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Lu Y, Huang C, Fu W, Gao L, Mi N, Ma H, Bai M, Xia Z, Zhang X, Tian L, Zhao J, Jiang N, Wang L, Zhong R, Zhang C, Wang Y, Lin Y, Yue P, Meng W. Design of the distribution of iron oxide (Fe 3O 4) nano-particle drug in realistic cholangiocarcinoma model and the simulation of temperature increase during magnetic induction hyperthermia. Pharmacol Res 2024; 207:107333. [PMID: 39089399 DOI: 10.1016/j.phrs.2024.107333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 07/23/2024] [Accepted: 07/29/2024] [Indexed: 08/04/2024]
Abstract
The prognosis for Cholangiocarcinoma (CCA) is unfavorable, necessitating the development of new therapeutic approach such as magnetic hyperthermia therapy (MHT) which is induced by magnetic nano-particle (MNPs) drug to bridge the treatment gap. Given the deep location of CCA within the abdominal cavity and proximity to vital organs, accurately predict the individualized treatment effects and safety brought by the distribution of MNPs in tumor will be crucial for the advancement of MHT in CCA. The Mimics software was used in this study to conduct three-dimensional reconstruction of abdominal computed tomography (CT) and magnetic reso-nance imaging images from clinical patients, resulting in the generation of a realistic digital geometric model representing the human biliary tract and its adjacent structures. Subsequently, The COMSOL Multiphysics software was utilized for modeling CCA and calculating the heat transfer law resulting from the multi-regional distribution of MNPs in CCA. The temperature within the central region of irregular CCA measured approximately 46°C, and most areas within the tumor displayed temperatures surpassing 41°C. The temperature of the inner edge of CCA is only 39 ∼ 41℃, however, it can be ameliorated by adjusting the local drug concentration through simulation system. For CCA with diverse morphologies and anatomical locations, the multi-regional distribution patterns of intratumoral MNPs and a slight overlap of drug distribution areas synergistically enhance intratumoral temperature while ensuring treatment safety. The present study highlights the practicality and imperative of incorporating personalized intratumoral MNPs distribution strategy into clinical practice for MHT, which can be achieved through the development of an integrated simulation system which incorporates medical image data and numerical calculations.
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Affiliation(s)
- Yawen Lu
- The First Clinical Medical College of Lanzhou University, Lanzhou 730030, China
| | - Chongfei Huang
- The First Clinical Medical College of Lanzhou University, Lanzhou 730030, China
| | - WenKang Fu
- The First Clinical Medical College of Lanzhou University, Lanzhou 730030, China
| | - Long Gao
- The First Clinical Medical College of Lanzhou University, Lanzhou 730030, China
| | - Ningning Mi
- The First Clinical Medical College of Lanzhou University, Lanzhou 730030, China
| | - Haidong Ma
- The First Clinical Medical College of Lanzhou University, Lanzhou 730030, China
| | - Mingzhen Bai
- The First Clinical Medical College of Lanzhou University, Lanzhou 730030, China
| | - Zhili Xia
- The First Clinical Medical College of Lanzhou University, Lanzhou 730030, China
| | - Xianzhuo Zhang
- The First Clinical Medical College of Lanzhou University, Lanzhou 730030, China
| | - Liang Tian
- The First Clinical Medical College of Lanzhou University, Lanzhou 730030, China
| | - Jinyu Zhao
- The First Clinical Medical College of Lanzhou University, Lanzhou 730030, China
| | - Ningzu Jiang
- The First Clinical Medical College of Lanzhou University, Lanzhou 730030, China
| | - Leiqing Wang
- The First Clinical Medical College of Lanzhou University, Lanzhou 730030, China
| | - Ruyang Zhong
- The First Clinical Medical College of Lanzhou University, Lanzhou 730030, China
| | - Chao Zhang
- The First Clinical Medical College of Lanzhou University, Lanzhou 730030, China
| | - Yeying Wang
- Medical Frontier Innovation Research Center, The First Hospital of Lanzhou University, Lanzhou 730000, China
| | - YanYan Lin
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730030, China
| | - Ping Yue
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730030, China
| | - Wenbo Meng
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730030, China; Gansu Province Key Laboratory of Biological Therapy and Regenerative Medicine Transformation, Lanzhou 730030, China.
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Olmedo NB, Dos Santos JS, Junior JE. The Frequency of Anatomical Variants of the Bile Ducts: A Review Based on a Single Classification as Support for Cholangiographic Examinations. Cureus 2024; 16:e58905. [PMID: 38800324 PMCID: PMC11118781 DOI: 10.7759/cureus.58905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2024] [Indexed: 05/29/2024] Open
Abstract
Complications arising from hepatobiliary surgery can have adverse effects on both the quality of life and the survival of patients. Magnetic resonance cholangiography (MRC) techniques are highly effective at revealing anatomical variants of the bile ducts and thus play a vital role in minimizing the occurrence of complications. The aims of this review are threefold: to ascertain the classifications utilized for categorizing anatomical variants of the bile ducts, to present the reported results on the prevalence of these anatomical variants, and to explore the diagnostic modalities employed to visualize these anatomical variants and associated complications during surgical procedures. A review of the literature was carried out using the Cochrane Library database and the PubMed, Medical Literature Analysis and Retrieval System Online (MEDLINE), and Google Scholar platforms. We conducted a comprehensive review of relevant studies to categorize the different anatomical variants according to the Huang classification. According to the Huang classification, our study showed type A1, 60.44%; type A2, 11.76%; type A3, 11.73%; type A4, 5.47%; type A5, 0.26%; and type B, which was identified in insignificant numbers (0.16%) or does not appear; additionally, variants that do not fit into the Huang classification have also been identified (10.18%). The Huang classification serves as an invaluable presurgical guide, aiding in the strategic planning of biliary interventions and effectively reducing the risk of iatrogenic complications, morbidity, mortality, and postoperative length of stay. MRC is still considered the noninvasive gold standard method for evaluating the bile ducts and their anatomical variations.
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Affiliation(s)
- Norman B Olmedo
- Department of Imaging and Radiology, College of Medical Sciences, Central University of Ecuador, Quito, ECU
| | - José Sebastião Dos Santos
- Department of Surgery and Anatomy, Hospital das Clinicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, BRA
| | - Jorge Elías Junior
- Department of Medical Imaging, Hematology, and Oncology, Ribeirão Medical School, University of São Paulo, Ribeirão Preto, BRA
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Tian S, Shi H, Chen W, Li S, Han C, Du F, Wang W, Wen H, Lei Y, Deng L, Tang J, Zhang J, Lin J, Shi L, Ning B, Zhao K, Miao J, Wang G, Hou H, Huang X, Kong W, Jin X, Ding Z, Lin R. Artificial intelligence-based diagnosis of standard endoscopic ultrasonography scanning sites in the biliopancreatic system: a multicenter retrospective study. Int J Surg 2024; 110:1637-1644. [PMID: 38079604 PMCID: PMC10942157 DOI: 10.1097/js9.0000000000000995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/27/2023] [Indexed: 03/16/2024]
Abstract
BACKGROUND There are challenges for beginners to identify standard biliopancreatic system anatomical sites on endoscopic ultrasonography (EUS) images. Therefore, the authors aimed to develop a convolutional neural network (CNN)-based model to identify standard biliopancreatic system anatomical sites on EUS images. METHODS The standard anatomical structures of the gastric and duodenal regions observed by EUS was divided into 14 sites. The authors used 6230 EUS images with standard anatomical sites selected from 1812 patients to train the CNN model, and then tested its diagnostic performance both in internal and external validations. Internal validation set tests were performed on 1569 EUS images of 47 patients from two centers. Externally validated datasets were retrospectively collected from 16 centers, and finally 131 patients with 85 322 EUS images were included. In the external validation, all EUS images were read by CNN model, beginners, and experts, respectively. The final decision made by the experts was considered as the gold standard, and the diagnostic performance between CNN model and beginners were compared. RESULTS In the internal test cohort, the accuracy of CNN model was 92.1-100.0% for 14 standard anatomical sites. In the external test cohort, the sensitivity and specificity of CNN model were 89.45-99.92% and 93.35-99.79%, respectively. Compared with beginners, CNN model had higher sensitivity and specificity for 11 sites, and was in good agreement with the experts (Kappa values 0.84-0.98). CONCLUSIONS The authors developed a CNN-based model to automatically identify standard anatomical sites on EUS images with excellent diagnostic performance, which may serve as a potentially powerful auxiliary tool in future clinical practice.
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Affiliation(s)
- Shuxin Tian
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
- Department of Gastroenterology, The First Affiliated Hospital of Medical College, Shihezi University, Shihezi
- National Health Commission Key Laboratory of Central Asia High Incidence Disease Prevention and Control, Shihezi
| | - Huiying Shi
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - Weigang Chen
- Department of Gastroenterology, The First Affiliated Hospital of Medical College, Shihezi University, Shihezi
- National Health Commission Key Laboratory of Central Asia High Incidence Disease Prevention and Control, Shihezi
| | - Shijie Li
- National Health Commission Key Laboratory of Central Asia High Incidence Disease Prevention and Control, Shihezi
- Department of Endoscopy Center, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing
| | - Chaoqun Han
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - Fan Du
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - Weijun Wang
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - Hongxu Wen
- Department of Gastroenterology, Lanzhou Second People’s Hospital, Lanzhou
| | - Yali Lei
- Department of Gastroenterology, Weinan Central Hospital, Weinan
| | - Liang Deng
- Department of Gastroenterology, The First Affiliated Hospital of Chongqing Medical University, Chongqing
| | - Jing Tang
- Department of Gastroenterology, Fuling Hospital Affiliated to Chongqing University, Chongqing
| | - Jinjie Zhang
- Department of Gastroenterology, The Second Affiliated Hospital of Baotou Medical College, Baotou
| | - Jianjiao Lin
- Department of Gastroenterology, Longgang District People’s Hospital, Shenzhen
| | - Lei Shi
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou
| | - Bo Ning
- Department of Gastroenterology, The Second Affiliated Hospital Chongqing Medical University, Chongqing
| | - Kui Zhao
- Department of Gastroenterology, The First Affiliated Hospital of Chendu Medical College, Chengdu
| | - Jiarong Miao
- Department of Gastroenterology, The First Affiliated Hospital of Kunming Medical University, Kunming
- Yunnan Province Clinical Research Center for Digestive Diseases, Kunming
| | - Guobao Wang
- Department of endoscopy, Sun Yat-sen University Cancer Center,Guangzhou
| | - Hui Hou
- Department of Gastroenterology, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi
| | - Xiaoxi Huang
- Department of Gastroenterology, Haikou People’s Hospital, Haikou
| | - Wenjie Kong
- Department of Gastroenterology, People’s Hospital of Xinjiang Autonomous Region, Urumqi
| | - Xiaojuan Jin
- Department of Gastroenterology, Suining Central Hospital, Suining, People’s Republic of China
| | - Zhen Ding
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
- Department of Endoscopy Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou
| | - Rong Lin
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
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Meza-Hernandez JA, Zubillaga-Mares A, Serrano-Sanchez M, Alvarez-Bautista FE, Trejo-Avila M, Nuñez-Venzor A. An uncommon case of right hepatic duct entering cystic duct associated to multiple complications of biliary tract disease: acute pancreatitis, hepatolithiasis, acute cholecystitis and hepatic abscess. J Surg Case Rep 2024; 2024:rjad637. [PMID: 38495040 PMCID: PMC10941810 DOI: 10.1093/jscr/rjad637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 11/03/2023] [Indexed: 03/19/2024] Open
Abstract
Anatomical variations of the biliary tree pose diagnostic and treatment challenges. While most are harmless and often discovered incidentally during procedures, some can lead to clinical issues and biliary complications, making knowledge of these variants crucial to prevent surgical mishaps. Here, we present an unusual and clinically significant case. A 61-year-old man is admitted to the hospital with epigastric pain and diagnosis of pancreatitis of biliary origin and intermediate risk of choledocholithiasis. Magnetic resonance cholangiopancreatography (MRCP) reported hepatolithiasis and choledocholithiasis, whereas endoscopic retrograde cholangiopancreatography showed cystic drain of the right hepatic duct. One month later the patient presented again to the emergency room with increasing abdominal pain and a computed tomography that demonstrated the presence of hepatic abscess and acute cholecystitis. The patient underwent percutaneous drain abscess and a subtotal laparoscopic cholecystectomy. Biliary anatomical variants present challenges on the diagnostic investigations, interventional and surgical procedures, understanding the possible complications is essential.
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Affiliation(s)
- Javier A Meza-Hernandez
- Department of General and Endoscopic Surgery, Hospital General Dr Manuel Gea Gonzalez, Calzada de Tlalpan 4800, Mexico City 14090, Mexico
- Faculty of Medicine, Autonomous University of Mexico (UNAM), Mexico City 14090, Mexico
| | - Asya Zubillaga-Mares
- Department of General and Endoscopic Surgery, Hospital General Dr Manuel Gea Gonzalez, Calzada de Tlalpan 4800, Mexico City 14090, Mexico
- Faculty of Medicine, Autonomous University of Mexico (UNAM), Mexico City 14090, Mexico
| | - Minnet Serrano-Sanchez
- Department of General and Endoscopic Surgery, Hospital General Dr Manuel Gea Gonzalez, Calzada de Tlalpan 4800, Mexico City 14090, Mexico
| | - Francisco E Alvarez-Bautista
- Department of General and Endoscopic Surgery, Hospital General Dr Manuel Gea Gonzalez, Calzada de Tlalpan 4800, Mexico City 14090, Mexico
- Faculty of Medicine, Autonomous University of Mexico (UNAM), Mexico City 14090, Mexico
| | - Mario Trejo-Avila
- Department of General and Endoscopic Surgery, Hospital General Dr Manuel Gea Gonzalez, Calzada de Tlalpan 4800, Mexico City 14090, Mexico
- Faculty of Medicine, Autonomous University of Mexico (UNAM), Mexico City 14090, Mexico
| | - Alejandra Nuñez-Venzor
- Department of General and Endoscopic Surgery, Hospital General Dr Manuel Gea Gonzalez, Calzada de Tlalpan 4800, Mexico City 14090, Mexico
- Faculty of Medicine, Autonomous University of Mexico (UNAM), Mexico City 14090, Mexico
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Fujiwara K, Hiraka K, Shindo K, Abe A, Masatsugu T, Hirano T, Sada M. Variations in the cystic duct: frequency and the relationship among insertion sides and heights on the bile duct. Surg Radiol Anat 2024; 46:223-230. [PMID: 38197959 DOI: 10.1007/s00276-023-03275-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 11/27/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND Evaluation of the cystic duct anatomy prior to bile duct or gallbladder surgery is important, to decrease the risk of bile duct injury. This study aimed to clarify the frequency of cystic duct variations and the relationship between them. METHODS Data of 205 patients who underwent cholecystectomy after imaging at Sada Hospital, Japan, were analyzed. The Chi-square test was used to analyze the relationships among variations. RESULTS The lateral and posterior sides of the bile duct were the two most common insertion points (92 patients, 44.9%), and the middle height was the most common insertion height (135 patients, 65.9%). Clinically important variations (spiral courses, parallel courses, low insertions, and right hepatic duct draining) relating to the risk of bile duct injury were observed in 24 patients (11.7%). Regarding the relationship between the insertion sides and heights, we noticed that the posterior insertion frequently existed in low insertions (75.0%, P < 0.001) and did not exist in high insertions. In contrast, the anterior insertion coexisted with high and never low insertions. Spiral courses have two courses: anterior and posterior, and anterior ones were only found in high insertion cases. CONCLUSIONS The insertion point of the cystic duct and the spiral courses tended to be anterior or lateral superiorly and posterior inferiorly. Clinically significant variations in cystic duct insertions are common and surgeons should be cautious about these variations to avoid complications.
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Affiliation(s)
- Kenji Fujiwara
- Department of Surgery, Sada Hospital, Fukuoka, Japan.
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
- Department of Surgery, Kimura Hospital, Fukuoka, Japan.
| | | | - Koji Shindo
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Atsushi Abe
- Department of Surgery, Sada Hospital, Fukuoka, Japan
- Department of Surgery, Shin-Kokura Hospital, Kitakyushu, Japan
| | | | - Tatsuya Hirano
- Department of Surgery, Sada Hospital, Fukuoka, Japan
- Department of Surgery, Yagi Hospital, Fukuoka, Japan
| | - Masayuki Sada
- Department of Surgery, Sada Hospital, Fukuoka, Japan
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Guo X, Fan Q, Guo Y, Li X, Hu J, Wang Z, Wang J, Li K, Zhang N, Amin B, Zhu B. Clinical study on the necessity and feasibility of routine MRCP in patients with cholecystolithiasis before LC. BMC Gastroenterol 2024; 24:28. [PMID: 38195417 PMCID: PMC10777623 DOI: 10.1186/s12876-023-03117-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 12/30/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND In the past quite a long time, intraoperative cholangiography(IOC)was necessary during laparoscopic cholecystectomy (LC). Now magnetic resonance cholangiopancreatography (MRCP) is the main method for diagnosing common bile duct stones (CBDS). Whether MRCP can replace IOC as routine examination before LC is still inconclusive. The aim of this study was to analyze the clinical data of patients undergoing LC for cholecystolithiasis, and to explore the necessity and feasibility of preoperative routine MRCP in patients with cholecystolithiasis. METHODS According to whether MRCP was performed before operation, 184 patients undergoing LC for cholecystolithiasis in the Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University from January 1, 2017 to December 31, 2018 were divided into non-MRCP group and MRCP group for this retrospective study. The results of preoperative laboratory test, abdominal ultrasound and MRCP, biliary related comorbidities, surgical complications, hospital stay and hospitalization expenses were compared between the two groups. RESULTS Among the 184 patients, there were 83 patients in non-MRCP group and 101 patients in MRCP group. In MRCP group, the detection rates of cholecystolithiasis combined with CBDS and common bile duct dilatation by MRCP were higher than those by abdominal ultrasound (P < 0.05). The incidence of postoperative complications in non-MRCP group (8.43%) was significantly higher (P < 0.05) than that in MRCP group (0%). There was no significant difference in hospital stay (P > 0.05), but there was significant difference in hospitalization expenses (P < 0.05) between the two groups. According to the stratification of gallbladder stone patients with CBDS, hospital stay and hospitalization expenses were compared, and there was no significant difference between the two groups (P > 0.05). CONCLUSIONS The preoperative MRCP can detect CBDS, cystic duct stones and anatomical variants of biliary tract that cannot be diagnosed by abdominal ultrasound, which is helpful to plan the surgical methods and reduce the surgical complications. From the perspective of health economics, routine MRCP in patients with cholecystolithiasis before LC does not increase hospitalization costs, and is necessary and feasible.
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Affiliation(s)
- Xu Guo
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Tieyi Road 10th, Yangfangdian Street, Haidian District, 100038, Beijing, China
| | - Qing Fan
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Tieyi Road 10th, Yangfangdian Street, Haidian District, 100038, Beijing, China
| | - Yiman Guo
- School of Clinical Medicine, Hebei University, Wusi East Road 180th, Lianchi District, Hebei Province, 071000, Baoding City, China
| | - Xinming Li
- Department of Urology, Fuyang People's Hospital, Anhui Medical University, Sanqing Road 501th, Ying Zhou District, 236012, Fuyang City, Anhui Province, China
| | - Jili Hu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe Dong Road, ErQi District, 450052, Zhengzhou City, Henan Province, China
| | - Zhuoyin Wang
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Tieyi Road 10th, Yangfangdian Street, Haidian District, 100038, Beijing, China
| | - Jing Wang
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Tieyi Road 10th, Yangfangdian Street, Haidian District, 100038, Beijing, China
| | - Kai Li
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Tieyi Road 10th, Yangfangdian Street, Haidian District, 100038, Beijing, China
| | - Nengwei Zhang
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Tieyi Road 10th, Yangfangdian Street, Haidian District, 100038, Beijing, China
| | - Buhe Amin
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Tieyi Road 10th, Yangfangdian Street, Haidian District, 100038, Beijing, China.
| | - Bin Zhu
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Tieyi Road 10th, Yangfangdian Street, Haidian District, 100038, Beijing, China.
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Renzulli M, Brandi N, Brocchi S, Balacchi C, Lanza C, Pettinari I, Stefanini B, Carrafiello G, Piscaglia F, Golfieri R, Marasco G. Association between anatomic variations of extrahepatic and intrahepatic bile ducts: Do look up! J Anat 2023; 242:683-694. [PMID: 36670522 PMCID: PMC10008292 DOI: 10.1111/joa.13808] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/06/2022] [Accepted: 12/06/2022] [Indexed: 01/22/2023] Open
Abstract
Biliary anatomic variations are usually asymptomatic, but they may cause problems in diagnostic investigations and interventional and surgical procedures, increasing both their technical difficulty and their postoperative complication rates. The aim of the present study was to evaluate the prevalence of anatomic variations in the intrahepatic biliary ducts (IHBD) in relation to demographical and clinical characteristics in a large study population requiring magnetic resonance cholangiopancreatography (MRCP) for various clinical conditions. The possible association between IHBD and extrahepatic biliary ducts (EHBD) variants was then explored. From January 2017 to May 2019, 1004 patients underwent MRCP. Demographical and clinical data were collected. IHBD and EHBD anatomy were recorded and the EHBD anatomy was classified using both qualitative and quantitative classifications. The presence of a type 3 EHBD variant (an abnormal proximal cystic duct [CD] insertion) in both qualitative and quantitative classifications and an intrapancreatic CD were associated with the presence of IHBD variants at univariate analysis (p = 0.008, p = 0.019, and p = 0.001, respectively). The presence of a posterior or medial insertion of the CD into the EHBD was a strong predictive factor of the presence of IHBD variants both at uni- and multivariate analysis (p = 0.002 and p = 0.003 for posterior insertion and p = 0.002 and p = 0.002 for medial insertion, respectively). The presence of gallstones on MRCP resulted in a strong predictor of the presence of an anatomical variant of the IHBD both at uni- and multivariate analysis (p = 0.027 and p = 0.046, respectively). In conclusion, the presence of a type 3 variant of the EHBD, an intrapancreatic CD and, especially, a posterior/medial CD insertion into the EHBD represent predictive factors of the concomitant presence of IHBD variants, thus radiologists must be vigilant when encountering these EHBD configurations and always remember to "look up" at the IHBD. Finally, the presence of an IHBD variant is a strong predictive factor of gallstones.
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Affiliation(s)
- Matteo Renzulli
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Nicolò Brandi
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Stefano Brocchi
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Caterina Balacchi
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Carolina Lanza
- Diagnostic and Interventional Radiology Department, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Irene Pettinari
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Bernardo Stefanini
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Giampaolo Carrafiello
- Diagnostic and Interventional Radiology Department, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Fabio Piscaglia
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Rita Golfieri
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Giovanni Marasco
- Internal Medicine and Digestive Physiopathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Mehta V, Hopson PE, Smadi Y, Patel SB, Horvath K, Mehta DI. Development of the human pancreas and its exocrine function. Front Pediatr 2022; 10:909648. [PMID: 36245741 PMCID: PMC9557127 DOI: 10.3389/fped.2022.909648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 08/11/2022] [Indexed: 11/25/2022] Open
Abstract
The pancreas has both endocrine and exocrine function and plays an important role in digestion and glucose control. Understanding the development of the pancreas, grossly and microscopically, and the genetic factors regulating it provides further insight into clinical problems that arise when these processes fail. Animal models of development are known to have inherent issues when understanding human development. Therefore, in this review, we focus on human studies that have reported gross and microscopic development including acinar-, ductal-, and endocrine cells and the neural network. We review the genes and transcription factors involved in organ formation using data from animal models to bridge current understanding where necessary. We describe the development of exocrine function in the fetus and postnatally. A deeper review of the genes involved in pancreatic formation allows us to describe the development of the different groups (proteases, lipids, and amylase) of enzymes during fetal life and postnatally and describe the genetic defects. We discuss the constellation of gross anatomical, as well as microscopic defects that with genetic mutations lead to pancreatic insufficiency and disease states.
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Affiliation(s)
- Vijay Mehta
- Center for Digestive Health and Nutrition, Arnold Palmer Hospital for Children, Orlando, FL, United States
| | - Puanani E Hopson
- Department of Children Center, Pediatric and Adolescent Medicine, Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, United States
| | - Yamen Smadi
- Center for Digestive Health and Nutrition, Arnold Palmer Hospital for Children, Orlando, FL, United States
| | - Samit B Patel
- Pediatric Gastroenterology and Nutrition of Tampa Bay, Tampa Bay, FL, United States
| | - Karoly Horvath
- Center for Digestive Health and Nutrition, Arnold Palmer Hospital for Children, Orlando, FL, United States
| | - Devendra I Mehta
- Center for Digestive Health and Nutrition, Arnold Palmer Hospital for Children, Orlando, FL, United States
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Gündüz N, Doğan MB, Alacagöz M, Yağbasan M, Orhan Söylemez UP, Atalay B. Anatomical variations of cystic duct insertion and their relationship with choledocholithiasis: an MRCP study. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-021-00579-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The frequency of insertion variations of cystic duct (CD) is inconsistent between studies caused to some extent by the way they give the relative frequency of the variations. Moreover, certain insertion variations have been reported to be associated with choledocholithiasis. This study aimed to assess the frequency of CD insertion variations with a comprehensive way of classification in an unselected population in whom MRCP was performed. Moreover, the relationship between the types of variant insertions and choledocholithiasis using MRCP was also assessed. Patients undergoing magnetic resonance cholangiopancreatography (MRCP) were reviewed retrospectively by two radiologists who were blinded to the clinical data. The normal insertion was defined as the union through middle one third of the lateral border of the extrahepatic bile duct. The transverse site (lateral, medial, anterior, and posterior) and the craniocaudal level (high, mid and low) of insertions and their intersections were assessed using axial and coronal slices, respectively. In addition, the frequencies of the CD insertion variations were compared between choledocholithiasis and control (no-choledocholithiasis) groups.
Results
A total of 307 patients (124 with choledocholithiasis and 183 controls) were analyzed. A true variant insertion was found in 149 (48.5%) cases. The insertion variations were less frequent in the choledocholithiasis group [50 (40.3%) vs. 99 (54.1%), respectively, p = 0.018]. The frequencies of craniocaudal level of insertion differed significantly between groups (p = 0.014) that was driven by a lower rate of low medial insertion (1.6% vs. 9.8%, respectively) in the choledocholithiasis group. The frequencies of transverse site of insertion were similar between groups (p = 0.314). The low medial insertion was 80.7% less likely associated with choledocholithiasis even after adjustment for age (Odds ratio: 0.193, 95% Confidence interval: 0.039–0.954, p = 0.044). The interreader agreement for insertion assessment was good (Cohen’s Kappa: 0.748, p < 0.001).
Conclusions
The prevalence of CD insertion variations in an unselected population undergoing MRCP is quite high and a mid-posterior insertion is the most common variant type. Insertion variations of CD, the low medial insertion in particular, are less common in patients with choledocholithiasis than controls.
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