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EDUCATION EXHIBIT |
1 From the Department of Radiology, Medical College of Virginia, 401 N 12th St, Box 980615-MCV Station, Richmond, VA 23298. Presented as an educational exhibit at the 1999 RSNA scientific assembly. Received March 10, 2000; revision requested April 11 and received June 15; accepted June 29. Address correspondence to M.A.T. (e-mail: maturner@hsc.vcu.edu).
The cystic duct can be depicted with a variety of imaging modalities but is optimally visualized with direct cholangiography or magnetic resonance cholangiopancreatography. Nevertheless, unrecognized anatomic variants of the cystic duct may cause confusion on imaging studies and complicate subsequent surgical, endoscopic, and percutaneous procedures. Primary entities involving the cystic duct include calculous disease, Mirizzi syndrome, cystic duct–duodenal fistula, biliary obstruction, neoplasia, and primary sclerosing cholangitis. The cystic duct may also be secondarily involved by adjacent malignant or inflammatory processes. Postoperative alterations are seen after liver transplantation or cholecystectomy when a portion of the cystic duct is left behind as a remnant. Recognized postoperative complications include retained cystic duct stones, cystic duct leakage, and malposition of T tubes in the remnant. Pitfalls encountered in cystic duct imaging include pseudocalculous defects from overlap of the cystic duct and common bile duct, underfilling of the cystic duct during direct cholangiography, and admixture defects at the cystic duct orifice. Pseudomass or pseudotumor defects may result from an impacted cystic duct stone or from a tortuous, redundant cystic duct. Familiarity with the imaging appearance of the normal cystic duct, its anatomic variants, and related disease processes facilitates accurate diagnosis and helps avoid misinterpretation.
Index Terms: Bile duct radiography, 76.1222, 76.1224, 76.1226 • Bile ducts, anatomy, 76.92 • Bile ducts, calculi, 76.28 • Bile ducts, CT, 76.1211 • Bile ducts, diseases, 76.28 • Bile ducts, MR, 76.12142 • Bile ducts, neoplasms, 76.32, 76,331 • Bile ducts, stenosis or obstruction, 76.28 • Bile ducts, US, 76.1298
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