Magnetic Resonance Cholangiopancreatography with Construction of Three-dimensional Models in Children with Cystic Bile Ducts Dilatations

Objective. Evaluation of the possibility of magnetic resonance cholangiopancreatography with the construction of three-dimensional models in children with cystic dilation of the bile ducts.

Materials and methods. 73 children with cystic dilation of the bile ducts were examined: 47 girls (64 %) and 26 boys (36 %). The age of the patients ranged from 5 days of life to 17 years 7 months. All children were examined by ultrasound and MRCP with the construction of 3D-models.

Results. During the MRCP study, 43 children (58.9 %) were found to have fusiform cystic bile ducts and 30 children (41.1 %) had spherical cystic bile ducts. The variability of intrahepatic ducts in children with cystic bile ducts was assessed.

 It was found that in children with choledochal cyst and the presence of APBS, the risk of developing pancreatitis is 5.13 times higher than in children with normal duct fusion, the results are statistically significant (p < 0.05). It was shown that computer 3D processing improves the efficiency of the method in diagnosing cystic dilation of the bile ducts in children, allowing to overcome the limitations in the form of projection superposition of anatomical structures. Thus, statistically significant differences were obtained in the construction of 3D models compared to the analysis of only MRCP images in relation to the assessment of the variability of the fusion of intrahepatic ducts (χ² = 34, p < 0.001), variants of the cystic duct return (χ² = 46, p < 0.001), when analyzing the type of abnormal pancreatobiliary anastomosis (χ² = 46, p < 0.001).

Conclusion. MRCP allows non-invasively, without radiation exposure and intravenous contrast, to obtain a complete picture of the topography of the extrahepatic bile and pancreatic ducts, which allows planning the course of surgical intervention and avoiding damage to important anatomical structures.

Supplementing the standard MRCP study with the construction of 3D models improves the effectiveness of the method in diagnosing cystic dilation of the bile ducts in children, allowing to overcome limitations in the form of projection layering of anatomical structures, which allows to reduce or completely eliminate intraoperative studies.

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