Multidetector CT in detection of troublesome posterior sectoral hepatic duct communicating with cystic duct

Abstract

Objective: To investigate whether multiple detector CT (MDCT) could detect troublesome aberrant posterior sectoral hepatic duct (PHD) communicating with cystic duct (CD).

Methods: The most troublesome bile duct anomaly during cholecystectomy is an aberrant PHD communicating with CD. It has been suggested that an unenhanced small duct between Rouviere's sulcus and CD on MDCT could be coincident to an aberrant PHD communicating with CD. A total of 224 patients who underwent laparotomy with complete lymph node dissection in the hepatoduodenal ligament for hepatobiliary or pancreatic tumour were enrolled. Retrospective review of preoperative MDCT images and surgical records was performed.

Results: Preoperative MDCT detected 8 (3.6%) unenhanced ducts between Rouviere's sulcus and CD. Surgical records identified 7 (3.1%) cases of aberrant PHD communicating with CD, and all 7 cases showed an unenhanced duct between Rouviere's sulcus and CD on preoperative MDCT imaging. Among the 7 patients, 5 (71%) were without bile duct dilatation.

Conclusion: MDCT could detect troublesome aberrant PHD communicating with CD, regardless of the presence or absence of bile duct dilatation. Advances in knowledge: MDCT could detect most troublesome PHD communicating with CD, regardless of the presence or absence of bile duct dilatation.

Figure 1.

Normal anatomy of the posterior sectoral hepatic duct (PHD) and confluence type of aberrant PHD (a) A PHD running cranially to the right portal vein is supraportal type. (b) A PHD running caudate to the right portal vein is infraportal type. (c) Confluence type of aberrant PHD. All aberrant PHDs are infraportal type. (a) PHD draining into the common hepatic duct or upstream hepatic duct. b: PHD and cystic duct opening at the same position of common hepatic duct. c: PHD communicating with the cystic duct. d: PHD draining into the common bile duct. AHD, anterior sectoral hepatic duct; CD, cystic duct; CBD, common biliary duct; Pant, right anterior portal vein; Ppost, right posterior portal vein; RHA, right hepatic artery; *, right posterior hepatic artery. The right posterior hepatic artery is located betweenthe PHD and Ppost.

Figure 2.

Most troublesome aberrant posterior sectoral hepatic duct (PHD). (a) Schema of PHD communicating with cystic duct (CD). AHD, anterior sectoral hepatic duct; CBD, common biliary duct; Pant, right anterior portal vein; Ppost, right posterior portal vein; RHA, right hepatic artery; *, right posterior hepatic artery. (b) CT image showing an unenhanced small duct (arrows) between Rouviere’s sulcus and the CD. GB, gallbladder. (c) Intraoperative photograph. Arrows show the infraportal PHD draining into the CD.

Figure 3.

Diagnosis of the type of posterior sectoral hepatic duct (PHD) using CT. (a), (d) bilateral portal vein level, (b), (e) portal vein bifurcation level, (c), (f) main portal vein level. A PHD draining into the AHD from the cranial side of the right portal vein is identified as supraportal PHD (a, b, c), and when draining into the AHD from the caudal side of the right portal vein, it is identified as infraportal PHD (d, e, f). Pant, right anterior portal vein; AHD, anterior sectoral hepatic duct; LHD, left hepatic duct; LPV, left portal vein; RPV, right portal vein.

Figure 4.

CT imaging of 6 cases (a–f) of aberrant PHD draining into the cystic duct (CD). Black arrow shows a PHD draining into the CD, and dot arrow shows the CD. CT imaging of remaining case is shown in Figure 3. CBD, common bile duct; PHD, posterior sectoral hepatic duct.

Figure 5.

False-positive case. (a) CT shows an unenhanced small duct (white arrow) draining into the CD (dot arrow). (b) Magnetic resonance cholangiopancreatography shows that the small duct on CT is not aberrant posterior sectoral hepatic duct draining into the CD, but is instead the right hepatic duct. CD, cystic duct.