Document Detail


Dual-phase 3D CT angiography during a single breath-hold using 16-MDCT: assessment of vascular anatomy before laparoscopic gastrectomy.
MedLine Citation:
PMID:  16554582     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: In this study, we evaluated the efficacy of dual-phase 3D CT angiography (CTA) during a single breath-hold using 16-MDCT in the assessment of vascular anatomy before laparoscopic gastrectomy. MATERIALS AND METHODS: The study involved 20 consecutive patients (10 men, 10 women; mean age, 59 years) scheduled for laparoscopic gastrectomy for the treatment of early gastric cancer. A dual-phase contrast-enhanced CT scan using 16-MDCT was obtained before laparoscopic gastrectomy. After rapid infusion of a nonionic contrast agent, arterial and venous phase scans were obtained serially with an interval of 15 sec during a single breath-hold of 31 sec. Three-dimensional CTA images in the arterial phase (3D CT arteriography) and venous phase (3D CT venography) were individually reconstructed using the volume-rendering technique, and then the images were fused together. We evaluated the detectability of the celiac trunk, left gastric artery (LGA), right gastric artery (RGA), left gastric coronary vein (LCV), Henle's gastrocolic trunk, right gastroepiploic vein (RGEV), and accessory right colic vein on 3D CTA to compare with surgical findings. RESULTS: In all 20 patients, 3D CT arteriography and venography clearly showed the celiac trunk, LGA, RGA, Henle's gastrocolic trunk, RGEV, and accessory right colic vein, which were correctly identified during surgery. The branching pattern of the celiac trunk was classified as Michels type I in 19 patients and Michels type II in one patient. Imaging showed the RGA originating from the proper hepatic artery (PHA) in nine patients; from the gastroduodenal artery (GDA) in seven patients; and from the left hepatic artery (LHA) in four patients. In 12 patients, the LCV joined the portal vein (PV) and in eight, the splenic vein (SV). In all patients, the accessory right colic vein joined the RGEV, and Henle's gastrocolic trunk proximal to the joining point flowed to the superior mesenteric vein (SMV). In all 20 patients, the fused image simultaneously showed arteries and veins around the stomach, with no mismatch between the arterial and venous phase images. In 10 patients, the LCV joined the PV after running along the dorsal side of the PHA, common hepatic artery (CHA), or splenic artery (SA). In eight patients, the LCV joined the SV after running along the ventral side of the PHA, CHA, or SA. In two patients, the LCV joined the PV after running along the ventral side of the CHA, which correlated with the surgical findings. Both the sensitivity and positive predictive values of 3D CTA revealed 100% correct identification of the celiac trunk, LGA, RGA, LCV, Henle's gastrocolic trunk, RGEV, and accessory right colic vein. CONCLUSION: Dual-phase 3D CTA using 16-MDCT clearly revealed individual arteries and veins around the stomach before laparoscopic gastrectomy. The fused image of 3D CT arteriography and venography during a single breath-hold enabled the simultaneous assessment of arteries and veins before laparoscopic gastrectomy.
Authors:
Mitsuru Matsuki; Masato Tanikake; Hiroyuki Kani; Fuminari Tatsugami; Shuji Kanazawa; Takaaki Kanamoto; Yuki Inada; Syushi Yoshikawa; Isamu Narabayashi; Sang-Woong Lee; Eiji Nomura; Junji Okuda; Nobuhiko Tanigawa
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  AJR. American journal of roentgenology     Volume:  186     ISSN:  0361-803X     ISO Abbreviation:  AJR Am J Roentgenol     Publication Date:  2006 Apr 
Date Detail:
Created Date:  2006-03-23     Completed Date:  2006-05-30     Revised Date:  2008-02-15    
Medline Journal Info:
Nlm Unique ID:  7708173     Medline TA:  AJR Am J Roentgenol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1079-85     Citation Subset:  AIM; IM    
Affiliation:
Department of Radiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka 569-8686, Japan. rad053@poh.osaka-med.ac.jp
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Angiography / methods*
Female
Gastrectomy / methods*
Humans
Imaging, Three-Dimensional*
Laparoscopy*
Male
Middle Aged
Preoperative Care
Respiration*
Stomach / blood supply*,  radiography*
Stomach Neoplasms / radiography*,  surgery*
Tomography, X-Ray Computed / methods*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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