Application of imaging techniques in pancreaticobiliary maljunction

Abstract

Imaging techniques are useful tools in the diagnosis and treatment of pancreaticobiliary maljunction (PBM). PBM is a precancerous lesion often relative to the disease of the pancreas and biliary tract, for example, cholecystolithiasis, protein plugs, and pancreatitis. For patients with PBM, early diagnosis and timely treatment are highly important, which is largely dependent on imaging techniques. The continuous development of imaging techniques, including endoscopic retrograde cholangiopancreatography, magnetic resonance cholangiopancreatography, computed tomography, ultrasound, and intraoperative cholangiography, has provided appropriate diagnostic and therapeutic tools for PBM. Imaging techniques, including non-invasive and invasive, have distinct advantages and disadvantages. The purpose of this paper is to review the application of various imaging techniques in the diagnosis and treatment of PBM.

Keywords: Computed tomography; Endoscopic retrograde cholangiopancreatography; Intraoperative cholangiography; Magnetic resonance cholangiopancreatography; Pancreaticobiliary maljunction; Ultrasound.

Figure 1

Pathophysiology of pancreaticobiliary maljunction.

Figure 2

Endoscopic retrograde cholangiopancreatography. Endoscopic retrograde cholangiopancreatography in a patient with pancreaticobiliary maljunction showed a long common channel[22]. Citation: Wang CL, Ding HY, Dai Y, Xie TT, Li YB, Cheng L, Wang B, Tang RH, Nie WX. Magnetic resonance cholangiopancreatography study of pancreaticobiliary maljunction and pancreaticobiliary diseases. World J Gastroenterol 2014; 20: 7005-7010. Copyright © The Authors 2022. Published by Baishideng Publishing Group Inc.

Figure 3

Magnetic resonance cholangiopancreatography. Coronal 4 mm-thick half fourier acquisition single shot turbo spin echo image shows the pancreatic duct joining the common bile duct outside the duodenal wall[24]. Citation: Guo WL, Huang SG, Wang J, Sheng M, Fang L. Imaging findings in 75 pediatric patients with pancreaticobiliary maljunction: a retrospective case study. Pediatr Surg Int 2012; 28: 983-988. Copyright © The Authors 2022. Published by Springer Nature Switzerland AG.

Figure 4

Ultrasound imaging and endoscopic ultrasound. A: Ultrasound showing a thick-walled gallbladder and intraluminal mass (arrow); B: Ultrasound showing intrahepatic bile duct dilation[10]. Citation: Rungsakulkij N, Boonsakan P. Synchronous gallbladder and pancreatic cancer associated with pancreaticobiliary maljunction. World J Gastroenterol 2014; 20: 14500-14504. Copyright © The Authors 2022. Published by Baishideng Publishing Group Inc; C: The confluence of pancreatic duct and bile duct in the proximal portion of the duodenal wall[19]. Citation: Kamisawa T, Takuma K, Itokawa F, Itoi T. Endoscopic diagnosis of pancreaticobiliary maljunction. World J Gastrointest Endosc 2011; 3: 1-5. Copyright © The Authors 2022. Published by Baishideng Publishing Group Inc.

Figure 5

Computed tomography. Coronal images generated from pancreatic phase scanning show that the 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[51]. Citation: Itoh S, Fukushima H, Takada A, Suzuki K, Satake H, Ishigaki T. Assessment of anomalous pancreaticobiliary ductal junction with high-resolution multiplanar reformatted images in MDCT. AJR Am J Roentgenol 2006; 187: 668-675. Copyright © The Authors 2022. Published by American Roentgen Ray Society.

Figure 6

Intraoperative cholangiography. Intraoperative cholangiography shows the junction of the bile and pancreatic ducts located outside the duodenal wall. The common bile duct joins the pancreatic duct[24]. Citation: Guo WL, Huang SG, Wang J, Sheng M, Fang L. Imaging findings in 75 pediatric patients with pancreaticobiliary maljunction: a retrospective case study. Pediatr Surg Int 2012; 28: 983-988. Copyright © The Authors 2022. Published by Springer Nature Switzerland AG.