Clinical Application Of Biliary System Measurement Based On High Field3D MRCP

Background and objectiveCholangiocarcinoma is one of the world’s common malignant tumor, and the incidence increases year by year. most patients lose the opportunity of surgical resection. The palliative treatment is for the use of maintaining biliary drainage.In recent years, the technology of PTCD and related interventional equipment are continuous improvement. Most scholars believe that the PTCD biliary stent placement is simple, small trauma, drainage effect is remarkable, low biliary infection, without indwelling drainage bag, etc., so it is the simple and effective way to relieve obstructive jaundice.Klastkin adenoma is a common type of cholangiocarcinoma. Parallel with double stent placement for the patients, but there are two stent poor combined and mutual extruding to cause inadequate drainage. Korea-Taewoong Medical company launched fission combined Y stents, to relieve the problem of parallel stent extrusion, its drainage effect is better, but there are disadvantages including complex operating procedure, trauma, difficult to accurately affirm the combination of double stent, and ilittle common types, expensive, influenced the clinical application of this kind of stent in the domestic.Now there is little literature about the three dimensional space structure of porta hepatis biliary system in physiological conditions of Chinese people. It affect the design and application of biliary stent. We use3.0T ultra-high field MRCP technology, the3D reconstruction fully shows the spatial structure relations of porta hepatis biliary system, provides a convenient conditions for accurate measurement the various parameters of biliary system.Materials and methodsRetrospectively analysis of427cases adult3.0ultra-high field3d MRCP images:somatotype for the left and right hepatic duct, gallbladder, pancreas and bile duct confluence points, measure the length of left and right hepatic duct, Angle, the length of hepatic duct and bile duct, the horizontal distance between the left and right hepatic duct confluence and right chest wall, measurement the first lumbar vertebral body height. Statistical analysis of the measured data of the first lumbar vertebral body height, left and right hepatic duct Angle, length of left and right hepatic duct, hepatic duct, and the bile duct, the relevance between the left and right hepatic duct confluence and the right chest wall.ResultsLeft and right hepatic duct in the common type of65.9%, the fork type15.1%, stretch across converging type accounted for12.5%, low convergence is3.9%, special types of remit total2.6%; Deputy hepatic duct occurred in27.8%; Cystic duct and bile duct confluence way normal converging on the right side (65.5%), on the left side of the join to19.2%,8.4%low convergence, high convergence6.9%;79.2%of normal pancreas and bile duct confluence, confluence too long13.4%,3.7%of right Angle rendezvous, independent into the intestinal tract of3.7%; Into the pancreatic and duodenal in7.5%,67.7%into the middle, into the next period of19.4%, the level of5.4%, accessory pancreatic duct occurrence ratio of14.6%; The left hepatic duct length on average about13.55±4.66mm; The right hepatic duct length of12.03±4.28mm; Hepatic duct length25.84±6.62mm; Common bile duct length45.10±9.54mm; Left and right hepatic duct Angle with a mean of89.61±25.09°, including acute Angle type accounted for47.18%, obtuse type52.82%; Confluence is apart from the right side of the chest wall horizontal distance of93.02±8.15mm. The first lumbar average height:22.07±1.48mm. Statistics software to carry on the correlation analysis results:the first lumbar vertebral body height and hepatic duct Angle were positively correlated, the Pearson correlation coefficient was0.273, P=0.008<0.01, significant correlation. There is no correlation between the length of left and right hepatic duct, hepatic duct, and the bile duct, the relevance between the left and right hepatic duct confluence and the right chest wall.Conclusions1.3T ultra-high field3D MRCP can distinctly display biliary system, especially the three dimensional space structure of porta hepatis biliary system.2. There ia a big variation rate for hepatic duct converge in Chinnse people, should design a variety types of stent to choose.3. Left and right hepatic duct angle were positively correlated with height in Chinese people, so choosing different types of Y type biliary stent should be considering the height problem.