MR cholangiopancreatography of congenital choledochal cyst in children and its diagnostic value

Abstract

Abstract: Objective To analyze characteristics and diagnostic value of magnetic resonance cholangiopancreatography (MRCP) in children with congenital choledochal cyst (CCC). Methods Between January 2020 and December 2023, 90 children with CCC were admitted to Children's Hospital Affiliated to Soochow University, and 50 children with normal MRI examination were included as the control group. The general MRI data of CCC group and control group were compared, the CCC classification and MRCP manifestations were analyzed, and the performance of conventional MRI, MRCP and DWI examination of CCC was analyzed. Results The largest cross-sectional area of spleen in CCC group was significantly higher than that in control group, and the ratio of length to diameter of gallbladder in CCC group was significantly higher than that in control group. In addition, the diameter of portal vein in CCC group was significantly wider than that in control group, and the differences were statistically significant (P<0.05). MRCP showed that the common bile duct in CCC children was accompanied by cystic, spindle or columnar dilatation in different degrees. Among Todani's classification, type 1 was the most common (70 cases, 77.8%), and Ia was the most common (65 cases, 72.2%). MRCP showed that the cyst was located between the hilum of the liver and the head of the pancreas, with a diameter of 1.4 ~ 7.2 cm, including 23 cases with gallstones (25.5%) and 25 cases with intrahepatic bile duct dilatation (27.8%). No V-type cases were found in each Todani classification. Kurumi typing is mainly C type. In Todani classification, type A and type B were most common, the common channel was 1.3 ~ 2.0 cm, and 6 cases had no abnormal pancreaticobiliary confluence. Conventional MRI combined with MRCP detected 67 cases of CCC (74.4%), and MRI, MRCP combined with DWI diagnosed 83 cases of CCC (92.2%). The diagnostic accuracy of the latter was significantly higher than that of conventional MRI combined with MRCP (P<0.05). Conclusion MRCP plays an important role in the diagnosis of CCC in children, especially in morphological evaluation, complication identification and multi-parameter imaging combined application. Combined with DWI diagnosis mode, the accuracy of imaging examination is further improved, which provides an important reference for clinical diagnosis and treatment of CCC.

Key words: Congenital choledochal cyst, Magnetic resonance cholangiopancreatography, Todani typing

ZHOU Qi-fang, WU Lin, CHEN Meng-meng. MR cholangiopancreatography of congenital choledochal cyst in children and its diagnostic value[J]. Chinese Hepatolgy, 2025, 30(2): 258-261.

References

[1] Lin Y, Xu X, Chen S, et al. Construction of nomogram based on clinical factors for the risk prediction of postoperative complications in children with choledochal cyst[J]. Front Pediatr, 2024, 12:1372514.
[2] Philpose RT, Mohammed AA, Gowni AR. Histopathological study and expression of beta-catenin in congenital choledochal cyst in a tertiary care pediatric referral center in South India[J]. Pediatr Gastroenterol Hepatol Nutr, 2024, 27(1):62-70.
[3] Lu H, Hou W. Comparison of open and laparoscopic outcomes of adult Type-I congenital choledochal cysts[J]. Pak J Med Sci, 2023, 39(6):1783-1787.
[4] Bian Z, Zhi Y, Zeng X, et al. Curative effect and technical key points of laparoscopic surgery for choledochal cysts in children[J]. Front Surg, 2023, 9:1051142.
[5] Tanaka R, Nakamura H, Yoshimoto S, et al. Postoperative anastomotic stricture following excision of choledochal cyst: a systematic review and meta-analysis[J]. Pediatr Surg Int, 2022, 39(1):30.
[6] Guo F, Yang H, Zhang G. Computed tomography reconstruction of an aberrant hepatic duct in a child with a congenital choledochal cyst[J]. ANZ J Surg, 2023, 93(3):732-733.
[7] Xin Y, Wang XM, Wang Y, et al. Value of ultrasound in diagnosing perforation of congenital choledochal cysts in children[J]. J Ultrasound Med, 2021, 40(10):2157-2163.
[8] Gadelhak N, Shehta A, Hamed H. Diagnosis and management of choledochal cyst: 20 years of single center experience[J]. World J Gastroenterol, 2014, 20(22):7061-7066.
[9] Sacher VY, Davis JS, Sleeman D, et al. Role of magnetic resonance cholangiopancreatography in diagnosing choledochal cysts: Case series and review[J]. World J Radiol, 2013, 5(8):304-312.
[10] 武林, 吴继志, 王爱平. 一站式磁共振成像评估儿童胆总管囊肿和胰胆管解剖结构价值分析[J]. 实用肝脏病杂志, 2023, 26(5):750-753.
[11] Wang P, Gong Y, Lu S, et al. Three-dimensional visualization technique compared with magnetic resonance cholangiopancreatography for evaluation of anatomic variants of pediatric congenital choledochal cysts[J]. Pediatr Surg Int, 2021, 37(6):705-713.
[12] Aggerwal N, Menon P, Rao KL, et al. Comparative analysis of spherical and fusiform choledochal cyst based on three-dimensional magnetic resonance cholangiopancreatography, biliary amylase, and histopathological examination[J]. J Indian Assoc Pediatr Surg, 2015, 20(3):128-132.
[13] Issa R, Hatoum S, Yazbeck N, et al. A congenital choledochal cyst in an adolescent: A unique case report and the role liver-specific contrast agents in the diagnosis of challenging cases[J]. Cureus, 2022, 14(4):e24384.
[14] Sarawagi R, Sundar S, Gupta SK, et al. Anatomical variations of cystic ducts in magnetic resonance cholangiopancreatography and clinical implications[J]. Radiol Res Pract, 2016, 2016:3021484.
[15] Saito T, Hishiki T, Terui K, et al. Use of preoperative, 3-dimensional magnetic resonance cholangiopancreatography in pediatric choledochal cysts[J]. Surgery, 2011, 149(4):569-575.
[16] Fumino S, Ono S, Kimura O, et al. Diagnostic impact of computed tomography cholangiography and magnetic resonance cholangiopancreatography on pancreaticobiliary maljunction[J]. J Pediatr Surg, 2011, 46(7):1373-1378.
[17] Yu MH, Kim YJ, Park HS, et al. Benign gallbladder diseases: Imaging techniques and tips for differentiating with malignant gallbladder diseases[J]. World J Gastroenterol, 2020, 26(22):2967-2986.
[18] Chavhan GB, Alsabban Z, Babyn PS. Diffusion-weighted imaging in pediatric body MR imaging: principles, technique, and emerging applications[J]. Radiographics, 2014, 34(3):E73-E88.
[19] Liu J, Huang M, Ren Y, et al. Added value of zoomed-echo-planar imaging diffusion-weighted imaging for evaluation of periampullary carcinomas[J]. Abdom Radiol (NY), 2023, 48(10):3079-3090.
[20] Cui XY, Chen HW. Role of diffusion-weighted magnetic resonance imaging in the diagnosis of extrahepatic cholangiocarcinoma[J]. World J Gastroenterol, 2010, 16(25):3196-3201.