Magnetic resonance cholangiopancreatography reveals common biliary and pancreatic duct anatomical variations in an Ethiopian cohort

Abstract

This study aimed to determine the prevalence of biliary and pancreatic ductal anatomical variations in an Ethiopian population using magnetic resonance cholangiopancreatography (MRCP) and to assess the frequency of reporting these variants in routine clinical radiology reports. A retrospective cross-sectional study was conducted on 354 patients who underwent MRCP at a diagnostic center in Addis Ababa, Ethiopia, between September 2023 and May 2025. Two experienced radiologists independently evaluated MRCP images for intrahepatic biliary branching patterns, cystic duct insertion, and pancreatic duct morphology using established classifications. Adequate image quality for optimal evaluation was achieved in 92.4% (intrahepatic ducts), 86.4% (cystic duct), and 83.9% (pancreatic duct) of patients. Typical (“classic”) anatomy was observed in only 57.5% (right intrahepatic) and 74.9% (left intrahepatic) of cases. Common variations included trifurcation (18%) and right posterior sectoral duct draining into the left hepatic duct (15.3%). Typical mid-lateral cystic duct insertion was present in only 41.2%. Importantly, significant anatomical variants were mentioned in only 2.4–12.8% of original clinical radiology reports. This first Ethiopian cohort study demonstrates a high prevalence of pancreatobiliary ductal variations, highlighting the critical need for preoperative MRCP. The marked under-reporting of these variants in routine practice represents a significant safety gap. Standardized inclusion of ductal anatomy in radiological reports is recommended to guide surgical planning and reduce iatrogenic injuries.