PURPOSES: In the current study, we evaluated the efficacy of dual-phase three-dimensional (3D) CT angiography (CTA) in the assessment of the vascular anatomy, especially the right hepatic artery (RHA), before gastrectomy. METHODS: The study initially included 714 consecutive patients being treated for gastric cancer. A dual-phase contrast-enhanced CT scan using 32-multi detector-row CT was performed for all patients. RESULTS: Among the 714 patients, 3D CTA clearly identified anomalies with the RHA arising from the superior mesenteric artery (SMA) in 49 cases (6.9 %). In Michels' classification type IX, the common hepatic artery (CHA) originates only from the SMA. Such cases exhibit defective anatomy for the CHA in conjunction with the celiac-splenic artery system, resulting in direct exposure of the portal vein beneath the #8a lymph node station, which was retrospectively confirmed by video in laparoscopic gastrectomy cases. Fused images of both 3D angiography and venography were obtained, and could have predicted the risk preoperatively, and the surgical finding confirmed its usefulness. CONCLUSION: Preoperative evaluations using 3D CTA can provide more accurate information about the vessel anatomy. The fused images from 3D CTA have the potential to reduce the intraoperative risks for injuries to critical vessel, such as the portal vein, during gastrectomy.
PURPOSES: In the current study, we evaluated the efficacy of dual-phase three-dimensional (3D) CT angiography (CTA) in the assessment of the vascular anatomy, especially the right hepatic artery (RHA), before gastrectomy. METHODS: The study initially included 714 consecutive patients being treated for gastric cancer. A dual-phase contrast-enhanced CT scan using 32-multi detector-row CT was performed for all patients. RESULTS: Among the 714 patients, 3D CTA clearly identified anomalies with the RHA arising from the superior mesenteric artery (SMA) in 49 cases (6.9 %). In Michels' classification type IX, the common hepatic artery (CHA) originates only from the SMA. Such cases exhibit defective anatomy for the CHA in conjunction with the celiac-splenic artery system, resulting in direct exposure of the portal vein beneath the #8a lymph node station, which was retrospectively confirmed by video in laparoscopic gastrectomy cases. Fused images of both 3D angiography and venography were obtained, and could have predicted the risk preoperatively, and the surgical finding confirmed its usefulness. CONCLUSION: Preoperative evaluations using 3D CTA can provide more accurate information about the vessel anatomy. The fused images from 3D CTA have the potential to reduce the intraoperative risks for injuries to critical vessel, such as the portal vein, during gastrectomy.
Authors: Corinne B Winston; Nancy A Lee; William R Jarnagin; Jerrold Teitcher; Ronald P DeMatteo; Yuman Fong; Leslie H Blumgart Journal: AJR Am J Roentgenol Date: 2007-07 Impact factor: 3.959
Authors: H Yano; T Monden; M Kinuta; Y Nakano; T Tono; S Matsui; T Iwazawa; T Kanoh; S Katsushima Journal: Gastric Cancer Date: 2001 Impact factor: 7.370
Authors: Bertram J Stemmler; Erik K Paulson; Frank J Thornton; Sharon R Winters; Rendon C Nelson; Bryan M Clary Journal: AJR Am J Roentgenol Date: 2004-12 Impact factor: 3.959
Authors: Jieun Kim; Su Mi Kim; Jeong Eun Seo; Man Ho Ha; Ji Yeong An; Min Gew Choi; Jun Ho Lee; Jae Moon Bae; Sung Kim; Woo Kyoung Jeong; Tae Sung Sohn Journal: J Gastric Cancer Date: 2016-06-24 Impact factor: 3.720