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Abstract：
BACKGROUND: In the classic descriptions of the human liver, the common hepatic duct forms at the confluence of left and right hepatic ducts. Many authors have documented variations in the intra-hepatic ductal system, but to the best of our knowledge there has been no report on bile duct variations in Caribbean populations.
OBJECTIVE: To evaluate the variations in bile duct anatomy using magnetic resonance cholangiography (MRC) in unselected patients at a major hepatobiliary referral centre in the Eastern Caribbean. Knowledge of the intra-hepatic biliary anatomy is important to optimize service delivery for any physician treating liver and biliary disorders.
METHODS: This study was carried out at a tertiary referral hospital for hepatobiliary diseases in the Eastern Caribbean. We retrospectively evaluated magnetic resonance cholangiograms in 152 consecutive patients at this facility over a two-year period from April 1, 2017 to March 31, 2019. Two consultant radiologists experienced in MRC interpretation reviewed all scans and described biliary anatomy according to the Huang\'s classification. A systematic review of published studies was performed and relevant data were extracted in order to calculate the global prevalence of each biliary variant. The variants in our population were compared to the global population.
RESULTS: There were 152 MRCs evaluated in this study in 86 males and 66 females. There were 109 (71.7%) persons with \"classic\" biliary anatomy (type A1) and variants were present in 43 (28.3%) persons. There was no statistical relationship between the presence of anatomic variants and gender or ethnicity. We encountered the following variants: 29 (19.1%) type A2, 7 (4.6%) type A3, 6 (3.95%) type A4, 0 type A5 and a single variant (quadrification) that did not fit the classification system. Compared to the global prevalence, our population had a significantly greater occurrence of A1 anatomy (71.7% vs 62.6%; P = 0.0227) and A2 trifurcations (19.1% vs 11.5%; P = 0.0069), but a significantly lower incidence of A3 variants (4.61% vs 11.5%; P = 0.0047).
CONCLUSIONS: There are significant differences in intra-hepatic biliary anatomy in this unselected Eastern Caribbean population compared to global statistics. Specifically, persons of Caribbean descent have a greater incidence of Huang A2 trifurcations and a lower incidence of Huang A3 variants.
OBJECTIVE: To evaluate the variations in bile duct anatomy using magnetic resonance cholangiography (MRC) in unselected patients at a major hepatobiliary referral centre in the Eastern Caribbean. Knowledge of the intra-hepatic biliary anatomy is important to optimize service delivery for any physician treating liver and biliary disorders.
METHODS: This study was carried out at a tertiary referral hospital for hepatobiliary diseases in the Eastern Caribbean. We retrospectively evaluated magnetic resonance cholangiograms in 152 consecutive patients at this facility over a two-year period from April 1, 2017 to March 31, 2019. Two consultant radiologists experienced in MRC interpretation reviewed all scans and described biliary anatomy according to the Huang\'s classification. A systematic review of published studies was performed and relevant data were extracted in order to calculate the global prevalence of each biliary variant. The variants in our population were compared to the global population.
RESULTS: There were 152 MRCs evaluated in this study in 86 males and 66 females. There were 109 (71.7%) persons with \"classic\" biliary anatomy (type A1) and variants were present in 43 (28.3%) persons. There was no statistical relationship between the presence of anatomic variants and gender or ethnicity. We encountered the following variants: 29 (19.1%) type A2, 7 (4.6%) type A3, 6 (3.95%) type A4, 0 type A5 and a single variant (quadrification) that did not fit the classification system. Compared to the global prevalence, our population had a significantly greater occurrence of A1 anatomy (71.7% vs 62.6%; P = 0.0227) and A2 trifurcations (19.1% vs 11.5%; P = 0.0069), but a significantly lower incidence of A3 variants (4.61% vs 11.5%; P = 0.0047).
CONCLUSIONS: There are significant differences in intra-hepatic biliary anatomy in this unselected Eastern Caribbean population compared to global statistics. Specifically, persons of Caribbean descent have a greater incidence of Huang A2 trifurcations and a lower incidence of Huang A3 variants.
摘要：
背景：在人类肝脏的经典描述中，肝总管在左、右肝管汇合处形成。许多作者已经记录了肝内导管系统的变化，但据我们所知，还没有关于加勒比海人群胆管变异的报道。
目的：使用磁共振胆管造影术（MRC）评估未选择的患者在东加勒比主要肝胆转诊中心的胆管解剖结构的变化。肝内胆道解剖的知识对于优化任何治疗肝脏和胆道疾病的医生的服务提供很重要。
方法：这项研究是在东加勒比海地区的三级转诊医院进行的。我们回顾性评估了从2017年4月1日至2019年3月31日的两年期间在该设施的152名连续患者的磁共振胆管造影。两位在MRC解释方面有经验的放射科顾问根据Huang的分类审查了所有扫描并描述了胆道解剖结构。对已发表的研究进行了系统评价，并提取了相关数据，以计算每种胆道变异的全球患病率。将我们人口中的变体与全球人口进行了比较。
结果：在这项研究中评估了152个MRC，其中有86个男性和66个女性。有109人（71.7％）患有“经典”胆道解剖结构（A1型），有43人（28.3％）存在变异。解剖变异的存在与性别或种族之间没有统计学关系。我们遇到了以下变体：29（19.1％）A2型，7（4.6％）A3型，6（3.95％）A4型，0型A5和不适合分类系统的单个变体（四化）。与全球流行相比，我们的人群发生A1解剖结构（71.7％vs62.6％；P=0.0227）和A2分叉（19.1％vs11.5％；P=0.0069）的发生率明显更高，但A3变体的发生率显着降低（4.61％vs11.5％；P=0.0047）。
结论：与全球统计数据相比，该未选择的东加勒比人群的肝内胆管解剖结构存在显着差异。具体来说,加勒比海血统的人黄A2分叉的发生率较高，黄A3变体的发生率较低。
目的：使用磁共振胆管造影术（MRC）评估未选择的患者在东加勒比主要肝胆转诊中心的胆管解剖结构的变化。肝内胆道解剖的知识对于优化任何治疗肝脏和胆道疾病的医生的服务提供很重要。
方法：这项研究是在东加勒比海地区的三级转诊医院进行的。我们回顾性评估了从2017年4月1日至2019年3月31日的两年期间在该设施的152名连续患者的磁共振胆管造影。两位在MRC解释方面有经验的放射科顾问根据Huang的分类审查了所有扫描并描述了胆道解剖结构。对已发表的研究进行了系统评价，并提取了相关数据，以计算每种胆道变异的全球患病率。将我们人口中的变体与全球人口进行了比较。
结果：在这项研究中评估了152个MRC，其中有86个男性和66个女性。有109人（71.7％）患有“经典”胆道解剖结构（A1型），有43人（28.3％）存在变异。解剖变异的存在与性别或种族之间没有统计学关系。我们遇到了以下变体：29（19.1％）A2型，7（4.6％）A3型，6（3.95％）A4型，0型A5和不适合分类系统的单个变体（四化）。与全球流行相比，我们的人群发生A1解剖结构（71.7％vs62.6％；P=0.0227）和A2分叉（19.1％vs11.5％；P=0.0069）的发生率明显更高，但A3变体的发生率显着降低（4.61％vs11.5％；P=0.0047）。
结论：与全球统计数据相比，该未选择的东加勒比人群的肝内胆管解剖结构存在显着差异。具体来说,加勒比海血统的人黄A2分叉的发生率较高，黄A3变体的发生率较低。
