Objectives: The aim of the study was to evaluate the frequency of anatomic variations of the hepatic duct bifurcation using magnetic resonance cholangiopancreatography (MRCP). Methods: A total of 1,160 consecutive patients, referred to our department for MRCP due to suspected pancreatobiliary disease or before liver transplantation, were reviewed retrospectively. A total of 149 patients with less than optimal results due to imaging limitations or secondary differentiations of bile duct anatomy were excluded from the study. The final study population was composed of 1,011 cases. Results: Of the 1,160 patients, 149 were excluded from the analysis. Typical biliary anatomy was observed in 79.4% of cases, but female potential living liver donors more frequently presented an anatomic variation. Typical anatomy was present in 75.7% of the females and 85.3% of the males (p < 0.05). Out of the remaining 1,011 patients, 208 (20.57%) were diagnosed with different levels of various anatomic variations of the intra- and extrahepatic biliary ducts. Of the 208 cases with diagnosed variations, 204 (98.07%) and 4 (1.92%) turned out to have 1 and 2 different variations, respectively. The trifurcation variant was observed in 81 cases (8.01%), while 73 subjects (7.23%) had an aberrant right biliary duct draining into the common hepatic duct. A right dorsocaudal branch draining into the left hepatic duct was present in 42 cases (4.15%). Four cases (0.4%) had 2 different variations and 8 (0.8%) had uncommon anatomic variations. Conclusions: Typical intrahepatic biliary anatomy is present in about 80% of the inhabitants of the Aegean region of Turkey, but anatomic variants seem to be more frequent in females as compared to males. Trifurcation was the most common anatomic variation in our study population. The presence of an aberrant right hepatic duct emptying into the common hepatic duct was the second most common observation amongst our findings.

A 21-year-old woman with tuberous sclerosis presented with abdominal distension and flank pain. Imaging studies, including CT and MR imaging, revealed bilateral renal mass lesions, containing fat and suggesting the diagnosis of tuberous sclerosis. However the imaging characteristics of one of these lesions differed from the others with no radiologically detectable fat tissue in this solid lesion suggesting renal cell carcinoma. Histopathological examination of this lesion in the left kidney revealed an angiomyolipoma within minimal fat tissue. The radiological diagnosis of angiomyolipomas with minimal fat tissue remains difficult and the differential diagnosis is discussed.

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Color pixel ratio values reflect the MVD in RCC. Therefore, these results suggest that preoperative quantification of angiogenesis can be possible with the help of PDUS in RCC.

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