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Concordance of Second-Order Portal Venous and Biliary Tract Anatomies on MDCT Angiography and MDCT Cholangiography

James S. Chen1, Benjamin M. Yeh1, Zhen J. Wang1, John P. Roberts2, Richard S. Breiman1, Aliya Qayyum1 and Fergus V. Coakley1

1 Abdominal Imaging, Department of Radiology, University of California, San Francisco, Box 0628, C-324C, 505 Parnassus Ave., San Francisco, CA 94143-0628.
2 Department of Surgery, University of California, San Francisco, San Francisco, CA 94143-0628.



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  		Fig. 1. —Schematic guide for assignment of categories of conventional and variant portal venous and biliary tract branching anatomies. RA = right anterior branch, LM = left medial branch, RP = right posterior branch, CD = common bile duct, LL = left lateral branch.

 


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  		Fig. 2A. —Conventional MDCT angiographic and MDCT cholangiographic images obtained in 50-year-old male potential liver donor displaying discordance between second-order portal venous and biliary tract branching anatomies. Volume-rendered oblique axial CT reformation of MDCT angiogram shows right posterior portal vein (large arrow) arising from main portal vein (large arrowhead). Right anterior portal vein (small arrowheads) arises from left portal vein (small arrow).

 


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  		Fig. 2B. —Conventional MDCT angiographic and MDCT cholangiographic images obtained in 50-year-old male potential liver donor displaying discordance between second-order portal venous and biliary tract branching anatomies. Volume-rendered coronal CT reformation of MDCT cholangiogram reveals right posterior bile duct (small arrowheads) draining into left bile duct (small arrow). Right anterior bile duct (large arrow) drains into main bile duct (large arrowhead).

 


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  		Fig. 3A. —Conventional MDCT angiographic and MDCT cholangiographic images obtained in 36-year-old woman potential liver donor illustrating discordance between second-order portal venous and biliary tract branching anatomies. Volume-rendered oblique axial CT reformation of MDCT angiogram shows conventional second-order portal venous branching anatomy with main portal vein (large arrowhead) bifurcating into left portal vein (small arrow) and right portal vein. Right portal vein then bifurcates into right anterior (small arrowheads) and right posterior (large arrow) portal vein.

 


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  		Fig. 3B. —Conventional MDCT angiographic and MDCT cholangiographic images obtained in 36-year-old woman potential liver donor illustrating discordance between second-order portal venous and biliary tract branching anatomies. Volume-rendered coronal CT reformation of MDCT cholangiogram shows right posterior biliary branch (large arrow) draining directly into common bile duct (large arrowhead) inferior to confluence of right anterior (small arrowheads) and left main (small arrow) biliary branches.

 

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