THE WEST BENGAL UNIVERSITY OF HEALTH SCIENCES

KOLKATA, WEST BENGAL

SYNOPSIS OF DISSERTATION

“CORRELATION OF ULTRASONOGRAPHY AND MAGNETIC RESONANCE

CHOLANGIOPANCREATOGRAPHY IN DIFFERENT TYPES OF
CHOLEDOCHAL CYSTS”

Submitted by
DR. JIMUT BAHAN MURMU, MBBS
1st YEAR POST GRADUATE TRAINEE,

DEPARTMENT OF RADIODIAGNOSIS

NILRATAN SIRCAR MEDICAL COLLEGE & HOSPITAL, KOLKATA

138 A.J.C. BOSE ROAD, KOLKATA-700014.

GUIDE

Prof. (Dr.) SWADHA PRIYA BASU

PROFESSOR & HOD, DEPARTMENT OF RADIODIAGNOSIS

NILRATAN SIRCAR MEDICAL COLLEGE & HOSPITAL, KOLKATA

CO-GUIDE

Prof. (Dr.) NISITH CHANDRA KARMAKAR

PROFESSOR, DEPARTMENT OF GENERAL SURGERY

NILRATAN SIRCAR MEDICAL COLLEGE & HOSPITAL, KOLKATA

 INVESTIGATOR’S UNDERTAKING

I hereby declare that, I, Dr. Jimut Bahan Murmu, Post Graduate Trainee ( Session 2018-2021)
in the department of Radio-Diagnosis, NilratanSircar Medical College and Hospital, Kolkata,
am doing the study entitled “Correlation of Ultrasonography and Magnetic resonance
cholangiopancreatography in different types of Choledochal Cysts” – a Hospital base
cross sectional study under the guidance and close supervision of Prof.( Dr.) Swadha Priya
Basu, Professor & HOD, Department of Radio-Diagnosis, Nilratan Sircar Medical College &
Hospital, Kolkata & Prof. Dr. Nisith Chandra Karmakar, Professor, Department of General
Surgery, Nilratan Sircar Medical College & Hospital, Kolkata, solely for the purpose of my
thesis as a part of my M.D. course. I shall be liable to bring to notice of the Ethics Committee
the developments regarding this study including any adverse outcome. The protocol will be in
parity with the present standards maintained in this hospital. The investigations and treatment
will be done in Govt. hospital set-up and those which will not be available in Govt. setup will
be done from outside.

DR. JIMUT BAHAN MURMU

Post Graduate Trainee,
(Session 2018-2021)
Department of Radio-Diagnosis,
Nilratan Sircar Medical College & Hospital, Kolkata
 1. SUMMARY OF THE PROPOSAL

a) TITLE OF THE RESEARCH PROPOSAL:

“CORRELATION OF ULTRASONOGRAPHY AND MAGNETIC RESONANCE CHOLANGIOPANCREATOGRAPHY IN
DIFFERENT TYPES OF CHOLEDOCHAL CYSTS”
b) HYPOTHESIS TO BE TESTED:
This study is a correlation of the two techniques of diagnosis: no hypothesis is present at the
beginning of the study.
c) PROJECT SUMMARY:
A cross sectional study will be conducted in department of Radiodiagnosis, Nilratan Sircar Medical
College and Hospital, Kolkata over a period of one and half year( January2019 to June2020).
1. a) Name of candidate: Dr. Jimut Bahan Murmu
Designation: 1st year Post Graduate Trainee
Place of Posting: Nilratan Sircar Medical College & Hospital, Kolkata
b) Place of proposed research work: Nilratan Sircar Medical College & Hospital, Kolkata
Name of the Department: Department of Radiodiagnosis
c) Broad area: Clinical
Specific area: Department of Radiodiagnosis.
2.a) Proposed supervisor:
i) Prof. (Dr.) Swadha Priya Basu, Professor & HOD, Department of Radio-Diagnosis, Nilratan
Sircar Medical College & Hospital, Kolkata.
ii) Prof. (Dr.) Nisith Chandra Karmakar, Professor, Department of General Surgery, Nilratan
Sircar Medical College & Hospital, Kolkata.

d) Statement of the problem (Scientific Justification)

Choledochal Cysts are most commonly present in childhood and about 25% patients present in
adulthood4. The classic triad of symptoms, which includes pain abdomen, palpable abdominal mass, and
jaundice, is seen in less than 20% of cases. An 85% of children have at least 2 features of classic triad,
whereas only 25% of adults present with at least 2 features of the classic triad9. Although benign,
Choledochal Cyst can be associated with serious complications including malignant transformation,
cholangitis, pancreatitis, and cholelithiasis4,5.
However, the recent experience of the different authors suggested that the disease currently is
recognized more commonly in adults5,9. Adult patients most commonly had abdominal pain and were
thought to have pancreatitis (23%) or acute biliary tract symptoms, prompting cholecystectomy (50%)9.
Ultrasound is the most frequently used imaging modality for its low cost, accessibility, and has been
shown to be reliable and cost effective for investigation of Choledochal Cyst and it is first line of
investigation at the current time10,15.
However, ultrasound fails to determine the cause of a dilated CBD in one-third of patients. Moreover, it
is unable to accurately identify APBDU (anomalous pancreaticobiliary duct union)10,15.
Magnetic resonance cholangiopancreatography is noninvasive and does not require irradiation or oral
or intravenous contrast. Modern MRCP technology has removed the need for exaggerated breath holding
techniques, increasing its utility and accuracy. The MRCP is highly sensitive (90% -100%) and specific
(90% to 100%) in Choledochal Cyst diagnosis and classification. Moreover, it reliably identifies APBDU
 (anomalous pancreaticobiliary duct union) as well as cholangiocarcinoma and choledocholithiasis with
concurrent Choledochal Cyst12.
e) Research objective (General & Specific):
General:
➢ To evaluate and correlate the findings of Ultrasonography and Magnetic resonance
cholangiopancreatography in diagnosis of different types of Choledochal Cysts.
Specific
➢ To evaluate and correlate the accuracy of Ultrasonography and Magnetic resonance
cholangiopancreatography in diagnosis of different types of Choledochal Cysts.
➢ To study the effectiveness of Ultrasonography and Magnetic resonance
cholangiopancreatography as a prime diagnostic modality for patients with clinical features
of Choledochal Cysts.
➢ To assess the limitation of Ultrasonography and Magnetic resonance
cholangiopancreatography in diagnosis of different types of Choledochal Cysts.
f) Methodology:
1. Study Design: Hospital base cross sectional study.
2. Study Timeline: January 2019 to June 2020
3. Place of study: Nilratan Sircar Medical College & Hospital, Kolkata
➢ Department of Radiology

4. Study Population: The study will be of hospital base cross sectional study comprising of thirty patients
who will be referred for Ultrasonography and Magnetic resonance cholangiopancreatography to the
department of Radiodiagnosis, Nilratan Sircar Medical College, Kolkata, with clinical suspicion of
Choledochal Cysts lesions and incidentally found Choledochal Cysts lesions on patient’s
Ultrasonography and Magnetic resonance cholangiopancreatography done for other reasons during
January 2019 to June 2020.
Exclusion Criteria: Critically ill and Moribund patients.
5. Sample Size: 30 patients(minimum)
6. Sample Design: Randomized
7. Data collection & interpretation: A proforma will be made. The relevant clinical findings are filled up
from case records and investigations are noted for interpretation.

g) Statistical analysis plan: Data analysis will be done using rate, ratios, percentages etc by using
proper statistical method.

h) Justification and Use of the Results: From this study expected outcomes will be –
i) Percentage of different types of Choledochal Cysts in this region.
ii) Major clinical Presentation.
iii) Age and Sex wise distribution.
iv) Classification of different varieties Cysts with sonographic and Magnetic resonance
cholangiopancreatographic findings according to its location.
v) Ultrasonography and Magnetic resonance cholangiopancreatography are complementary
imaging modalities in the evaluation of suspected case of Choledochal Cysts. Thus, in all the cases both
these modalities have their own importance in diagnosing and classifying different types of Choledochal
Cysts and should be used in combination for accurate diagnosis and treatment
 2. TITLE

“CORRELATION OF ULTRASONOGRAPHY AND MAGNETIC

RESONANCE CHOLANGIOPANCREATOGRAPHY IN DIFFERENT
TYPES OF CHOLEDOCHAL CYSTS”

3 BACKGROUND
A) Justification and relevance of the proposed research work:

Choledochal Cysts are most commonly present in childhood and about 25% patients present in
adulthood4. The classic triad of symptoms, which includes pain abdomen, palpable abdominal
mass, and jaundice, is seen in less than 20% of cases. An 85% of children have at least 2 features
of classic triad, whereas only 25% of adults present with at least 2 features of the classic triad9.
Although benign, Choledochal Cyst can be associated with serious complications including
malignant transformation, cholangitis, pancreatitis, and cholelithiasis4,5.
Ultrasound is the most frequently used imaging modality for its low cost, accessibility, and has
been shown to be reliable and cost effective for investigation of Choledochal Cyst And it is first
line of investigation at the current time10,15.
A CBD measuring greater than the normal in comparison to age may be the possibilities of
cystic dilatation of the biliary tree or obstructive biliary lithiasis. Additionally, a right upper
quadrant cyst separate from the gallbladder is suggestive of Choledochal Cyst disease.
Choledochal cyst diagnosis is further supported by the presence of a direct communication
between the biliary tree and the cystic duct. These criteria allow for the differentiation of
Choledochal Cysts disease and other right upper quadrant cystic entities, such as pancreatic
pseudocyst, renal cyst, and hepatic cysts. Thickening and irregularity of the Choledochal Cysts
wall suggests malignancy10,15.
However, ultrasound fails to determine the cause of a dilated CBD in one-third of patients.
Moreover, it is unable to accurately identify APBDU (anomalous pancreaticobiliary duct
union)10,15.
Magnetic resonance cholangiopancreatography is noninvasive and does not require irradiation
or oral or intravenous contrast. Modern MRCP technology has removed the need for exaggerated
breath holding techniques, increasing its utility and accuracy. The MRCP is highly sensitive (90%
-100%) and specific (90% to 100%) in Choledochal Cyst diagnosis and classification. Moreover,
it reliably identifies APBDU (anomalous pancreaticobiliary duct union) as well as
cholangiocarcinoma and choledocholithiasis with concurrent Choledochal Cyst. Although MRCP
is associated with relatively lower cost and decreased morbidity, but it is limited in its ability to
detect minor ductal abnormalities or small choledochoceles12. The clinical classification, which
describes different types and subtypes, was revised in 1977 by Todani and colleagues. The most
common cystic dilatation is type I with diffuse or segmental fusiform dilatation of the common
bile duct. This type accounts for 50 to 85% of cases. Type I cysts should be considered in the
differential diagnosis of any patient with ductal dilatation1.
 However, the recent experience of the different authors suggested that the disease currently is
recognized more commonly in adults5,9. Adult patients most commonly had abdominal pain and
were thought to have pancreatitis (23%) or acute biliary tract symptoms, prompting
cholecystectomy (50%). The type of choledochal cyst seen in children and adults was similar; the
fusiform extrahepatic (Type I) was most common (50%), and the combined intrahepatic and
extrahepatic (Type IVA) was the next most prominent (33%). Treatment consisted of excision of
the cyst and biliary reconstruction with a hepaticojejunostomy9.

B) Introduction:
Choledochal cysts are rare congenital anomalies in which cystic dilatations of the biliary
tree can involve extrahepatic biliary radicles, the intrahepatic radicles, or both. Choledochal
cysts are principally diagnosed by disproportionate dilatation of the biliary radicles. In
addition, choledochal cysts are believed to arise from the anomalous union of the common
bile duct and pancreatic duct outside the duodenal wall which is also proximal to the
sphincter of the Oddi mechanism14. The various types of choledochal cysts have been
classified on the basis of these anomalous unions (Komi classification) and their anatomical
locations (Todani classification)1,16.

The Todani classification of bile duct cysts divides choledochal cysts into five groups.

Type I: Fusiform dilation of the extrahepatic bile duct, account for 50-80% of all bile duct
cysts.

Type II: Bile duct diverticulum, Saccular outpouchings, 2% of all bile duct cysts.

Type III: Choledochocele, protrusion of a focally dilated, intramural segment of the distal
CBD into the duodenum.1.4-4.5% of all bile duct cysts.

Type IV: Multiple communicating intra and extrahepatic duct cysts, 15-35% of all bile duct
cysts.

Type V: Caroli disease, cystic dilations of intrahepatic bile duct, 20%.

This study describes the various imaging features of a choledochal cyst according to the
various types of anomalous unions of the pancreaticobiliary duct according to Komi's
classification and anatomic location according to Todani's classification

C) Brief account of the present knowledge/ understanding:

Over the past decade, a number of published studies have assessed the diagnostic accuracy
of Ultrasonography and and Magnetic resonance cholangiopancreatography in diagnosis of
different types of Choledochal Cysts.
D) State the research question/hypothesis:
Choledochal cysts are rare congenital anomalies in which cystic dilatations of the biliary
tree can involve extrahepatic biliary radicles, the intrahepatic radicles, or both. Choledochal
cysts are principally diagnosed by disproportionate dilatation of the biliary radicles. The
various types of choledochal cysts have been classified on the basis of these anomalous
unions and their anatomical locations (Todani classification)1,16. This study looks at the
 correlation of Ultrasonographic and Magnetic resonance cholangiopancreatographic finfing
in diagnosis of different types of Choledochal Cysts

E) Gap in existing research:

The study population is small because it is relatively rare disease and study period is also
short. So as in comparison with national based or international based study, there will some
variation in terms of result.

4. Review of literature:
Initial classification by Alonso-Lej and colleagues in 1959 described 3 types of choledochal
cysts, type I–III.
Later Todani and colleagues in 1977 modified it by adding type IV and V. Modified Todani
and colleague’s classification is most commonly used by surgeons. Type I choledochal cysts
make up about 50%–80% of all choledochal cysts, type II 2%, type III 1.4%–4.5%, type IV
15%–35%, and type V 20%.
Ziegler and colleagues in their analysis of comparing choledochoceles to Todani types I, II,
IV, and V, with respect to age, sex, complications, and management concluded that
classification of choledochal cysts should not include choledochoceles.
Lilly and colleagues described an entity called “forme fruste” choledochal cysts, where the
patients present with typical symptoms of choledochal cysts and are associated with abnormal
pancreaticobiliary duct junction (APBDJ) but without dilation of biliary ducts. Sarin and
colleagues believe this to be included under the spectrum of choledochal cysts.
Kaneyama and colleagues reported 4 cases of type II diverticulum arising from type IC
choledochal cysts, which they termed as mixed type I and II choledochal cysts. The incidence
was 1.1% in their series of 356 cases. Four cases have also been reported of diverticular cysts
of the cystic duct, which the authors suggested might be another subtype. The question arises,
however, whether this is just a variant type-II cyst.
Four cases of diverticular cysts of cystic duct have been reported by Loke and colleagues,
which might be another variant of choledochal cysts.
Visser and colleagues in their case series experienced all types of type I choledochal cysts
had some element of intrahepatic dilation making them to contend type I and IVA cysts are
variation of same disease and the degree of intrahepatic dilation defining one type versus the
other was arbitrary.
P A Lipsett have done a Retrospective Study with forty-two patients (11 children, 32 adults)
with choledochal cyst disease which were treated primarily between 1976 and 1993. One
child but no adults had the classic triad of jaundice, abdominal mass, and pain abdomen.
Children were more likely to have two of the three signs or symptoms (82% vs. 25%; p = <
0.05). Adult patients most commonly had abdominal pain and were thought to have
pancreatitis (23%) or acute biliary tract symptoms, prompting cholecystectomy (50%). The
type of choledochal cyst seen in children and adults was similar; the fusiform extrahepatic
(Type I) was most common (50%), and the combined intrahepatic and extrahepatic (Type
IVA) was the next most prominent (33%). Gallbladder or cholangiocarcinoma was identified
in three adults (9.7%).
5.OBJECTIVES
General:
➢ To evaluate and correlate the findings of Ultrasonography and Magnetic resonance
cholangiopancreatography in diagnosis of different types of Choledochal Cysts.

Specific
➢ To evaluate and correlate the accuracy of Ultrasonography and Magnetic resonance
cholangiopancreatography in diagnosis of different types of Choledochal Cysts.
➢ To study the effectiveness of Ultrasonography and Magnetic resonance
cholangiopancreatography as a prime diagnostic modality for patients with clinical
features of Choledochal Cysts.
➢ To assess the limitation of Ultrasonography and Magnetic resonance
cholangiopancreatography in diagnosis of different types of Choledochal Cysts.

6.MATERIALS AND METHODS:

1. Study Design: Hospital based cross sectional study.

2. Study Setting: Nilratan Sircar Medical College & Hospital, Kolkata.
• Department of Radiology
3. Study Population:
The study will be of hospital base cross sectional study comprising of thirty patients who
will be referred for Ultrasonography and Magnetic resonance cholangiopancreatography to
the department of Radiodiagnosis, Nilratan Sircar Medical College, Kolkata, with clinical
suspicion of Choledochal Cysts lesions and incidentally found Choledochal Cysts lesions on
patient’s Ultrasonography and Magnetic resonance cholangiopancreatography done for
other reasons during January 2019 to June 2020.
✓ Exclusion Criteria: Critically ill and Moribund patients.
4. Timeline: January 2018 to June 2019.
5. Sample Size: 30 patients

6. Sample Design: Randomized

7. Data collection & interpretation: A proforma will be made. The relevant clinical
findings are filled up from case records and investigations are noted. Parameters to be
studied:

A. Clinical –

History –

i) The triad of jaundice, upper abdominal mass, and pain Abdomen.

Local Examination of Abdomen-
 i) Tenderness – Present/Absent
Systemic Examination –

i) Examination of Abdomen

B. INVESTIGATIONS –

i. Blood – > Hb%

> TC, DC
> ESR
> Fasting Blood Sugar
> Post prandial blood sugar
> Liver function test
> Serum amylase and lipase
> Serum urea and creatinine
> Coagulation profile
> Virology marker
> Estimation of CA-19.9

ii. Radiological Investigations –

Ultrasonography & Magnetic resonance cholangiopancreatography for-

a) Characteristics of the CYST:

- Location of the cyst
- Shape of the cyst
- Size of the cyst
b) Intra hepatic biliary radicles

c) Pancreas-
- Size, shape, and associated mass lesion
- Echogenicity- Hypoechoic/Hyperechoic/Isoechoic/Anechoic,
- Uniformity- Homogeneous/Heterogeneous
- Calcification/Shadowing-Present/absent
- Guidance for further interventional procedure – FNAC/Biopsy
d) Any associated important findings– Enlarged Retroperitoneal/Peri-pancreatic lymph
node/Retroperitoneal/pancreatic mass etc.

(iii). CT Scan/MRI Scan/ERCP – whenever clinically indicated.

8. STUDY TOOLS:

i) Ultrasonography machine: Philips HD7 machine with mainly and 3.5-5

MHz curvilinear probe and 3-12 MHz linear probe in selected cases.
 ii) MRI machine: 1.5 Tesla MRI machine (GE Healthcare) will be used
iii) CT Scan machine – 16 slice GE Machine.
iv) A proforma is designed for recording age of presentation, sex, clinical,
radiological & other investigation findings.

9.WORK PLAN:
We are going to do hospital base cross sectional study comprising of thirty patients
who will be referred for Ultrasonography and Magneti resonance cholangiopancreatography
to the department of Radiodiagnosis, Nilratan Sircar Medical College, Kolkata, with clinical
suspicion of Choledochal Cysts lesions and incidentally found Choledochal Cysts lesions on
patient’s Ultrasonography and Magnetic resonance cholangiopancreatography done for
other reasons during January 2019 to June 2020. First, we will clinically identify suspected
study cases. Then we shall subject the study cases for radiological investigation at
department of Radiodiagnosis Nilratan Sircar Medical College & Hospital, Kolkata.
At first, Consent forms are duly signed by the patient (parents in case of Minor)

- The proforma is to be filled up

-Relevant clinical findings & routine investigations are noted.

- Radiological techniques to be used:

1) Sonographic technique of upper abdominal examination for early screening and

diagnosis.

2) Magnetic resonance cholangiopancreatography for farther evaluation & diagnosis of

choledochal cysts.

10.STATISTICAL ANALYSIS PLAN:

Data will be compared and analysed with appropriate statistical tests to determine
significance level and power of study. Descriptive statistical analysis would be carried out in
the present study.

11. OUTCOME DEFINITION AND PARAMETERS:

From this study expected outcomes will be –

i) Percentage of different types of Choledochal Cysts in this region.
ii) Major clinical Presentation.
iii) Age and Sex wise distribution.
iv) Classification of different varieties Cysts with sonographic and Magnetic
resonance cholangiopancreatographic findings according to its location.
v) Ultrasonography and Magnetic resonance cholangiopancreatography are
complementary imaging modalities in the evaluation of suspected case of Choledochal Cysts.
Thus, in all the cases both these modalities have their own importance in diagnosing and
classifying different types of Choledochal Cysts and should be used in combination for
accurate diagnosis and treatment.
 CASE RECORD FORM

Case No. :

1. Patient Particulars –

Name:

Age:

Sex:

Religion:

Address:

2. Clinical History –

i. Pain - Present/Absent

ii. Duration of symptom -

3. Local examination of the Abdomen –

i. Tenderness – Present/Absent

4. Systemic Examination –

❖ Examination of Abdomen-

❖ Clinically palpable lymph nodes in the inguinal/neck region-

 ❖ Ascites-

5. Investigations –

(i) Blood – Hb%

> TC, DC
> ESR
> Fasting Blood Sugar
> Post prandial blood sugar
> Liver function test
> Serum amylase and lipase
> Serum urea and creatinine
> Coagulation profile
> Virology marker
> Estimation of CA-19.9

(ii) Radiological Investigations –

Ultrasonography & Magnetic resonance cholangiopancreatography for-

a) Characteristics of the CYST:

- Location of the cyst
- Shape of the cyst
- Size of the cyst
b) Intra hepatic biliary radicles-
c) Pancreas-

- Size, shape, and associated mass lesion

- Echogenicity- Hypoechoic/Hyperechoic/Isoechoic/Anechoic,
- Uniformity- Homogeneous/Heterogeneous
- Calcification/Shadowing-Present/absent
- Guidance for further interventional procedure – FNAC/Biopsy

d) Any associated important findings– Enlarged Retroperitoneal/Peri-pancreatic lymph

node/Retroperitoneal/pancreatic mass etc.

(iii). CT Scan/MRI Scan/ERCP – whenever clinically indicated.

 PATIENT INFORMATION SHEET

You are welcome to the Department of Radio-Diagnosis, Nilratan Sircar Medical College &
Hospital, Kolkata. The research we are doing is “Correlation Ultrasonography and Magnetic
resonance cholangiopancreatography (MRCP) in different types of Choledochal Cysts”.

Through this research work we are going to assess the relative frequency of occurrence of
the different types of Choledochal Cysts and evaluate the Sensitivity and Specificity of
Ultrasonography and Magnetic resonance cholangiopancreatography (MRCP) in this disease.

The reason why we included you in this study is that you are suffering from jaundice/ and
upper abdominal mass /and pain Abdomen. The clinical examination, Ultrasonography and
Magnetic resonance cholangiopancreatography (MRCP) and other relevant investigations
will help us to diagnose the disease earlier and relieve you of the disease by starting the
exact and early treatment.

If you are ready to participate in this research work, then you must sign a consent form and
you will be asked a few questions regarding the disease. You will be clinically examined and
after that we will perform Ultrasonography of the Abdomen and Magnetic resonance
cholangiopancreatography (MRCP). We assure that there is no risk involved. You will not
bear any extra expenditure for participating in this trial.

However, you are free to refuse the participation in this trial. You are also free to opt out of
the trial at any point of time and still you will get all the usual medical and surgical services
and nothing possible in the available infrastructure will be denied to you. All the information
provided by you will only be used for the study and the same will be kept confidential. Your
name and identity will not be disclosed anywhere.

Please feel free to ask any queries which may not have been answered by this material or
consent form itself.

Thank you.
 র োগী তথ্য পত্র

নীল তন স কো রেডিকযোল কললজ ও হোসপোতোলল র ডিওলজী ডিভোলগ আপনোলক স্বোগত জোনোই।আে ো

রে গলিষণো ক লত চললডি তো হল ডিডভন্ন প্রকো রকোলললিোকোল ডসলে আলট্রোল োলনোগ্রোফী এিং েযোগলনটিক
র লজোনযোন্স রকোলোনডজওপযোনডিলেল োগ্রোফী- এে( আ ডস ডপ -)সম্পর্
এই গলিষণো েোধ্যলে আে ো ডিডভন্ন প্রকো রকোলললিোকোল ডসেএ - আলপডিক ঘ লন ডনরূপণ এিং তো
উপ আলট্রোল োলনোগ্রোফী এিং েযোগলনটিক র লজোনযোন্স রকোলোনডজওপযোনডিলেল োগ্রোফী- (এে আ ডস
ডপ) সংলিদন ীলতো ও ডিল ষত্ব েূলযোেন ক লত চললডি। এই গলিষণোে আপনোলক অন্তভভু ক্ত ক ো
কো ণটি হল রে আপডন জডিস /ও উপল রপল ভ /ও রপল িযথ্ো অনভভি ক লিন।ডিডনকোল
প ীিো, আলট্রোলসোলনোগ্রোডফ এিংেযোগলনটিক র লজোনযোন্স রকোলোনডজওপযোনডিলেল োগ্রোফী (এেআ ডসডপ )
এিং অনযোনয প্রোসডিক প ীিো আলগ আেোলদ র োগটি ডনণুে ক লত এিং েথ্োেথ্ ও প্রোথ্ডেক
ডচডকৎসো শুরু কল র োলগ উপ ে ক লত সোহোেয ক লি। েডদ আপডন এই গলিষণো কোলজ অং
রনওেো জনয প্রস্তুত থ্োলকন তলি আপনোলক সম্মডতপলত্র স্বোি ক লত হলি এিং আপনোলক র োগ
সম্পডকু ত ডকিভ প্রশ্ন ডজজ্ঞোসো ক ো হলি। আপনো প্রথ্লে ডিডনকোল প ীিো ক ো হলি এিং পল
আে ো রপল আলট্রোলসোলনোগ্রোডফ এিং েযোগলনটিক র লজোনযোন্স
রকোলোনডজওপযোনডিলেল োগ্রোফী(এেআ ডসডপক ো হলি। )
আে ো ডনডিত রে এই গলিষণো কোলজ রকোন ঝভুঁ ডক জড়িত রনই। আপডন এই গলিষণো কোলজ
অং গ্রহলণ জনয রকোন অডতড ক্ত িযে িহন ক লিন নো। েোইলহোক, আপডন এই গলিষণো কোলজ অং গ্রহণ
প্রতযোখ্যোন ক লত েভক্ত। আপনো এই গলিষণো চলোকোলীন রে রকোলনো সেে গলিষণোে অং গ্রহলন প্রতযোখ্যোন ক িো অডধ্কো
আলি এিং এই প্রতযোখ্যোনএ ফলল আপডন সি সোধ্ো ণ ডচডকৎসো এিং অলরোপচো পড লষিো পোলিন এিং উপলব্ধ
পড কোঠোলেোলত সম্ভি সি ডকিভ পড লষিোই রদওেো হলি। আপনো দ্বো ো প্রদত্ত সেস্ত তথ্য শুধ্ভেোত্র অধ্যেলন জনয
িযিহো ক ো হলি এিং এটি রগোপন োখ্ো হলি। আপনো নোে এিং পড চে রকোথ্োও প্রকো ক ো হলি নো।
অনভগ্রহ কল রকোনও ডজজ্ঞোসো থ্োকলল ডজজ্ঞোসো ক লত পোল ন কো ণ সি উত্ত এই উপোদোলন িো
সম্মডত ফলেু নোও থ্োকলত পোল ।

ধ্নযিোদ.
 रोगी सच
ू ना पत्र

रे डियो-निदाि विभाग, िीलरति सरकार मेडिकल कॉलेज एिं अस्पताल, कोलकाता में ,
आपका स्िागत है । हम जो शोध कर रहे हैं िह हैं "अल्ट्रासोिोग्राफी एंि मेगिेटिक रे जोिेंस
कोलािजजओप्यािक्रियोिोग्राफी (एमआरसीपी) के विभभन्ि प्रकार के कोलेिोकल भसस््स में
सहसंबंध"।
इस शोध कायय के माध्यम से हम विभभन्ि प्रकार के कोलेिोकल भसस््स की घििाओं की
सापेक्ष आिवृ ि का आकलि करिे जा रहे हैं और इस रोग में संिेदिशीलता और विभशष्िता
अल्ट्रासोिोग्राफी और मेगिेटिक अिुिादता कोलांगगयोपायरे रोग्राफी (एमआरसीपी) का
मूल्ट्यांकि करते हैं।
इस अध्ययि में आपको क्यों शाभमल क्रकया गया, यह है क्रक आप पीभलया / ऊपरी पेि के
द्रव्यमाि और ददय से पीड़ित हैं। जक्लनिकल परीक्षा, अल्ट्रासोिोग्राफी और मेगिेटिक रे जोिेंस
कोलािजजओप्यािक्रियोिोग्राफी (एमआरसीपी) और अन्य प्रासंगगक जांच से हमें पहले बीमारी का
पता लगािे और सिीक और प्रारं भभक उपचार शुरू करिे से बीमारी से मुक्त होिे में मदद
भमलेगी।
यटद आप इस शोध कायय में भाग लेिे के भलए तैयार हैं, तो आपको सहमनत फॉमय पर
हस्ताक्षर करिा होगा और आपको रोग के बारे में कुछ सिाल पूछे जाएंगे। आपको िैदानिक
रूप से जांच की जाएगी और इसके बाद हम अल्ट्रासोिोग्राफी और मेगिेटिक रे जोिेंस
कोलािजजओप्यािक्रियोिोग्राफी (एमआरसीपी)को क्रियाजन्ित करें गे। हम यह आश्िस्त करते हैं
क्रक इसमें कोई भी जोखिम िहीं है । इस परीक्षण में भाग लेिे के भलए आपको कोई
अनतररक्त िचय िहीं उठािा होगा।
हालांक्रक, आप इस परीक्षण में भागीदारी को अस्िीकार करिे के भलए स्ितंत्र हैं। आप क्रकसी
भी समय परीक्षण से बाहर निकलिे के भलए स्ितंत्र हैं और क्रफर भी आपको सभी सामान्य
गचक्रकत्सा और सजजयकल सेिाएं भमलें गी और उपलब्ध बुनियादी ढांचे में संभि कुछ भी आपको
अस्िीकार कर टदया जाएगा। आपके द्िारा प्रदाि की गई सभी जािकारी केिल अध्ययि के
भलए इस्तेमाल की जाएगी और इसे गोपिीय रिा जाएगा। आपका िाम और पहचाि कहीं भी
िल
ु ासा िहीं क्रकया जाएगा।
कृपया क्रकसी भी ऐसे प्रश्ि पछ
ू िे के भलए बेखििक महसस
ू करें जो इस सामग्री या सहमनत
से स्ियं का उिर िहीं टदया जा सकता है ।

धन्यिाद
 CONSENT FORM

I,

Mr./Mrs. ---------------------------------------------------------------,

Father’s/Husband’s name --------------------------------------------------,

Address-----------------------------------------------------------------------------------,

am aware of the research work to be done by Dr. Jimut Bahan Murmu entitled
“Ultrasonography and Magnetic resonance cholangiopancreatography correlation in
different types of Choledochal Cysts” and do hereby declare that I am voluntarily giving my
consent to include myself as subject in the study.
I have been explained to my full satisfaction in my own language about the procedure
involved in the study along with the right to refuse to participate in the study at any time
during the course of the study. This refusal however is not going to interfere with the
treatment of my illness from the department.
I do hereby declare that I will provide medical history of the disease, undergo follow-up
clinical examination at regular interval for next two years, and allow collection of necessary
clinical material.
I also understand that this research study will help understand the disease better and
benefit the treatment of my illness. I have been assured that my medical records will be
kept confidential and will not be used without my permission. I have been assured that my
medical records will be kept confidential and will not be used without my permission.
I have also been informed to contact Dr. Jimut Bahan Murmu, MD PGT in the Dept. of Radio-
Diagnosis, Nilratan Sircar Medical College &Hospital in case of any emergency arising during
the study.

Signature/Thumb Impression of Declarant/ Guardian with full name:

Signature/Thumb Impression of Witness with full name:

Signature of investigator with full name:

Dated: ……………………… Place……………………..
 সম্মডতপত্র

আডে,
শ্রী/শ্রীেতী
------------------------------------------------- -------------,

ডপতো / স্বোেী নোে ---------------------------------------------- ----,

ঠিকোনো ------------------------------------------------- ----------------------------------,

িোাঃ জীেভত িোহন েভেভু - দ্বো ো সম্পন্ন ক ো গলিষণো কোজ “Correlation of Ultrasonography and
Magnetic resonance cholangiopancreatography in different types of Choledochal Cysts”
সম্পলকু পভল োপভড অিগত হইলোে। আডে সম্পভনু রসচ্ছোে এিং সভস্থ েডস্তলে এই গলিষনোে অন্ত ভভ ক্ত হলত
অনভেডত ডদডচ্ছ।আেো পভনু পড তৃ ডি-সহ,আেো ডনলজ ভোষোে আেোে ডচডকৎসো পদ্ধডত িযোখ্যো ক ো
হলেলি।আেো গলিষণো চলোকোলীন রে রকোলনো সেে গলিষণোে অং গ্রহলন প্রতযোখ্যোন ক িো অডধ্কো
আলি এিং এই প্রতযোখ্যোনএ ফলল এই ডিপো ু লেন্ট রথ্লক আেো ডচডকৎসো রকোনও িযোঘোত ঘ লিনো। আডে
এতদ্বো ো রঘোষনো ক ডি রে আডে েথ্োেথ্ র োলগ ইডতহোস প্রদোন ক ি, এিং আগোেী দভইিি ডনেডেত
প্রলেোজনীে প ীিোডন ীিো ক োি ও েোিতীে তথ্য স ি োহ ক ি। আডে এ ো িভলঝডি রে এই গলিষণো
আেো এই র োগটিলক আ ও ভোলভোলি িভঝলত ও আেো ডচডকৎসো আ ও ভোলভোলি ক োলত সোহোেয ক লি।
আেোলক এ োও জোনোলনো হলেলি রে আেো েোিতীে তথ্য রগোপন োখ্ো হলি এিং আেো অনভেডত িো়িো
িযোিহো ক ো হলিনো। গলিষণো চলোকোলীন রকোলনো আপদকোলীন পড ডস্থডত সৃডি হলল আেোলক নীল তন
স কো রেডিলকল কলললজ র ডিওললোজী ডিভোলগ স্নোতলকোত্ত পলিু িোত্র িোক্তো জীেভত িোহন েভেভু , সোলথ্
রেোগোলেোগ ক লতও িলো হলেলি।

রঘোষণোকো ী স্বোি / অডভভোিলক স্বোি / িভল়িো আিভলল িোপ :-

পভল ো নোে ডদলে সোিী স্বোি / িভল়িো আিভলল িোপ:-

পভল ো নোে ডদলে তদন্তকো ী স্বোি :-

তোড খ্ :- ...........................

জোেগো:- ......................
 सहमनतपत्र

मैं,
श्री/श्रीमती -------------------------------------------------- -------------,

वपता / पनतकािाम ---------------------------------------------- ----,

पता ------------------------------------------------- ---------------------

“Correlation of Ultrasonography and Magnetic resonance cholangiopancreatography in

different types of Choledochal Cysts” शीर्यक से िााः जीमत
ु िाहि मम
ु ूय द्िारा क्रकया जािा
अिस
ु न्धाि काययके बारे में परू ा इयाि प्राप्त करिेके बाद, मैं सेच्छासे आपिे आपको घोवर्त
अध्ययिमे, विर्यके रूपमे, शभमल करिे के भलये अपिी सहमनत दे रहा हूं। मेरे शाभमल
प्रक्रियाके बारे में मेरी िद
ु की भार्ामें मेरी परू ी संतजु ष्ि के भलए समिाया गया है । मैं, अध्ययिके दौराि
क्रकसी भी समय इस अध्ययिमें भाग लेिे से मिा करिे के अगधकार प्राप्त करता हूं। हालांक्रक इस
इंकार से विभागकी ओरसे मेरी बीमारीके उपचारके साथ कोई हस्तक्षेप िही क्रकया जािेकी
आश्िासि टदया गया है । मैं इस के द्िारा मेरे रोग की गचक्रकत्साके इनतहास प्रदाि करिे का
घोवर्त करते हैं । मूिे अगले दो साल के भलए नियभमत अंतराल पर अिुिती िैदानिक परीक्षासे
गुजरिा है ।और इसके दौराि आिश्यक िैदानिक सामग्री के संग्रह के भलए अिुमनत दे ते हैं। हम
ये भी समिते हैं की इस शोध अध्ययिसे मेरे बीमारी को बेहतर समििे में मदद और मेरी बीमारी
के उपचारको फायदा होगा । मेरा मेडिकल रे कॉिय और अपिे डिकलरर कॉिय गोपिीय रिा जाएगा
और मेरी अिुमनत के बबिा उपयोग िहीं क्रकया जािेकी आश्िासि टदया गया है । मैं भी अध्ययि के
दौराि उत्पन्ि होिे िाली क्रकसी भी आपातजस्थनत के मामलेमें िॉ, जीमुत िाहि मुमूय रे डियो-निदाि,
िीलरति सरकार मेडिकल कॉलेज एिं अस्पतालके विभाग में एम िी पी जी िी संपकय करिे के भलए
सूगचत क्रकया गया है ।

परू ासाथ घोर्क / अभभभािक के हस्ताक्षर / अंगठ

ू े का निशाि / िाम:-

परू ा िाम के साथ गिाह का हस्ताक्षर / अंगठ

ू े का निशाि :-

परू ा िाम के साथ अन्िेर्क के हस्ताक्षर :-

ताररि :-
जगह :-
7.ADDITIONAL RESOURCES
The imaging modality used in my thesis is completely free of cost,so no financial disclosure
needed.

8.REFERENCES:
1) Todani T, Watanabe Y, Narusue M, Tabuchi K, Okajima K. Congenital bile duct
cysts: classification, operative procedures, and review of thirty-seven cases including
cancer arising from choledochal cyst. Am J Surg. 1977; 134:263–269.
2) Alonso-Lej F, Rever WB, Pessango DJ. Congenital choledochal cyst, with a report of
2, and analysis of 94 cases. Int Abstr Surg. 1959;108:1–30
3) Ziegler KM Ann Surg. 2010 Oct; 252(4):683-90. doi:
10.1097/SLA.0b013e3181f6931f
4) Liu CL, Fan ST, Lo CM, Lam CM, Poon RT, Wang J. Choledochal cysts in adults.
Arch Surg. 2002; 137:465–468.
5) Visser BC, Suh I, Way LW et-al. congenital choledochal cysts in adults. Arch Surg.
2004; 139 (8): 855-60.
6) Lilly JR, Stellin GP, Karrer FM. Forme fruste choledochal cyst. J Pediatr Surg.
1985;20:449–51
7) Todani T, Watanabe Y, Toki A, Morotomi Y. Classification of congenital biliary
cystic disease: special reference to type Ic and IVA cysts with primary ductal
stricture. J Hepatobiliary Pancreat Surg. 2003; 10:340–344.
8) Kaneyama K, Yamataka A, Kobayashi H, et al. Mixed type I and II choledochal cyst:
A new clinical subtype. Pediatr Surg Int. 2005;21:911–3
9) Lipsett PA -Choledochal cyst disease. A changing pattern Ann Surg. 1994 Nov;
220(5):644-52.
10) Kim OH, Chung HJ, Choi BG. Imaging of the choledochal cyst. Radiographics. 1995;
15 (1): 69-88.
11) Liu YB, Wang JW, Devkota KR, Ji ZL, Li JT, Wang XA, et al. Congenital choleochal
cysts in adults: twenty-five-year experience. Chin Med J. 2007;120:1404–1407.
12) Park DH, Kim MH, Lee SK, Lee SS, Choi JS, Lee YS, et al. Can MRCP replace the
diagnostic role of ERCP for patients with choledochal cysts? Gastrointest Endosc.
2005;62:360–366.
13) Loke TK, Lam SH, Chan CS. Choledochal cyst. An unusual type of cystic dilatation
of the cystic duct. AJR Am J Roentgenol. 1999;173:619–20.
14) Babbitt DP. Congenital choledochal cyst: New etiological concept based on
anomalous relationships of the common bile duct and pancreatic bulb. Ann Radiol
(Paris) 1969;12:231–40.
15) Huang SP, Wang HP, Chen JH, Wu MS, Shun CT, Lin JT. Clinical application of
EUS and peroral cholangioscopy in a choledochocele
with choledocholithiasis. Gastrointest Endosc. 1999;50:568–71

16) Komi N, Takehara H, Kunitomo K, Miyoshi Y, Yagi T. Does the type of anomalous
arrangement of pancreaticobiliary ducts influence the surgery and prognosis of
choledochal cyst? J Pediat Surg. 1992; 27:728–731.
 CURRICULUM VITAE

DR. JIMUT BAHAN MURMU

QUALIFICATION: MBBS
DESIGNATION: MD PGT, Department of Radio-Diagnosis, Nilratan Sircar Medical College and
Hospital, Kolkata.
CONTACT NO. +919002829101
E. MAIL ID: jb.murmu@gmail.com
ADDRESS: Vill: Dhumadih, P.O: Karkara, Dist: Purulia, West Bengal, Pin code: 723213
PERSONAL PROFILE:
DATE OF BIRTH: 18th August 1977
FATHER’S NAME: Muneshwar Murmu
MOTHER’S NAME: Padma Murmu
GENDER: MALE
NATIONALITY: INDIAN
MARITAL STATUS: MARRIED
LANGUAGES KNOWN: BENGALI, HINDI, ENGLISH,
EDUCATIONAL QUALIFICATION
NAME OF THE NAME OF THE NAME OF YEAR OF MARKS % OF
EXAMINATION BOARD/UNIVERSITY INSTITUTION PASSING OBTAINED MARKS
MADHYAMIK (10TH) WEST BENGAL Ananda Marga High 1994 577 64.11
BOARD OF School.
SECONDARY
EDUCATION
HIGHER SECONDARY WEST BENGAL Purulia Zilla School 1996 523 52.40
(10+2) COUNCIL OF
HIGHER SECONDARY
EDUCATION
MBBS UNIVERSITY OF Calcutta National 2004 1384 56.48
CALCUTTA Medical College

DPH WBUHS A.I.I.H&P.H 2015 416 59.42

YEAR OF PASSING MBBS: 2004

NO. AND DATE OF REGISTRATION: 60683; 30/05/2005

ISSUING AUTHORITY: WEST BENGAL MEDICAL COUNCIL

EMPLOYMENT: West Bengal Health Service- 2008