ÇOK KESİTLİ BİLGİSAYARLI TOMOGRAFİ İLE PORTAL VEN ANATOMİK VARYASYONLARININ DEĞERLENDİRİLMESİ

Yıl 2017, Cilt: 8 Sayı: 29, 19 - 26, 01.03.2017

Rasim Yanmaz

https://doi.org/10.17944/mkutfd.304243

Öz

Amaç: Bu çalışmada amaç; rutin üst abdominal
çok kesitli bilgisayarlı tomografi (ÇKBT) görüntülerinde portal ven (PV)
varyasyon dağılımını ve sıklığını belirlemektir.

Gereç ve Yöntem: Rutin
abdominal tomografileri 64 kesit ÇKBT ile çekilen 363’ükadın,387’sierkektoplam
750hastanın görüntüleri retrospektif olarak değerlendirildi.Portal fazda elde
edilen görüntüler multiplanar reformat ve üç boyutlu postprosesing sonrası
değerlendirildi.

Bulgular: Toplam 750 hastanın 134’ünde (%17.9)
ana PV varyasyonları saptandı. Sekiz hastada (% 1.2) sağ posterior portal ven
varyasyonu tespit edildi. Tip 1 varyasyon 616 hastada (% 82.1), tip 2 varyasyon
72 hastada (%9.6),tip 3 varyasyon 53 hastada (% 7.4),sağ portal ven
trifurkasyonu 8 hastada (%0.9), quadrifikasyon 1 hastada (%0.1),total
ramifikasyon 1 hastada (% 0.1) bulundu. Toplamda PV varyason ve anomalisi 142
hastada (%19.1) tespit edildi.

Sonuç: Portal ven varyasyon varlığının
saptanmasında ÇKBT etkin bir yöntemdir. Abdominal tomografi incelemelerinin
raporlanması sırasında portal ven varyasyonlarına dikkat edilmesi ve belirtilmesi
klinik açıdan önemli varyasyonların cerrahi planı değiştirebilmesi ve
komplikasyonları azaltması açısından önemlidir.

Anahtar Kelimeler

Abdomen, portal ven, varyasyon, çok kesitli bigisayarlı tomografi

Kaynakça

• 1. Guven K, Acunas B. Multidetector computed tomography angiography of the abdomen. Eur J Radiol 2004;52:44–55.
• 2. Şaylısoy S, Atasoy Ç, Ersöz S, Karayalçın K, Akyar S, Karaciğer sağ lob dönor adaylarında çok kesitli BT anjiografi ile vaskuler sistemin değerlendirilmesi. Diagn İnterv Radiol 2005;11:51–59
• 3. Şahin H.S.Kalp embriyolojisi. Ankara: Hacettepe ünv kardivaskuler cerrahi, 2005;s: 5
• 4. Bass J, Redwine M. D, KramerL , Huynh P, Harris J. Spectrum of Congenital Anomalies of theInferior Vena Cava: Cross-sectional ImagingFindings. Radiographics. 2000;20:639–652.
• 5. Apaydın M, Apaydın A, Sarsılmaz A, Varer M. Kesitsel radyolojik incelemelerde karşılaşılan VCİ devamsızlığı anomalisi ve muhtemel embriyolojik kökenleri. Turkish J Vasc Surg 2007;16 25–30
• 6. Chuang V, Mena C, Hoskins P. Con-renal veins and inferior vena cava at maggenital anomalies of the left renal vein: an-neticres on anceangiography. Cardiovascgiographic consideration. Br J Radiol Intervent Radiol 1995; 18:153–157.
• 7. Aljabri B, MacDonald P, Satin R, Stein L, Obrand D, Steinmetz O.Incidence of major venous and renal anomalies revelant to aortoiliac surgery as demonstrated by computedtomography. AnnVasc Surg 2001;15:615–618.
• 8. Kayalı H. Özel histoloji. In: Sindirim sistemi. İstanbul: Taş matbaası, 1984;s:140.
• 9. Sadler TW. Medikal embriyoloji. In: Sindirim sistemi. Ankara: Özkan Matbaacılık, 1996; s:231–59.
• 10. 10. Difiore M.S. H, Histoloji Atlası. İstanbul: Güven yayıncılık, 1992;s:86.
• 11. Arıncı K, Elhan A. Anatomi. Ankara: Güneş Kitapevi, 1997;123–34.
• 12. Kuran O. Sistematik anatomi. İstanbul: Filiz Kitapevi,1983;340–497
• 13. Nayak S. Commonceliaco-mesenterico-phrenictrunk and renal vascular variations. Saudi Med J. 2006;27:1894–6.
• 14. Urban B, RatnerL, FishmanE. Three-dimensional volume- rendered CT angiography of the rena larteries andv eins: normal anatomy, variants, and clinicalapplications.Radiographics 2001;21:373–86.
• 15. TunaY. Karaciğer arter variasyonları üzerinde anatomik araştırmalar. Edirne: Tıp Fakültesi Dergisi 1979;1:89–96.
• 16. Snell R. Karın boşluğu. In: Klinik anatomi. istanbul: Nobel; 1998;s:183–274.
• 17. Paker F. Sindirim sistemi. In: Histoloji. Bursa: Uludağ Üniversitesi Basımevi; 1993;s:361
• 18. Covey A, Brody L, Getrajdman G, Sofocleous C, Brown K. Incidence, patterns and clinical relevance of variants portal veinanatomy. Am J Roentgenol 2004;183:1055–64
• 19. Arıncı K, Elhan A. Anatomi. Ankara: Güneş Kitabevi, 1997:123–34.
• 20. Federative Comittee of Anatomical Terminology (FCAT). Terminologia anatomica. Stuttgart: Georg Thieme Verlag; 1998;s: 55.
• 21. Tuncel E. Klinik radyoloji. Bursa: Nobel&Güneş Tıp Kitabevi 2008;73–76,87–103.
• 22. Rubin G, Alfrey E, Dake M. Assessent of living renal donors with spiral CT. Radiology 1995;195:457–462.
• 23. Platt J, Ellis J, Korobkin M, Reige K. Helical CT evaluation of potential kidney donors, findings in 154 subjects. Am J Roentgenol 1997;169:1325–1330
• 24. Patil U, Ragavan A, Nadaraj K, Murthy K, Shankar R, Bastani B, Ballal SH. Helical CT angiography in evaluation of livekidneydonors. Nephrol Dial Transplant 2001;16 : 1900–1904.
• 25. Michels N. Blood supply and anatomy of the upper abdominal organs with a descriptive atlas. Philadelphia, PA: Lippincott, 1955; s:122.
• 26. Diehm N, Herrmann P, Dinkel H. Multidetector CT angiography versus digital subtraction angiography for aortoiliac length measurements before endovascular AAA repair. J Endovasc Ther 2004;11:527 -534.
• 27. Guven K, Acunas B. Multidetector CT angiography of the abdomen. Eur J Radiol 2004; 52:44 – 55.
• 28. Vandamme J, Bonte J, Van der Schueren G. A revaluation of hepatic and cystic arteries: the importance of the aberrant hepatic branches. Acta Anat 1969;73:192–209.
• 29. Atasoy C, Ozyurek E. Prevalence and types of main and right portal vein branching variations on MDCT. AJR Am J Roentgenol 2006; 187:676–681.
• 30. Koç Z, Ulusan Ş, Oğuzkurt L, Tokmak N. Venous variant sand anomalies on routine abdominal multi-detector row CT. Eur J Radiol 2007;61:267–78.
• 31. Bass J, Redwine M, Kramer L, Huynh P, Harris Jr J. Spectrum of congenital anomalies of the inferior vena cava: cross-sectional imaging findings. Radiographics 2000;20:639–52.
• 32. Yeşildağ A, Adanır E, Köroğlu M, Baykal B, Oyar O, Gülsoy UK, Rutin abdomen BT’de sol renal ven anomalilerinin görülme sıklığı. Tanısal ve Girişimsel Radyoloji. 2004;10:140–143
• 33. Chai J, Lee W, Yin Y, Jae H, Chung J, Kim H, Park J. CT angiograph for living kidney donors: accuracy, cause of misinterpretation and prevalence of variation Korean J Radiol. 2008 ;9:333–9.
• 34. Satyapal K, Kalideen J, Haffejee A, Singh B, Robbs J. Left renal vein variations. Surg RadiolAnat 1999; 21:77–81.
• 35. Mitty H. Circumaortic renal collar. A potentially hazardous anomaly of the left renal vein. Am J Roentgenol Radium TherNuclMed 1975;125:307–310.
• 36. Urban B, RatnerL, Fishman E,Three-dimensional volume-rendered CT angiography of the renal arteries and veins: normal anatomy, variants, and clinical applications. Radiographics2001;21:373–86.
• 37. Kamel I, Kruskal J, Keogan M, Gold-E, Keogan M, Warmbrand G, Raptopoberg S, Warmbrad G,Raptopoulos V.Multidetector CT of potential right-lobe liver donors. Am J Roentgenol 2001;177:645–651.
• 38. Kamel I, Kruskal J, Keogan,PomfretA,Keogan M,Warmbrand G,Raptopoberg S,Warmbrad G,Raptopoulos V.Impact of multidetector CT on donor selection and surgical planning before 177:645–651.living adult right lobe liver transplantation. Am J Roentgenol 2001;176:193200
• 39. Kamel I, Raptopoulos V, Pomfret E, Kruskal J, Kane R, Yam C, Jenkins R. Living adult right lobe liver transplantation: imaging before surgery with multidetector multiphase CT. Am J Roentgenol 2000;175:1141–1143.
• 40. Guiney M, Kruscal J, Sosna J, Hanto D, Goldberg S, Raptopoulos V. Multidetector row CT of relevant vascular anatomy of the surgical plane in split-liver transplantation. Radiology 2003;229:401–407.
• 41. Kruskal J, Raptopaulos V. How I do it: preoperative CT scanning for adult living right lobe liver transplantation. Eur Radiol 2002;12:1423–1431.
• 42. Deshpande R, Heaton N, Rela M. Surgical anatomy of segmental liver transplantation. Br J Surg 2002; 89:1078–1079.
• 43. Mortele K, Cantisani V, Troisi R, de Hemptine B, Silverman S. Preoperative liver donor evaluation: imaging and pitfalls. Liver Transpl 2003; 9:6–14.
• 44. Laverdiere JT, Laor T, Benacerraf B. Congenital absence of the portal vein: Case report and MR demonstration. Pediatr Radiol 1995; 25: 52–53.
• 45. Marcos A. Right lobe living donor liver transplantation: a review. Transplantation 2000; 6: 3 20.
• 46. Pomfret EA, Pomposelli JJ, Lewis WD, Gordon FD, Burns DL, LallyA,Raptopoulos V, Jenkins JL. Live donor adult liver transplantation using right lobe grafts: donor evaluation and surgical outcome. ArchSurg 2001; 136: 425–433.
• 47. Marcos A, Orloff M, Mieles L, Olzinski AT, Renz JF, Sitzmann JV. Functional venous anatomy for right-lobe grafting and techniques to optimize outflow. Liver Transpl 2001; 7: 845–852.
• 48. Kitami M, Takase K, Murakami G, Ko S, Tsuboi M, Saito H, Higano S, NakajimaY,Takahashi S.Types and frequencies of biliary tract variations associated with a major portal venous anomaly: analysis with multi-detector row CT cholangiography. Radiology 2006; 238: 156–166.
• 49. .Mc Collough CH, Zink FE. Performance evaluation of a multi-slice CT system. Med Phys 1999; 26: 2223-2230.
• 50. Nakamura TN, Tanaka K, Kiuchi T, et al. Anatomical variations and surgical strategies in right lobe living donor liver transplantation: lessons from 120 cases. Transplantation 2002; 73:1896–1903
• 51. Erbay N, Raptopoulos V, Pomfret E A,Kamel IR, Kruskal JB. Living donor liver transplantatio in adults: vascular variants important in surgical planning for donors and recipients. AJR Am J Roentgenol 2003;181:109–114.
• 52. Marcos A, Orloff M, Mieles L, Olzinski A, Sitzmann J. Reconstruction of double hepatic arterial and portal venous branches for right-lobe living donor liver transplantation. Liver Transpl 2001; 7:673–679
• 53. Fraser-Hill MA, Atri M, Bret PM, Aldis AE, Illescas FF, Herschorn SD.Intrahepatic portal venous system: variations demonstrated with duplex and colorDoppler US. Radiology 1990; 177:523–526
• 54. Soyer P, Bluemke DA, Choti MA, Fishman EK.Variations in the intrahepatic portions of the hepatic and portal veins: findings on helical CT scans during arterial portography. AJR 1995; 164:103–108
• 55. Hata F, Hirata K, Murakami G, Mukaiya M. Identification of segments VI and VII of the liver based on the ramification patterns of the intrahepatic portal and hepatic veins. Clin Anat 1999; 12:229–244
• 56. Baba Y, Hokotate H, Nishi H, Inoue H, NakajoM. Intrahepatic portal venous variations: demonstration by helical CT during arterial portography. J Comput Assist Tomogr 2000; 24:802–808
• 57. Akgul E, Inal M, Soyupak S, Binokay F, Aksungur E, Oguz M. Portal venous variations: prevalence withc ontrast-enhanced helical CT. Acta Radiol 2002; 43:315–319