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Published on: April 30, 2019
Normal morphometry of the biliary tree in pediatric and adult populations: A systematic review and meta-analysis
Patrick Chau1, Daniel Moses2, Nalini Pather3
1Department of Anatomy, School of Biomedical Sciences, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia.
Insights
This systematic review and meta-analysis characterizes normal biliary tree dimensions in pediatric and adult populations. Findings establish reference values for the common bile duct (CBD) diameter, aiding clinical diagnosis.
Area of Science:
- Anatomy
- Radiology
- Medical Imaging
Background:
- Accurate morphometric data of the biliary tree is crucial for diagnosing various hepatobiliary conditions.
- Establishing standardized reference values for biliary tree dimensions is essential for both pediatric and adult populations.
Purpose of the Study:
- To systematically review and meta-analyze existing literature to characterize the normal morphometry of the biliary tree.
- To establish reference ranges for the diameter and length of hepatic ducts and the common bile duct (CBD).
Main Methods:
- Systematic review and meta-analysis adhering to PRISMA guidelines.
- Searched multiple databases (MEDLINE, EMBASE, SCOPUS, Web of Science) up to August 2023.
- Included studies reporting on the diameter and length of the right, left, and common hepatic ducts, and the CBD, assessing quality with the AQUA tool.
Main Results:
- Analyzed data from 44 studies encompassing 23,796 subjects.
- Pooled mean CBD diameter was 4.69 mm, with significant differences between pediatric (1.32 mm) and adult (4.97 mm) populations.
- CBD diameter varied by imaging modality (US, MRI, ERCP) and was larger distally (5.20 mm) than proximally (4.01 mm).
Conclusions:
- The study provides evidence-based reference values for normal biliary tree morphometry.
- These findings can guide the establishment of standardized diagnostic criteria for biliary tree abnormalities.
- Aids in improving clinical understanding and diagnostic accuracy for pediatric and adult patients.
Purpose:
This study aimed to characterise the normal morphometry of the biliary tree in pediatric and adult populations, through a systematic review and meta-analysis.
Methods:
This study, conducted using the PRISMA guidelines and registered with PROSPERO, searched MEDLINE, EMBASE, SCOPUS and Web of Science databases up to October 2022, and updated to August 2023. Studies that reported extractable data on diameter and length of the right, left and common hepatic ducts (LHD, RHD and CHD), and common bile duct (CBD) were included. Quality of the included studies were assessed using the Anatomical Quality Assessment (AQUA) tool. Statistical analysis included subgroup analyses according to sex, age, geographical location, and imaging modality.
Results:
In total, 60 studies were included, of which 44 studies reported adequate data for meta-analysis on 23,796 subjects. Overall, the pooled mean diameter of the CBD was 4.69 mm (95 % CI: 4.28-5.11). Significant differences were found between pediatric (1.32 mm, 95 % CI: 1.03-1.61) and adult (4.97 mm, 95 % CI: 4.67-5.27) subjects, as well as US (3.82 mm, 95 % CI: 3.15-4.49) and other imaging modalities, including MRI (6.21 mm, 95 % CI: 4.85-7.57) and ERCP (7.24 mm, 95 % CI: 6.08-8.40). The CBD diameter measured significantly larger distally (5.20 mm, 95 % CI: 4.60-5.80) than proximally (4.01 mm, 95 % CI: 3.51-4.51).
Conclusions:
The results obtained from this evidence-based study may guide the establishment of standardised reference values and ranges of the normal biliary tree in pediatric and adult populations and aid clinical understanding.
