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• Clinical Article •
Prenatal MRI findings of type I congenital choledochal cyst and parameter measurement of liver and gallbladder
GU Leilei  GAO Duo  HAN Xuefang  GENG Zuojun  ZHOU Lixia 

Cite this article as: GU L L, GAO D, HAN X F, et al. Prenatal MRI findings of type I congenital choledochal cyst and parameter measurement of liver and gallbladder[J]. Chin J Magn Reson Imaging, 2024, 15(8): 139-144, 178. DOI:10.12015/issn.1674-8034.2024.08.021.


[Abstract] Objective To observe the MRI findings of type I congenital choledochal cyst (CCC) during the fetal period, analyze the differences in CCC fetal lung-to-liver ratio, liver, spleen, gallbladder, and portal vein measurement parameters compared to normal fetuses.Materials and Methods Follow-up analysis of clinical data and fetal MRI manifestations of 31 confirmed postnatally operated CCC patients. Observations included the morphology, course, connection with bile duct or gallbladder, relationship between the lower edge of the lesion and the lower edge of the liver, and measurement and calculation of the volume of the choledochal cyst. A control group of 90 healthy fetuses was used for comparison, analyzing differences in fetal lung to liver signal intensity ratio, liver (left and right diameters, upper and lower diameters, maximum cross-sectional area, apparent diffusion coefficient of the liver), spleen (length, thickness, maximum cross-sectional area), gallbladder (length, short diameter, length-to-short diameter ratio, maximum cross-sectional area), and portal vein diameter. The correlation between choledochal cyst volume and MRI measurement parameters was also analyzed.Results Among the 31 CCC patients, there were 9 male fetuses and 22 female fetuses, with a male-to-female ratio of approximately 1∶2.4. Among them, 26 cases had elliptical-shaped lesions, and 5 cases had cystic lesions. In all 31 cases, a pointed angle sign was observed at the upper end of the lesions. The lower edge of the lesions did not exceed the lower edge of the liver in 29 cases, while in 2 cases, the lower edge extended beyond the liver. The course of the lesions in 26 cases was from the upper right to the lower left. There was no statistically significant difference (P>0.05) in fetal lung to liver signal intensity ratio, liver dimensions (left and right diameters, upper and lower diameters, maximum cross-sectional area, apparent diffusion coefficient), spleen dimensions (length, thickness), gallbladder dimensions (length, short diameter, maximum cross-sectional area) between the CCC group and the control group. However, there were statistically significant differences (P<0.05) in the maximum cross-sectional area of the spleen, portal vein diameter, and the ratio of gallbladder length to short diameter between the lesion group and the control group fetuses. Further statistical analysis revealed no correlation (P>0.05) between the volume of the choledochal cyst and the maximum cross-sectional area of the fetal spleen, the ratio of gallbladder length to short diameter, and portal vein diameter.Conclusions CCC is more common in females. The fetal MRI manifestations include elliptical-shaped lesions, generally not extending beyond the lower edge of the liver. The course of the lesions is often from the upper right to the lower left, with a pointed angle sign at the upper end. The affected fetuses exhibit an enlarged spleen, widened portal vein, and an increased ratio of gallbladder length to short diameter. However, there is no correlation between the volume of the lesion and the maximum cross-sectional area of the fetal spleen, portal vein diameter, and the ratio of gallbladder length to short diameter.
[Keywords] liver；gallbladder；portal vein；prenatal diagnosis；congenital choledochal cyst；magnetic resonance imaging

GU Leilei   GAO Duo   HAN Xuefang   GENG Zuojun   ZHOU Lixia*  

Department of medical imaging, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China

Corresponding author: ZHOU L X, E-mail: doctorzhou@126.com

Conflicts of interest   None.

Received  2024-03-21
Accepted  2024-08-09
DOI: 10.12015/issn.1674-8034.2024.08.021
Cite this article as: GU L L, GAO D, HAN X F, et al. Prenatal MRI findings of type I congenital choledochal cyst and parameter measurement of liver and gallbladder[J]. Chin J Magn Reson Imaging, 2024, 15(8): 139-144, 178. DOI:10.12015/issn.1674-8034.2024.08.021.

[1]
WU Y, XU X W, ZHOU Q Y, et al. Research progress on the canceration and treatment of congenital choledochal cyst[J]. Chin J Clin Res, 2023, 36(9): 1352-1356. DOI: 10.13429/j.cnki.cjcr.2023.09.015.
[2]
WANG L, WANG X H, ZHANG S F, et al. Robot-assisted laparoscopic surgery for congenital choledochal cyst in newborn: the first case report in China(with video)[J]. Chin J Rob Surg, 2024, 5(1): 85-90. DOI: 10.12180/j.issn.2096-7721.2024.01.015.
[3]
Pediatric Group of Radiology Branch of Medicine Society of Hubei Province, Editorial Board of Chinese Journal of Magnetic Resonance Imaging. Expert consensus on the clinical application of large bore MRI in fetal disease[J]. Chin J Magn Reson Imag, 2023, 14(6): 1-8, 25. DOI: 10.12015/issn.1674-8034.2023.06.001.
[4]
ZHAO H F, JIN C, YANG J. Impacts of magnetic resonance imaging noise on hearing function in fetus and infants[J]. Chin J Magn Reson Imag, 2019, 10(7): 546-550. DOI: 10.12015/issn.1674-8034.2019.07.013.
[5]
WU H Y, TIAN J S, LI H H, et al. Accuracy of magnetic resonance imaging in prenatal diagnosis of choledochal cysts: a single-center retrospective analysis[J/OL]. Int J Clin Pract, 2022, 2022: 3268797 [2024-01-24]. https://pubmed.ncbi.nlm.nih.gov/36238902/. DOI: 10.1155/2022/3268797.
[6]
WU L, WU J Z, WANG A P. One-stop magnetic resonance imaging in typing and evaluating pancreaticobiliary duct anatomy in children with choledochal cysts[J]. J Pract Hepatol, 2023, 26(5): 750-753. DOI: 10.3969/j.issn.1672-5069.2023.05.037.
[7]
HE Y C, YAN J W, ZENG Y R, et al. Application value of lung volume,signal intensity ratio of lung to liver and ADC value in evaluating fetal lung maturity[J]. Chinese Imaging Journal of Integrated Traditional and Western Medicine, 2023, 21(5): 558-561, 570. DOI: 10.3969/j.issn.1672-0512.2023.05.017.
[8]
CLIFTON M S, GOLDSTEIN R B, SLAVOTINEK A, et al. Prenatal diagnosis of familial type I choledochal cyst[J/OL]. Pediatrics, 2006, 117(3): e596-e600 [2024-01-20]. https://pubmed.ncbi.nlm.nih.gov/16452322/. DOI: 10.1542/peds.2005-1411.
[9]
LANE G J, YAMATAKA A, KOBAYASHI H, et al. Different types of congenital biliary dilatation in dizygotic twins[J]. Pediatr Surg Int, 1999, 15(5/6): 403-404. DOI: 10.1007/s003830050612.
[10]
WONG J K, CAMPBELL D, NGO N D, et al. Genetic study of congenital bile-duct dilatation identifies de novo and inherited variants in functionally related genes[J/OL]. BMC Med Genomics, 2016, 9(1): 75 [2024-01-20]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5154011/. DOI: 10.1186/s12920-016-0236-z.
[11]
ISHIBASHI H, SHIMADA M, KAMISAWA T, et al. Japanese clinical practice guidelines for congenital biliary dilatation[J/OL]. J Hepatobiliary Pancreat Sci, 2017, 24(1): 1-16 [2024-01-20]. https://onlinelibrary.wiley.com/doi/10.1002/jhbp.415. DOI: 10.1002/jhbp.415.
[12]
HATTORI K, HAMADA Y, SATO M. Cyst size in fetuses with biliary cystic malformation: an exploration of the etiology of congenital biliary dilatation[J]. Pediatr Gastroenterol Hepatol Nutr, 2020, 23(6): 531-538. DOI: 10.5223/pghn.2020.23.6.531.
[13]
MCCLEAN P, WEAVER L T. Ontogeny of human pancreatic exocrine function[J]. Arch Dis Child, 1993, 68(1 Spec No): 62-65. DOI: 10.1136/adc.68.1_spec_no.62.
[14]
WONG A M, CHEUNG Y C, LIU Y H, et al. Prenatal diagnosis of choledochal cyst using magnetic resonance imaging: a case report[J]. World J Gastroenterol, 2005, 11(32): 5082-5083. DOI: 10.3748/wjg.v11.i32.5082.
[15]
CASTRO P T, JÚNIOR E A, FAZECAS T M, et al. Choledochal cyst theories going pear-shaped? Evolution of choledochal cyst during intrauterine life in a case evaluated using magnetic resonance imaging and postnatal outcomes[J]. J Obstet Gynaecol Res, 2021, 47(12): 4456-4460. DOI: 10.1111/jog.15052.
[16]
DAVENPORT M, BASU R. Under pressure: choledochal malformation manometry[J]. J Pediatr Surg, 2005, 40(2): 331-335. DOI: 10.1016/j.jpedsurg.2004.10.015.
[17]
SUGANDHI N, AGARWALA S, BHATNAGAR V, et al. Liver histology in choledochal cyst- pathological changes and response to surgery: the overlooked aspect?[J]. Pediatr Surg Int, 2014, 30(2): 205-211. DOI: 10.1007/s00383-013-3453-y.
[18]
LEE C, BYUN J, KO D, et al. Comparison of long-term biliary complications between open and laparoscopic choledochal cyst excision in children[J]. Ann Surg Treat Res, 2021, 100(3): 186-192. DOI: 10.4174/astr.2021.100.3.186.
[19]
TANAKA R, NAKAMURA H, YOSHIMOTO S, et al. Postoperative anastomotic stricture following excision of choledochal cyst: a systematic review and meta-analysis[J/OL]. Pediatr Surg Int, 2022, 39(1): 30 [2024-01-24]. https://link.springer.com/article/10.1007/s00383-022-05293-x. DOI: 10.1007/s00383-022-05293-x.
[20]
NIRAMIS R, NARUMITSUTHON R, WATANATITTAN S, et al. Clinical differences between choledochal cysts in infancy and childhood: an analysis of 160 patients[J/OL]. J Med Assoc Thai, 2014, 97(Suppl 11): S122-S128 [2024-01-24]. https://pubmed.ncbi.nlm.nih.gov/25509706/.
[21]
ISHIMARU T, KITANO Y, UCHIDA H, et al. Histopathologic improvement in biliary cirrhosis after definitive surgery for choledochal cyst[J/OL]. J Pediatr Surg, 2010, 45(5): e11-e14 [2024-01-20]. https://linkinghub.elsevier.com/retrieve/pii/S0022-3468(10)00078-3. DOI: 10.1016/j.jpedsurg.2010.01.030.
[22]
OKADA T, HONDA S, MIYAGI H, et al. Liver fibrosis in prenatally diagnosed choledochal cysts[J/OL]. J Pediatr Gastroenterol Nutr, 2013, 57(2): e14 [2024-01-20]. https://onlinelibrary.wiley.com/doi/10.1097/MPG.0b013e3182973579. DOI: 10.1097/MPG.0b013e3182973579.
[23]
VIJAYARAGHAVAN P, LAL R, SIKORA S S, et al. Experience with choledochal cysts in infants[J]. Pediatr Surg Int, 2006, 22(10): 803-807. DOI: 10.1007/s00383-006-1771-z.
[24]
LEI J, ZHANG S H, DENG Q Q, et al. Laparoscopy for Neonatal Choledochal Cyst: a Clinical Analysis of 17 Cases[J]. Shi Yong Lin Chuang Yi Xue, 2023, 24(6): 29-32. DOI: 10.13764/j.cnki.lcsy.2023.06.008.
[25]
YANG D, LI L, DIAO M, et al. Risk factors analysis for clinical symptoms of prenatally diagnosed choledochal cysts: a retrospective study[J/OL]. BMC Surg, 2023, 23(1): 217 [2024-01-20]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10403877/. DOI: 10.1186/s12893-023-02115-2.
[26]
MAHALIK S K, MITRA S, PATRA S, et al. Cystic biliary atresia or atretic choledochal cyst: a continuum in infantile obstructive cholangiopathy[J]. Fetal Pediatr Pathol, 2019, 38(6): 477-483. DOI: 10.1080/15513815.2019.1627621.
[27]
QIU Z M, MA Y, WANG Y D, et al. Characteristics of missed ultrasound diagnosis of infant biliary atresia[J]. Chin J Med Imag Technol, 2024, 40(1): 68-72. DOI: 10.13929/j.issn.1003-3289.2024.01.013.
[28]
CHEN Y Y, BAI G S, LIAO J Y, et al. Diagnostic value of prenatal ultrasound in fetal abdominal cystic mass[J]. China Pract Med, 2023, 18(10): 92-94. DOI: 10.14163/j.cnki.11-5547/r.2023.10.023.
[29]
ZENG K H, YANG Z Y, CHEN L Z, et al. Prediction of fetal biliary atresia based on second and third-trimester ultrasound characteristics[J]. Ultraschall Med, 2023, 44(3): 307-317. DOI: 10.1055/a-1562-1615.
[30]
KELLEY-QUON L I, SHUE E, BURKE R V, et al. The need for early Kasai portoenterostomy: a Western Pediatric Surgery Research Consortium study[J]. Pediatr Surg Int, 2022, 38(2): 193-199. DOI: 10.1007/s00383-021-05047-1.
[31]
SHIN H J, YOON H, HAN S J, et al. Key imaging features for differentiating cystic biliary atresia from choledochal cyst: prenatal ultrasonography and postnatal ultrasonography and MRI[J]. Ultrasonography, 2021, 40(2): 301-311. DOI: 10.14366/usg.20061.
[32]
MA Y, CUI L G. Early detection and diagnosis of biliary atresia in neonates[J]. Chin J Med Imag, 2024, 32(2): 204-208. DOI: 10.3969/j.issn.1005-5185.2024.02.019.

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