MRCP Research On The Correlation Between Extra-hepatic Biliary Stones And Biliary Tract Anatomical Structure

Objective:To explore the correlation between gallbladder stones,common bile duct stones and biliary tractanatomical structure by using 2D-MRCP.Materials and Methods:The data of patients who underwent conventional abdominalMRI and MRCP at the Affiliated Hospital of North Sichuan Medical College from January 2019 to September 2019 were collected.According to the inclusion and exclusion criteria,from March 2019 to September 2019,443 cases were included to analyze the correlation between gallstones and biliary anatomy,including 173 cases of gallstones and 270 cases of normal control group.From January 2019 to September 2019,261 cases of gallstones were included to analyze the correlation between gallstones with common bile duct stonesand biliary anatomy,including 207 cases of gallstones and 54 cases of gallstones complicated with common bile duct stones.Observed the type of gallbladder and cystic duct joint,the type of cystic duct draining into common hepatic duct,the junction type between the common bile duct and the main pancreatic duct on MRCP and conventional MRI images.The angle between the gallbladder and the cystic duct,the angle between the cystic duct and the common hepatic duct,the junction angle between the common bile duct and the main pancreatic duct,the length of the cystic duct,the length of the common bile duct,the maximum diameter of the cystic duct and the maximum diameter of the common bile duct were measured at the maximum level of the MRCP projection.The differences of different types and biliary tract structural parameters in the normal control group,the gallstones group and the gallstones complicated with common bile duct stones group were compared to evaluate the diagnostic efficiency of the statistically significant parameters,and logistic regression analysis was used to establish regression prediction model.Result:Compared with the normal control group,there were no significant differences in age,the junction type between the common bile duct and the main pancreatic duct,the angle between the gallbladder and the cystic duct,the angle between the cystic duct and the common hepatic duct,the length of the common bile duct,the maximum diameter of the cystic duct and the maximum diameter of the common bile duct(P>0.05).There were statistically significant differences in gender,the type of gallbladder and cystic duct joint,the type of cystic duct draining into common hepatic duct and the junction angle between the common bile duct and the main pancreatic duct(P<0.05).Women were more likely to develop gallstones than men(P=0.036).The incidence of gallstones was higher for the V-type joint between gallbladder and cystic duct(P=0.002).The lower confluence of the cystic duct with gallstones was more common than normal confluent type(P=0.003).The cystic duct in the gallstones group was longer(P=0.003).The junction angle between the common bile duct and the main pancreatic duct in the gallstones group was larger(P=0.023).The regression equation was Y=0.451(female)+0.611(V-type joint between gallbladder and cystic duct)+1.115(low confluence of the cystic duct)+0.028(length of the cystic duct)+0.011(the junction angle between the common bile duct and the main pancreatic duct)-2.441.The results showed that women,the V-type joint between gallbladder and cystic duct,the lower confluence of the cystic duct,the longer cystic duct and the larger junction angle between the common bile duct and the main pancreatic duct were the risk factors for gallstones.There were no statistically significant differences in gender,the type of cystic duct draining into common hepatic duct and the angle between the cystic duct and the common hepatic duct in the gallstone group and the common bile duct stone group(P>0.05).There were statistically significant differences in age,type of gallbladder stones,size of stones in the gallbladder,the type of gallbladder and cystic duct joint,and the angle between the gallbladder and the cystic duct(P<0.05).Gallstone patients with common bile duct stones were older than those without common bile duct stones(P=0.004).Multiple gallbladder stones are more likely to develop common bile duct stones than single stone(P=0.000).The smallest stone in the gallbladder was smaller than the group without common bile duct stones(P=0.003).Gallbladder and cystic duct N-type joint was more likely to have common bile duct stones than V-type joint(P=0.025).The angle between the gallbladder and the cystic duct was larger than the group without common bile duct stones(P=0.044).The regression equation was Y=0.031(age)+1.192(multiple gallbladder stones)-0.159(size of gallbladder stones)+0.761(N-type joint of gallbladder and cystic duct)-4.649.The results showed that increasing age,multiple stones in the gallbladder and N-type joint of gallbladder and cystic duct were risk factors for the formation of common bile duct stones,Gallbladder stones with larger diameter was a protective factor for the formation of common bile duct stones.Conclusion:Women are more likely to develop gallstones than men.The V-type joint between the gallbladder and the cystic duct is more likely to cause gallstones.The lower confluence of the cystic duct is more susceptible to gallstones.The risk is also higher when the cystic duct is longer and the junction angle between the common bile duct and the main pancreatic duct is larger.In addition,the length of the cystic duct(>23.39mm)and the junction angle between the common bile duct and the main pancreatic duct(>50.21°)are only used as the reference indexes forjudging the risk of gallstones.The older the patients with gallstones,the more likely they are complicated with common bile duct stones.The risk of common bile duct stones is higher for patients with multiple gallbladder stones and smaller gallstones.Gallbladder and cystic duct N-type joint is more likely to have common bile duct stonethan V-type joint.Those with a greater angle between the gallbladder and the cystic duct are also have a greater risk of common bile duct stones.In addition,the angle between the gallbladder and the cystic duct(>64.59°)is only used as a reference index for judging the risk of common bile duct stones.