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Assessment of Anomalous Pancreaticobiliary Ductal Junction with High-Resolution Multiplanar Reformatted Images in MDCT

Shigeki Itoh1, Hiromichi Fukushima2, Akira Takada2, Kojiro Suzuki2, Hiroko Satake2 and Takeo Ishigaki2

1 Department of Technical Radiology, Nagoya University School of Health Sciences, Nagoya, Aichi 461-8673, Japan.
2 Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.


Figure 1
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  		Fig. 1 —Anomalous pancreaticobiliary ductal junction with congenital choledochal cyst in 48-year-old woman. Patient presented with abdominal pain and underwent CT examination for further evaluation of dilatation of bile duct detected on sonography. Multiplanar reconstruction (MPR) images generated from pancreatic phase scanning show that pancreatic duct (thin arrow) and biliary duct (arrowhead) join within pancreatic parenchyma. Common bile duct shows cystic dilatation of extrapancreatic portion. Fan-shaped area showing less contrast enhancement between pancreatic head and duodenum (thick arrow) is also depicted. Line in upper image shows direction of section of MPR images.

 

Figure 2
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  		Fig. 2 —Normal pancreaticobiliary ductal junction in 81-year-old man with gallbladder carcinoma. Patient underwent CT examination for further evaluation of mass lesion of gallbladder detected on sonography. Multiplanar reconstruction (MPR) images generated from pancreatic phase scanning show that pancreatic duct (thin arrow) and biliary duct (arrowhead) follow independent courses within pancreatic parenchyma. Bandlike area showing less contrast enhancement between pancreatic head and duodenum (thick arrow) is also depicted. Line in upper image shows direction of section of MPR images.

 

Figure 3
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  		Fig. 3A —Anomalous pancreaticobiliary ductal junction with congenital choledochal cyst in 67-year-old woman. Patient underwent CT examination for further evaluation of dilatation of bile duct detected on sonography. Multiplanar reconstruction (MPR) images generated from pancreatic phase scanning show papillary tumor (arrowheads) and cystic dilatation of bile duct (straight arrows), but it is difficult to identify location of duct confluence with confidence. Fanlike area showing less contrast enhancement between pancreatic head and duodenum (curved arrow) is also depicted. Line in upper image shows direction of section of MPR images.

 

Figure 4
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  		Fig. 3B —Anomalous pancreaticobiliary ductal junction with congenital choledochal cyst in 67-year-old woman. Patient underwent CT examination for further evaluation of dilatation of bile duct detected on sonography. Axial source images clearly depict tortuous course of narrow ventral pancreatic duct (thin arrows) and duct confluence within pancreatic parenchyma. Thick arrows show cystic dilatation of bile duct, and arrowhead points to papillary tumor.

 

Figure 5
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  		Fig. 4A —Anomalous pancreaticobiliary ductal junction with congenital choledochal cyst in 24-year-old woman. Patient presented with abdominal pain and underwent CT examination for further evaluation of dilatation of bile duct detected on sonography. Coronal images generated from pancreatic phase scanning show that pancreatic and biliary ducts join within pancreatic parenchyma. Furthermore, these images make it possible to visualize common channel (arrowhead) and ventral pancreatic duct (thin arrows), which is narrow and tortuous. Thick arrows indicate dorsal pancreatic duct. In this case, area showing less contrast enhancement is not seen between pancreatic head and duodenum.

 

Figure 6
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  		Fig. 4B —Anomalous pancreaticobiliary ductal junction with congenital choledochal cyst in 24-year-old woman. Patient presented with abdominal pain and underwent CT examination for further evaluation of dilatation of bile duct detected on sonography. ERCP image shows findings that are in agreement with A. Thin arrows and thick arrow indicate ventral pancreatic duct and dorsal pancreatic duct, respectively, and arrowhead points to common channel.

 

Figure 7
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  		Fig. 5A —Congenital choledochocele without anomalous pancreaticobiliary ductal junction in 36-year-old woman. Patient presented with abdominal pain associated with slightly elevated bilirubin levels. Multiplanar reconstruction images generated from pancreatic phase scanning clearly show cystic dilatation of distal portion of common bile duct (arrowhead), which shows short segmental stenosis at upstream and downstream sites (thick arrows) and protrudes into duodenal lumen. It is judged that confluence of pancreatic (thin arrows) and biliary ducts is located within pancreatic parenchyma (curved arrow).

 

Figure 8
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  		Fig. 5B —Congenital choledochocele without anomalous pancreaticobiliary ductal junction in 36-year-old woman. Patient presented with abdominal pain associated with slightly elevated bilirubin levels. Intraoperative cholangiography image reveals that pancreatic duct passes through linear area showing less contrast enhancement between pancreatic head and duodenum and joins with biliary duct (dotted line, A). In other words, on multiplanar reconstruction images, such as A, pancreatic and biliary ducts join in portion of ducts involved in area showing less contrast enhancement. Thin arrows = pancreatic duct, thick arrows = short segmental stenosis, arrowhead = cystic dilatation of distal portion of common bile duct.

 

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