MAGNETIC RESONANCE CHOLANGIO PANCREATICOGRAPHY (MRCP) DETECTION OF WHETHER THE JUNCTION OF THE CYSTIC DUCT TO THE COMMON BILE DUCT IS ASSOCIATED WITH THE DEVELOPMENT OF GALLSTONES AND/OR CHOLECYSTITIS
Öz
Objective
The development of gallstones and stone-induced
inflammatory processes depends on a number of
biological factors. Knowledge of the predisposing
factors for both the development of stones and their
inflammation is important in predicting, monitoring,
and treating the disease and managing subsequent
complications. The aim of our study was to determine
whether the length of the cystic duct (CD), the level
and direction of the junction of the cystic duct with
the common hepatic duct (CHD) are associated with
cholecystitis and cholelithiasis.
Material and Method
This retrospective study included 172 patients
who underwent MRCP between January 2017 and
December 2020. A 1.5 Tesla MR device (Signa HDI,
General Electric, Milwaukee, WI, USA) was used with
an HD 8-channel body array coil. The findings were
analyzed using SPSS version 23 software.
Results
The level at which the CD merged with the main CHD
was not significantly correlated with the development
of calculi and/or cholecystitis (p>0.05). Similarly, there
was no significant correlation between the direction of
the CD opening into the CHD and the development
of calculi and/or cholecystitis (p>0.05).Of 27 (15.7%)
cases with CD length less than 2 cm, 3(11.1%) had
only stones, 8 (29.6%) had cholecystitis and 16
(59.2%) were normal. Of 88 (51.2%) cases between
2 and 4 cm, 43 (48.8%) had only calculi, 19 (21.5%)
had cholecystitis with calculi and 26 (29.5%) were
normal. Of 57 (33.1%) patients with cystic duct longer
than 4 cm, 31 (54.3%) had only stones, 16 (28%)
had cholecystitis and 10 (17.5%) were normal. As
CD length increased, the frequency of stone and/or
cholecystitis increased (p<0.05).
Conclusion
The direction and level of CD involvement in CHD
does not predispose to the development of stones
and/or cholecystitis, whereas an increase in its length
predisposes to the development of stones and/or
cholecystitis.
Anahtar Kelimeler
Kaynakça
- 1. Aerts R, Penninckx F. The burden of gallstone disease in Europe. Aliment Pharmacol Ther. 2003 Nov;18 Suppl 3:49-53. doi: 10.1046/j.0953-0673.2003.01721.x.
- 2. Chowdhury AH, Lobo DN. Gallstones. Surgery. 2011; 29: 610-617.
- 3. Nervi F, Covarrubias C, Bravo P, Velasco N, Ulloa N, Cruz F, Fava M, Severín C, Del Pozo R, Antezana C, et al. Influence of legume intake on biliary lipids and cholesterol saturation in young Chilean men. Identification of a dietary risk factor for cholesterol gallstone formation in a highly prevalent area. Gastroenterology. 1989 Mar;96(3):825-30.
- 4. Noel R, Arnelo U, Enochsson L, Lundell L, Nilsson M, Sandblom G. Regional variations in cholecystectomy rates in Sweden: impact on complications of gallstone disease. Scand J Gastroenterol. 2016;51(4):465-471. doi:10.3109/00365521.20 15.1111935.
- 5. Bar Dayan Y, Vilkin A, Niv Y. Gallbladder mucin plays a role in gallstone formation. Eur J Intern Med. 2004 Nov;15(7):411-414. doi: 10.1016/j.ejim.2004.07.010.
- 6. Shaffer EA. Gallstone disease: Epidemiology of gallbladder stone disease. Best Pract Res Clin Gastroenterol. 2006;20(6):981- 96. doi: 10.1016/j.bpg.2006.05.004.
- 7. Strasberg SM. The pathogenesis of cholesterol gallstones a review. J Gastrointest Surg. 1998 Mar-Apr;2(2):109-25. doi: 10.1016/s1091-255x(98)80001-2.
- 8. Srivastava A, Pandey SN, Dixit M, Choudhuri G, Mittal B. Cholecystokinin receptor A gene polymorphism in gallstone disease and gallbladder cancer. J Gastroenterol Hepatol. 2008 Jun;23(6):970-5. doi: 10.1111/j.1440-1746.2007.05170.x.
- 9. Nakamoto K, Wang S, Jenison RD, Guo GL, Klaassen CD, Wan YJ, Zhong XB. Linkage disequilibrium blocks, haplotype structure, and htSNPs of human CYP7A1 gene. BMC Genet. 2006 May 18;7:29. doi: 10.1186/1471-2156-7-29.
- 10. Lammert F, Sauerbruch T. Mechanisms of disease: the genetic epidemiology of gallbladder stones. Nat Clin Pract Gastroenterol Hepatol. 2005 Sep;2(9):423-33. doi: 10.1038/ncpgasthep0257.
- 11. Chuang SC, Juo SH, Hsi E, Wang SN, Tsai PC, Yu ML, Lee KT. Multiple mucin genes polymorphisms are associated with gallstone disease in Chinese men. Clin Chim Acta. 2011 Mar 18;412(7-8):599-603. doi: 10.1016/j.cca.2010.12.008.
- 12. Düşünceli E, Erden A, Erden I. Biliyer sistemin anatomik varyasyonlari: MRKP bulgulari [Anatomic variations of the bile ducts: MRCP findings]. Tani Girisim Radyol. 2004 Dec;10(4):296-303.
- 13. Pavlidis TE, Triantafyllou A, Psarras K, Marakis GN, Sakantamis AK. Long, parallel cystic duct in laparoscopic cholecystectomy for acute cholecystitis: the role of magnetic resonance cholangiopancreatography. JSLS. 2008 Oct-Dec;12(4):407-9.
- 14. Sureka B, Bansal K, Patidar Y, Arora A. Magnetic resonance cholangiographic evaluation of intrahepatic and extrahepatic bile duct variations. Indian J Radiol Imaging. 2016 Jan- Mar;26(1):22-32. doi: 10.4103/0971-3026.178283.
- 15. Uetsuji S, Okuda Y, Komada H, Yamamura M, Kamiyama Y. Clinical evaluation of a low junction of the cystic duct. Scand J Gastroenterol. 1993 Jan;28(1):85-8. doi: 10.3109/00365529309096050.
- 16. Sipahi M, Erkoç MF, Serin HI, Börekçi H, Banlı O. A novel approach for differentiating etiology of gallstone formation: sistocholedochal angle. Eur Rev Med Pharmacol Sci. 2015;19(6):1063-7.
- 17. Taştemur Y. Anatomical Variations of the Cystic Duct in Turkish Population and their Association with Biliary Track Stone. J Coll Physicians Surg Pak. 2020 Oct;30(10):1005-1008. doi: 10.29271/jcpsp.2020.10.1005.
- 18. Bird NC, Ooi RC, Luo XY, Chin SB, Johnson AG. Investigation of the functional three-dimensional anatomy of the human cystic duct: a single helix? Clin Anat. 2006 Sep;19(6):528-34. doi: 10.1002/ca.20219.
- 19. Caroli-Bosc FX, Demarquay JF, Conio M, Deveau C, Hastier P, Harris A, Dumas R, Delmont JP. Is biliary lithogenesis affected by length and implantation of cystic duct? Study of 270 patients with endoscopic retrograde cholangiopancreatography. Dig Dis Sci. 1997 Oct;42(10):2045-51. doi: 10.1023/a:1018810315994.
- 20. Castelain M, Grimaldi C, Harris AG, Caroli-Bosc FX, Hastier P, Dumas R, Delmont JP. Relationship between cystic duct diameter and the presence of cholelithiasis. Dig Dis Sci. 1993 Dec;38(12):2220-4. doi: 10.1007/BF01299899.
- 21. Ojo AS, Pollard A. Risk of Gallstone Formation in Aberrant Extrahepatic Biliary Tract Anatomy: A Review of Literature. Cureus. 2020 Aug 25;12(8):e10009. doi: 10.7759/cureus.10009.
SİSTİK KANALIN ANA SAFRA KANALINA BİRLEŞME YERİNİN SAFRA TAŞI VE/VEYA KOLESİSTİT GELİŞİMİYLE İLİŞKİLİ OLUP OLMADIĞININ MRKP İLE SAPTANMASI
Öz
Amaç
Safra taşı ve taşın neden olduğu inflamatuar süreçlerin
gelişmesi çok sayıda biyolojik faktöre bağlıdır. Hem taş
gelişmesi hem de bunun inflamasyona neden olması
için yatkınlık oluşturan faktörlerin bilinmesi hastalığı
öngörmede, takibini yapmada ve tedavisinde ve sonraki
komplikasyonların yönetiminde oldukça önemlidir.
Çalışmamızın amacı, sistik kanal (SK) uzunluğunun,
sistik kanalın ana hepatik kanal (AHK) ile birleşme yeri
düzeyinin ve yönünün, kolesistit ve kolelitiazis ile ilişkisi
olup olmadığını saptamaktır.
Gereç ve Yöntem
Çalışmamıza, 2017 ocak ile 2020 aralık tarihleri arasında
manyetik rezonans kolanjiopankteatikografi
(MRKP) çekilen 172 hasta retrospektif olarak değerlendirilmek
suretiyle dahil edildi. 1.5 Tesla MR cihazı
ile (Signa HDI, General Electric, Milwaukee, WI, USA),
HD 8 kanallı body array coil kullanılarak çekimler yapıldı.
Elde edilen bulgular SPSS Versiyon 23 programı
ile analiz edildi.
Bulgular
SK’nın ana AHK ile birleştiği düzeyin taş ve/veya kolesistit
gelişimiyle anlamlı olarak korelasyon göstermediği
saptandı (p>0.05). Benzer şekilde SK’nın AHK’ya
açıldığı yön ile taş ve/veya kolesistit gelişimi arasında
anlamlı ilişki saptanmadı(p>0,05). SK uzunluğu 2
cm’nin altında olan 27 (%15,7) olgunun 3(%11,1)’ünde
yalnızca taş, 8 (%29,6)’inde ise kolesistit saptanmış
olup 16 (%59,2)’u ise normaldir. 2-4 cm arasında 88
(%51,2) olgunun 43(%48,8)’ünde yalnızca taş, 19
(%21,5)’unda ise taşlı kolesistit saptanmış olup 26
(%29,5) olgu ise normaldir. 4 cm’den daha uzun sistik
kanalı olan 57 (%33,1) olgunun 31 (%54,3)’inde yalnızca
taş, 16 (%28)’sında ise kolesistit saptanmış olup
10 (%17,5)’u ise normaldir. SK uzunluğu arttıkça taş
ve/veya kolesistit gelişme sıklığı artmaktadır (p<0,05).
Sonuç
SK’nın AHK’ya açıldığı yön ve seviye taş ve/veya kolesistit
gelişimine yatkınlık oluşturmazken, uzunluğundaki
artış ise taş ve/veya kolesistit gelişimine yatkınlığı
arttırmaktadır.
Anahtar Kelimeler
Kaynakça
- 1. Aerts R, Penninckx F. The burden of gallstone disease in Europe. Aliment Pharmacol Ther. 2003 Nov;18 Suppl 3:49-53. doi: 10.1046/j.0953-0673.2003.01721.x.
- 2. Chowdhury AH, Lobo DN. Gallstones. Surgery. 2011; 29: 610-617.
- 3. Nervi F, Covarrubias C, Bravo P, Velasco N, Ulloa N, Cruz F, Fava M, Severín C, Del Pozo R, Antezana C, et al. Influence of legume intake on biliary lipids and cholesterol saturation in young Chilean men. Identification of a dietary risk factor for cholesterol gallstone formation in a highly prevalent area. Gastroenterology. 1989 Mar;96(3):825-30.
- 4. Noel R, Arnelo U, Enochsson L, Lundell L, Nilsson M, Sandblom G. Regional variations in cholecystectomy rates in Sweden: impact on complications of gallstone disease. Scand J Gastroenterol. 2016;51(4):465-471. doi:10.3109/00365521.20 15.1111935.
- 5. Bar Dayan Y, Vilkin A, Niv Y. Gallbladder mucin plays a role in gallstone formation. Eur J Intern Med. 2004 Nov;15(7):411-414. doi: 10.1016/j.ejim.2004.07.010.
- 6. Shaffer EA. Gallstone disease: Epidemiology of gallbladder stone disease. Best Pract Res Clin Gastroenterol. 2006;20(6):981- 96. doi: 10.1016/j.bpg.2006.05.004.
- 7. Strasberg SM. The pathogenesis of cholesterol gallstones a review. J Gastrointest Surg. 1998 Mar-Apr;2(2):109-25. doi: 10.1016/s1091-255x(98)80001-2.
- 8. Srivastava A, Pandey SN, Dixit M, Choudhuri G, Mittal B. Cholecystokinin receptor A gene polymorphism in gallstone disease and gallbladder cancer. J Gastroenterol Hepatol. 2008 Jun;23(6):970-5. doi: 10.1111/j.1440-1746.2007.05170.x.
- 9. Nakamoto K, Wang S, Jenison RD, Guo GL, Klaassen CD, Wan YJ, Zhong XB. Linkage disequilibrium blocks, haplotype structure, and htSNPs of human CYP7A1 gene. BMC Genet. 2006 May 18;7:29. doi: 10.1186/1471-2156-7-29.
- 10. Lammert F, Sauerbruch T. Mechanisms of disease: the genetic epidemiology of gallbladder stones. Nat Clin Pract Gastroenterol Hepatol. 2005 Sep;2(9):423-33. doi: 10.1038/ncpgasthep0257.
- 11. Chuang SC, Juo SH, Hsi E, Wang SN, Tsai PC, Yu ML, Lee KT. Multiple mucin genes polymorphisms are associated with gallstone disease in Chinese men. Clin Chim Acta. 2011 Mar 18;412(7-8):599-603. doi: 10.1016/j.cca.2010.12.008.
- 12. Düşünceli E, Erden A, Erden I. Biliyer sistemin anatomik varyasyonlari: MRKP bulgulari [Anatomic variations of the bile ducts: MRCP findings]. Tani Girisim Radyol. 2004 Dec;10(4):296-303.
- 13. Pavlidis TE, Triantafyllou A, Psarras K, Marakis GN, Sakantamis AK. Long, parallel cystic duct in laparoscopic cholecystectomy for acute cholecystitis: the role of magnetic resonance cholangiopancreatography. JSLS. 2008 Oct-Dec;12(4):407-9.
- 14. Sureka B, Bansal K, Patidar Y, Arora A. Magnetic resonance cholangiographic evaluation of intrahepatic and extrahepatic bile duct variations. Indian J Radiol Imaging. 2016 Jan- Mar;26(1):22-32. doi: 10.4103/0971-3026.178283.
- 15. Uetsuji S, Okuda Y, Komada H, Yamamura M, Kamiyama Y. Clinical evaluation of a low junction of the cystic duct. Scand J Gastroenterol. 1993 Jan;28(1):85-8. doi: 10.3109/00365529309096050.
- 16. Sipahi M, Erkoç MF, Serin HI, Börekçi H, Banlı O. A novel approach for differentiating etiology of gallstone formation: sistocholedochal angle. Eur Rev Med Pharmacol Sci. 2015;19(6):1063-7.
- 17. Taştemur Y. Anatomical Variations of the Cystic Duct in Turkish Population and their Association with Biliary Track Stone. J Coll Physicians Surg Pak. 2020 Oct;30(10):1005-1008. doi: 10.29271/jcpsp.2020.10.1005.
- 18. Bird NC, Ooi RC, Luo XY, Chin SB, Johnson AG. Investigation of the functional three-dimensional anatomy of the human cystic duct: a single helix? Clin Anat. 2006 Sep;19(6):528-34. doi: 10.1002/ca.20219.
- 19. Caroli-Bosc FX, Demarquay JF, Conio M, Deveau C, Hastier P, Harris A, Dumas R, Delmont JP. Is biliary lithogenesis affected by length and implantation of cystic duct? Study of 270 patients with endoscopic retrograde cholangiopancreatography. Dig Dis Sci. 1997 Oct;42(10):2045-51. doi: 10.1023/a:1018810315994.
- 20. Castelain M, Grimaldi C, Harris AG, Caroli-Bosc FX, Hastier P, Dumas R, Delmont JP. Relationship between cystic duct diameter and the presence of cholelithiasis. Dig Dis Sci. 1993 Dec;38(12):2220-4. doi: 10.1007/BF01299899.
- 21. Ojo AS, Pollard A. Risk of Gallstone Formation in Aberrant Extrahepatic Biliary Tract Anatomy: A Review of Literature. Cureus. 2020 Aug 25;12(8):e10009. doi: 10.7759/cureus.10009.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Radyoloji ve Organ Görüntüleme |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 23 Eylül 2023 |
| Gönderilme Tarihi | 17 Ağustos 2023 |
| Kabul Tarihi | 25 Ağustos 2023 |
| Yayımlandığı Sayı | Yıl 2023 Cilt: 30 Sayı: 3 |
Kaynak Göster
Süleyman Demirel Üniversitesi Tıp Fakültesi Dergisi/Medical Journal of Süleyman Demirel University is licensed under Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International.