Multislice Computed Tomography in the Detection of Abdominal Arterial Vascular Variations

Abstract

Objective: To evaluate, classify, and find the frequencies of the variations of the abdominal aorta and its main branches with multi-slice computed tomography.

Material and Method: Between January 2010 and March 2012, data of 390 adult patients with contrast-enhanced computed tomography were included in the study retrospectively. The patients who had an intraabdominal solid organ or vascular surgery that affects the normal anatomy were excluded. The data were evaluated at the workstation. The frequencies of the variations of the abdominal aorta and its main branches were examined. The effect of gender on variation frequencies was also investigated.

Results: In our study, the most frequent variations were at the hepatic artery, gastroduodenal artery, and renal arteries. The variations of the splenic artery and left gastric arteries were relatively rare. Statistically, a significant difference was not detected between genders in frequencies of variations of the arteries.

Conclusion: According to our study, variations of the hepatic artery and renal arteries were frequently seen. Identification of the vascular variation is very important before the transplantation of liver or kidney or interventional procedures.

Keywords

• multi-slice computed tomography
• abdominal vascular structures
• vascular variations

Abdominal Arteryel Vasküler Varyasyonlarının Tespitinde Çok Kesitli Bilgisayarlı Tomografi

Abstract

Amaç: Çok Kesitli Bilgisayarlı Tomografi ile abdominal aorta ve ana dallarında izlenen varyasyonları saptamak, bu varyasyonları sınıflandırmak ve sıklıklarını ortaya koymaktır.

Gereç ve Yöntem: Ocak 2010 –Mart 2012 tarihleri arasında intravenöz kontrast madde verilmesini takiben dinamik abdomen BT tetkiki yapılan 19-91 yaşları arasındaki 390 erişkin hastanın verileri cinsiyet ve yaş farkı gözetilmeksizin retrospektif olarak çalışmaya alındı. Geçirilmiş solid organ ya da abdominal ana damarsal anatomiyi etkileyebilecek cerrahi öyküsü olan hastalar çalışmaya dahil edilmedi. Veriler iş istasyonunda değerlendirildi. Abdominal aorta ve dallarında görülen varyasyon sıklıkları incelendi ve her iki cinsiyet arasında varyasyon sıklıkları açısından anlamlı bir farklılık olup olmadığı araştırıldı.

Bulgular: Çalışmamızda abdominal aorta ve ana dallarında hepatik arter, gastroduedonal arter, çöliyak arter ve renal arterlerde sıklıkla varyasyon saptandı. Splenik arter ve sol gastrik arterde ise diğer damarsal yapılara göre daha az varyasyon izlendi. Varyasyon sıklıkları açısından cinsiyetlere göre istatistiksel anlamlı farklılık saptanmadı.

Sonuç: Hepatik ve renal arterlerde varyasyonlar sık görülmektedir. Bu varyasyonların önceden bilinmesi özellikle karaciğer, böbrek nakilleri ve bu organlara yönelik yapılacak girişimsel radyolojik işlemlerde büyük önem arz etmektedir.

Keywords

• çok kesitli bilgisayarlı tomografi
• abdominal vasküler yapılar
• vasküler varyasyonlar

References

1. Lawler LP, Fishman EK. Three-dimensional CT angiography with multidetector CT data: study optimization, protocol design, and clinical applications in the abdomen. Crit Rev Comput Tomogr. 2002;43:77-141.
2. Sahani DV, Rastogi N, Greenfield AC, Kalva SP, Ko D, Saini S, et al. Multi-detector row CT in evaluation of 94 living renal donors by readers with varied experience. Radiology. 2005;235:905-910.
3. Santos PVD, Barbosa ABM, Targino VA, Silva NA, Silva YCM, Barbosa F, et al. Anatomical variations of the celiac trunk: A systematic review. Arq Bras Cir Dig. 2018;31(4):e1403.
4. Stemmler BJ, Paulson EK, Thornton FJ, Winters SR, Nelson RC, Clary BM. Dual-phase 3D MDCT angiography for evaluation of the liver before hepatic resection. AJR Am J Roentgenol. 2004;183:1551-1557.
5. Sahani D, Saini S, Pena C, Nichols S, Prasad SR, Hahn PF, et al. Using multidetector CT for preoperative vascular evaluation of liver neoplasms: technique and results. AJR Am J Roentgenol. 2002;179:53-59.
6. Uflacker R. Atlas of vascular anatomy. An angiographic approach. Second Edition, Philadelphia: Lippincott, Williams & Wilkins, 1997:81–112, p.131–142.
7. Sahani D, Mehta A, Blake M, Prasad S, Harris G, Saini S. Preoperative hepatic vascular evaluation with CT and MR angiography: implications for surgery. Radiographics. 2004;24:1367-1380.
8. Vandamme JP, Bonte J. The branches of the celiac trunk. Acta Anat (Basel). 1985;122:110-114.

9. Michel NA. Blood supply and anatomy of the upper abdominal organs, with a descriptive atlas. Philadelphia, Pa: Lippincott; 1955. Observatons on the blood supply of the liver and gallbladder (200 dissections) pp. 64–69.
10. Sagel SS: HSL, pleura, chest wall. Computed body tomography with MRI correlation. Edited by: Lee JKT, Sagel SS, Stanley RY. 2003, New York, NY: Raven.
11. Rubin GD, Shiau MC, Leung AN, Kee ST, Logan LJ, Sofilos MC. Aorta and iliac arteries: single versus multiple detector-row helical CT angiography. Radiology. 2000;215:670-676.
12. Zajko AB, Bron KM, Starzl TE, Van Thiel DH, Gartner JC, Iwatsuki S, et al. Angiography of liver transplantation patients. Radiology. 1985;157:305-311.
13. Winter TC 3rd, Nghiem HV, Freeny PC, Hommeyer SC, Mack LA. Hepatic arterial anatomy: demonstration of normal supply and vascular variants with three-dimensional CT angiography. Radiographics. 1995;15:771-780.
14. Song SY, Chung JW, Yin YH, Jae HJ, Kim HC, Jeon UB, et al. Celiac axis and common hepatic artery variations in 5002 patients: systematic analysis with spiral CT and DSA. Radiology. 2010;255:278-288.
15. Ferrari R, De Cecco CN, Iafrate F, Paolantonio P, Rengo M, Laghi A. Anatomical variations of the coeliac trunk and the mesenteric arteries evaluated with 64-row CT angiography. Radiol Med. 2007;112:988-998.
16. Iezzi R, Cotroneo AR, Giancristofaro D, Santoro M, Storto ML. Multidetector-row CT angiographic imaging of the celiac trunk: anatomy and normal variants. Surg Radiol Anat. 2008;30:303-310.
17. Hiatt JR, Gabbay J, Busuttil RW. Surgical anatomy of the hepatic arteries in 1000 cases. Ann Surg. 1994;220:50-52.
18. Kornafel O, Baran B, Pawlikowska I, Laszczyński P, Guziński M, Sąsiadek M. Analysis of anatomical variations of the main arteries branching from the abdominal aorta, with 64-detector computed tomography. Pol J Radiol. 2010;75:38-45.
19. Ugurel MS, Battal B, Bozlar U, Nural MS, Tasar M, Ors F, et al. Anatomical variations of hepatic arterial system, coeliac trunk and renal arteries: an analysis with multidetector CT angiography. Br J Radiol. 2010;83:661-667.
20. Koops A, Wojciechowski B, Broering DC, Adam G, Krupski-Berdien G. Anatomic variations of the hepatic arteries in 604 selective celiac and superior mesenteric angiographies. Surg Radiol Anat. 2004;26:239-244.
21. Pandey SK, Bhattacharya S, Mishra RN, Shukla VK. Anatomical variations of the splenic artery and its clinical implications. Clin Anat. 2004;17:497-502.
22. Ozkan U, Oğuzkurt L, Tercan F, Kizilkiliç O, Koç Z, Koca N. Renal artery origins and variations: angiographic evaluation of 855 consecutive patients. Diagn Interv Radiol. 2006;12:183-186.
23. Kim JK, Park SY, Kim HJ, Kim CS, Ahn HJ, Ahn TY, et al. Living donor kidneys: usefulness of multi-detector row CT for comprehensive evaluation. Radiology. 2003;229:869-876.
24. Khamanarong K, Prachaney P, Utraravichien A, Tong-Un T, Sripaoraya K. Anatomy of renal arterial supply. Clin Anat. 2004;17:334-336.