MRC, overestimation was mostly <1 mm (83.3 %), none exceeding 3 mm or over-categorized. The degree of underestimation between the two projection planes was comparable. CONCLUSION: Coronal 2D MRC overestimates the RHD in liver donors. We suggest adding axial 2D MRC to conventional coronal 2D MRC in the preoperative workup protocol for living liver donors to avoid unexpected confrontation with multiple ductal openings when harvesting the graft. KEY POINTS: • In living liver donors, RHD length influences the number of ductal openings. • Coronal 2D MRC overestimates the RHD length than does axial 2D MRC. • Adding axial 2D MRC to coronal 2D MRC may prevent overestimating RHD length.

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. MATERIAL/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.

Interventional radiologic approach to hilar malignant biliary obstruction

Biliary obstruction due to advanced hepatic hilar malignancy is difficult to treat, both surgically and non-surgically, using endoscopic or percutaneous drainage. Since only about 10% to 20% of patients are eligible for resection of hepatic hilar malignancies, most patients receive palliative rather than curative treatment. Percutaneous palliation of advanced hepatic hilar malignancies can be accomplished in a variety of ways. Percutaneous bilateral metallic stent placement may be a reasonable option in patients with hilar malignancies to preserve the functional volume of the liver during the course of chemotherapy and to prevent procedure-related cholangitis of a contaminated undrained lobe. Percutaneous bilateral stent-in-stent placement using wide-mesh or open-cell design stents is a feasible and effective method of achieving bilateral drainage. Moreover, unilateral covered or uncovered metallic stent placement in the lobe with patent portal vein is safe and effective method for palliative treatment in patients with contralateral portal vein occlusion caused by hilar malignancies, obviating the need for bilateral stent placement in these patients.