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[Arterial anatomy of the celiac trunk and the superior mesenteric artery with computerized tomography]
M Sponza1, R Pozzi Mucelli, F Pozzi Mucelli
1Istituto di Radiologia, Università, Trieste.
Insights
This study shows that computed tomography (CT) effectively visualizes the celiac trunk and its branches, including anatomical variants. Knowledge of these arterial variations is crucial for planning liver surgery.
Area of Science:
- Radiology
- Vascular Anatomy
- Medical Imaging
Background:
- The celiac trunk and superior mesenteric artery are critical for abdominal organ vascularization.
- Anatomical variations of these arteries can impact surgical planning, particularly for liver procedures.
- Computed tomography (CT) is a widely used imaging modality for evaluating abdominal vasculature.
Purpose of the Study:
- To retrospectively evaluate the visibility of the celiac trunk, its branches, and the superior mesenteric artery using CT.
- To assess the capability of CT in demonstrating common and uncommon anatomical variants of these arteries.
- To correlate CT findings with angiography for anatomical variant confirmation.
Main Methods:
- Retrospective review of 100 abdominal CT scans to assess visualization of the celiac trunk and superior mesenteric artery.
- 36 patients also underwent angiography to confirm suspected anatomical variants identified on CT.
- CT examinations were performed using a General Electric 9800 Advantage scanner with 10 mm or 5 mm contiguous slices.
Main Results:
- The celiac trunk and common hepatic artery were visualized in all 100 CT scans.
- Visibility varied for other branches: splenic artery (97%), superior mesenteric artery (100%), left gastric artery (82%), gastroduodenal artery (70%).
- Anatomical variants, such as the right hepatic artery originating from the superior mesenteric artery, were identified in 19% of cases when both CT and angiography were performed.
Conclusions:
- Modern CT scanners reliably depict the celiac trunk and its anatomical variants.
- Understanding these arterial variations is essential for surgeons performing liver surgery.
- Conventional 10 mm CT slices are adequate for visualizing major vessels and variants, while 5 mm slices offer improved detail for smaller branches.
Abstract:
A hundred patients with different conditions underwent CT and the results were retrospectively reviewed to evaluate the visibility of the celiac trunk, of its branches and of the superior mesenteric artery. Thirty-six patients underwent angiography too, which allowed the anatomical variants suspected on CT to be demonstrated, according to Kuhns' criteria. The other 64 patients were consecutively selected and only aneurysmal changes were not included. All examinations were performed using a General Electric 9800 Advantage scanner, with 2 second scanning time and 10 mm-thick contiguous scans. In 20 patients 5 mm contiguous scans were performed. All examinations followed i.v. injections of contrast agents which were given with an automatic injector. The cases with suspected anatomical variants on CT but with no angiographic confirmation were not considered. A hundred CT exams were retrospectively reviewed: the celiac trunk and the common hepatic artery were demonstrated in all of them. Visibility of the other branches was 40% for the hepatic artery, 53% for the right branch of the hepatic artery and 39% for its left branch, 70% for the gastroduodenal artery, 82% for the left gastric artery, 97% for the splenic artery and 100% for the superior mesenteric artery. As for the 36 patients who underwent both CT and angiography, right hepatic artery from the superior mesenteric artery was seen in 19% of cases with both modalities; common hepatic artery arising from the superior mesenteric artery was detected in 2% of cases. In both instances, these anatomical variants appeared as a vessel running posterior to the portal vein. The careful investigation of axial CT scans showed the level of origin of the artery from the superior mesenteric artery. These results are in agreement with the angiographic data reported in the literature. Our study demonstrated that the celiac trunk and its variants are always depicted by the new CT scanner. The knowledge of these variants may be useful in the patients to submit to liver surgery. The celiac trunk and its variants are demonstrated with conventional 10 mm slices. The use of 5 mm slices improves the visibility of thin anatomical branches but is not essential to recognize the major vessels and anatomical variants.