Cystic duct diameter as an independent predictor of choledocholithiasis in patients undergoing magnetic resonance cholangiopancreatography

Abstract

Abstract Purpose To assess the anatomy and variations of the cystic duct and biliary tree, along with their association with choledocholithiasis in patients undergoing magnetic resonance cholangiopancreatography (MRCP). Materials and methods Patients who were indicated for magnetic resonance cholangiopancreatography (MRCP) at our institution from January 2018 to May 2023 were identified retrospectively. Two radiologists, blinded to the clinical data, independently evaluated the MRCP images for variations in biliary anatomy and the presence of biliary stones. Any discrepancies between the two radiologists were resolved through consensus. Logistic regression analysis was conducted to identify the factors associated with choledocholithiasis. Results During the study period, 184 consecutive patients (84 men and 100 women, with a mean age of 64.2 ± 14.6 years) underwent magnetic resonance cholangiopancreatography (MRCP). Among them, 82 patients (44.6%) were diagnosed with choledocholithiasis. Regardless of the presence of choledocholithiasis, the most common anatomical variations identified were lateral insertion of the cystic duct (35.8%) and a high position of the cystic duct (52.7%). A higher body mass index and an acute cystic-hepatic angle (measured at less than 90 degrees) were significantly more prevalent in patients with choledocholithiasis (p = 0.004 and p = 0.008, respectively). Multiple logistic regression analysis showed a significant association between cystic duct diameter and the presence of choledocholithiasis, along with the presence of gallstones, with an adjusted odds ratio of 2.222 (95% confidence interval: 1.325–3.726, p = 0.02). Conclusion The most common biliary anatomical variations observed in patients with choledocholithiasis included the lateral insertion and a high position of the cystic duct. A higher body mass index and an acute cystic-hepatic angle were linked to an increased incidence of choledocholithiasis. In addition to the presence of gallstones, the diameter of the cystic duct has been identified as an independent predictor of the condition.

Keywords

• Choledocholithiasis
• Common bile duct stone
• Cholangiopancreatography
• Cystic duct diameter
• Acute cystic-hepatic angle