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Evaluation of Aberrant Bile Ducts Before Laparoscopic Cholecystectomy

Helical CT Cholangiography Versus MR Cholangiography

¹ Department of Radiology, Sasebo Chuo Hospital, 15 Yamato-cho, Sasebo City, Nagasaki 857-1195, Japan.
² Department of Radiology, Nagasaki University School of Medicine, Nagasaki, Japan.

View larger version (10K): [in a new window]   Fig. 1A. —Drawings of bile duct and cystic duct anatomy. Normal pattern.

View larger version (11K): [in a new window]   Fig. 1B. —Drawings of bile duct and cystic duct anatomy. Type 1 anomaly.

View larger version (11K): [in a new window]   Fig. 1C. —Drawings of bile duct and cystic duct anatomy. Type 2 anomaly.

View larger version (11K): [in a new window]   Fig. 1D. —Drawings of bile duct and cystic duct anatomy. Type 3 anomaly.

View larger version (11K): [in a new window]   Fig. 1E. —Drawings of bile duct and cystic duct anatomy. Type 4 anomaly.

View larger version (9K): [in a new window]   Fig. 1F. —Drawings of bile duct and cystic duct anatomy. Type 5 anomaly.

View larger version (10K): [in a new window]   Fig. 1G. —Drawings of bile duct and cystic duct anatomy. Type 6 anomaly.

View larger version (128K): [in a new window]   Fig. 2A. —Type 1 aberrant bile duct in 60-year-old man with gallbladder polyp. Posteroanterior three-dimensional shaded-surface—display helical CT cholangiogram shows cystic duct (arrow) draining into inferior aspect of right aberrant bile duct (arrowhead).

View larger version (134K): [in a new window]   Fig. 2B. —Type 1 aberrant bile duct in 60-year-old man with gallbladder polyp. Posteroanterior contrast-enhanced fat-suppressed single-shot T2-weighted turbo spin-echo MR cholangiogram obtained with half-Fourier technique shows aberrant bile duct (arrowhead). Overlapping of duodenum and aberrant bile duct obscures insertion site of cystic duct (arrow).

View larger version (99K): [in a new window]   Fig. 3A. —Type 2 aberrant bile duct in 64-year-old woman with gallbladder polyp. Posteroanterior oblique shaded-surface—display helical CT cholangiogram cannot show cystic duct (arrow) and aberrant bile duct (arrowhead) separately.

View larger version (131K): [in a new window]   Fig. 3B. —Type 2 aberrant bile duct in 64-year-old woman with gallbladder polyp. Axial source images from helical CT cholangiogram, of which each has intersection gap of 3 mm, clearly delineate both cystic duct (small arrow, D and E) and aberrant bile duct (arrowhead, B-D). Cystic duct runs anterior to and communicates with common hepatic duct (large arrow, D and E), and gallbladder polyp (arrow, C) is shown in gallbladder neck.

View larger version (149K): [in a new window]   Fig. 3C. —Type 2 aberrant bile duct in 64-year-old woman with gallbladder polyp. Axial source images from helical CT cholangiogram, of which each has intersection gap of 3 mm, clearly delineate both cystic duct (small arrow, D and E) and aberrant bile duct (arrowhead, B-D). Cystic duct runs anterior to and communicates with common hepatic duct (large arrow, D and E), and gallbladder polyp (arrow, C) is shown in gallbladder neck.

View larger version (151K): [in a new window]   Fig. 3D. —Type 2 aberrant bile duct in 64-year-old woman with gallbladder polyp. Axial source images from helical CT cholangiogram, of which each has intersection gap of 3 mm, clearly delineate both cystic duct (small arrow, D and E) and aberrant bile duct (arrowhead, B-D). Cystic duct runs anterior to and communicates with common hepatic duct (large arrow, D and E), and gallbladder polyp (arrow, C) is shown in gallbladder neck.

View larger version (145K): [in a new window]   Fig. 3E. —Type 2 aberrant bile duct in 64-year-old woman with gallbladder polyp. Axial source images from helical CT cholangiogram, of which each has intersection gap of 3 mm, clearly delineate both cystic duct (small arrow, D and E) and aberrant bile duct (arrowhead, B-D). Cystic duct runs anterior to and communicates with common hepatic duct (large arrow, D and E), and gallbladder polyp (arrow, C) is shown in gallbladder neck.

View larger version (119K): [in a new window]   Fig. 3F. —Type 2 aberrant bile duct in 64-year-old woman with gallbladder polyp. Fat-suppressed three-dimensional multislice T2-weighted turbo spin-echo MR cholangiogram using high concentration of ferric ammonium citrate, which did not completely eliminate hyperintensity of duodenal lumen, cannot show insertion sites of cystic duct and aberrant bile duct. It could not be determined which of two ducts (arrows) joining common bile duct was connected to cystic duct.

View larger version (97K): [in a new window]   Fig. 4A. —Type 3 aberrant bile duct in 61-year-old woman with cholecystolithiasis. Cranioposteroanterior shaded-surface—display helical CT cholangiogram clearly shows cystic duct (arrow) draining into common hepatic duct below confluence of right aberrant bile duct (arrowhead). Axial source images of helical CT cholangiography delineate cystic duct, although shaded-surface—display image partially obliterates small caliber of cystic duct.

View larger version (110K): [in a new window]   Fig. 4B. —Type 3 aberrant bile duct in 61-year-old woman with cholecystolithiasis. Posteroanterior maximum-intensity-projection image from contrast-enhanced fat-suppressed three-dimensional multislice T2-weighted turbo spin-echo MR cholangiogram clearly shows insertion site of aberrant bile duct (arrowhead) and cystic duct (arrow).

View larger version (143K): [in a new window]   Fig. 5A. —Type 4 aberrant bile duct in 60-year-old man with cholecystoand choledocholithiasis. Anteroposterior shaded-surface—display helical CT cholangiogram shows aberrant bile duct (arrowhead) draining into common hepatic duct opposite of confluence of cystic duct (arrow).

View larger version (104K): [in a new window]   Fig. 5B. —Type 4 aberrant bile duct in 60-year-old man with cholecystoand choledocholithiasis. Anteroposterior fat-suppressed single-shot T2-weighted turbo spin-echo MR cholangiogram obtained with half-Fourier technique using high concentration of ferric ammonium citrate shows aberrant bile duct (arrowhead) draining into common hepatic duct. Confluence of cystic duct (arrow) is obscured by overlapping common hepatic duct but is clearly shown in other direction of MR cholangiography.

View larger version (100K): [in a new window]   Fig. 6A. —Type 5 aberrant bile duct in 70-year-old woman with cholecystolithiasis and adenomyomatosis of gallbladder. Posteroanterior shaded-surface—display helical CT cholangiogram shows aberrant cystic duct (arrow) draining into inferior aspect of right hepatic duct (arrowhead).

View larger version (114K): [in a new window]   Fig. 6B. —Type 5 aberrant bile duct in 70-year-old woman with cholecystolithiasis and adenomyomatosis of gallbladder. Posteroanterior fat-suppressed three-dimensional multislice T2-weighted turbo spin-echo MR cholangiogram using high concentration of ferric ammonium citrate cannot depict aberrant cystic duct (arrow) because insertion site of cystic duct appears below confluence of right (arrowhead) and left hepatic ducts.

View larger version (79K): [in a new window]   Fig. 7A. —Type 6 aberrant bile duct in 36-year-old man with cholecystoand choledocholithiasis. Anteroposterior shaded-surface—display helical CT cholangiogram shows aberrant cystic duct (arrow) draining into left hepatic duct (arrowhead). Gallbladder is not opacified with contrast material using helical CT cholangiography because of severe cholecystitis.

View larger version (83K): [in a new window]   Fig. 7B. —Type 6 aberrant bile duct in 36-year-old man with cholecystoand choledocholithiasis. Posteroanterior maximum-intensity-projection image from fat-suppressed three-dimensional multislice T2-weighted turbo spin-echo MR cholangiogram using high concentration of ferric ammonium citrate shows aberrant cystic duct (arrow) draining into left hepatic duct (arrowhead).

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