Abstract
Purpose
This study was undertaken to evaluate the accuracy of 64-row computed tomography angiography (CTA) in the study of vascular anatomy by assessing the incidence of anatomical variations of the origin of the coeliac trunk, mesenteric arteries and collateral branches.
Materials and methods
Sixty patients were evaluated with 64-row CTA (VCT, General Electric Healthcare, Milwaukee, WI, USA) with a collimation of 0.625 mm after the injection of iodinated nonionic contrast material (4 ml/s). Exclusion criteria were the presence of any pathological condition likely to affect normal vascular anatomy.
Results
The coeliac trunk had a normal trifurcation in 56.7% of cases. The common hepatic artery was normal in 60% of patients. The inferior pancreaticoduodenal arteries were either absent or not assessable in 8.3% of cases and there was a double trunk in 5%, a common trunk in 83.3% and a single vessel in 3.3%. The number of jejunal and ileal arteries ranged from a minimum of six to a maximum of 13 (mean value 8.7 ± 1.34). The Riolan arcade was assessable in 31.7% and developed in 68.4% of these.
Conclusions
The 64-row CTA enables visualisation of small vessels and accessory arteries that are difficult to identify with other techniques. The technique’s high sensitivity allowed us to observe that the prevalence of vascular abnormalities is higher than that reported in the literature.
Riassunto
Obiettivo
Valutare l’adeguatezza dell’angio-TC a 64 strati nello studio dell’anatomia vascolare, studiando l’incidenza delle varianti anatomiche di origine del tripode celiaco, delle arterie mesenteriche superiori ed inferiori, e dei loro rami collaterali dall’aorta.
Materiali e metodi
Sono stati valutati 60 pazienti sottoposti a studio con angio-TC a 64 strati, utilizzando una collimazione submillimetrica (0,625) e previa somministrazione di mezzo di contrasto iodato non ionico ad alto flusso (4 ml/s). I criteri di esclusione riguardavano tutte quelle condizioni che potevano modificare normale anatomia vascolare.
Risultati
Il tripode celiaco presentava una normale triforcazione nel 56,7% dei casi. L’arteria epatica comune è risultata normale nel 60% dei casi. Le arterie pancreatico-duodenali inferiori risultavano assenti o non valutabili nel 8,3%, era presente un doppio tronco nel 5%, un tronco comune nel 83,3%, ed un unico vaso nel 3,3%. Il numero delle arterie digiuno-ileali variava da un minimo di 6 ad un massimo di 13 con una media di 8,7±1,34. L’arcata di Riolano è risultata valutabile nel 31,7% dei casi, e di questi era sviluppata nel 68,4%.
Conclusioni
L’angio-TC a 64 strati permette di visualizzare piccoli vasi ed arterie accessorie, difficilmente identificabili con altre metodiche. Questa elevata sensibilità ha permesso di rilevare come il numero di anomalie vascolari risulti più elevato di quello riportato in letteratura.
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References/Bibliografia
Adriaensen M, Kock M, Stijnen T et al (2004) Peripheral arterial disease: therapeutic confidence of CT versus digital subtraction angiography and effects on additional imaging. Radiology 233:385–391
Nelson TM, Pollak R, Jonasson O, Abcarian H (1988) Anatomic variants of the celiac, superior mesenteric, and inferior mesenteric arteries and their clinical relevance. Clin Anat 1:75–91
Ruzicka FF, Rankin RS (1977) Normal anatomy of the abdominal aorta. Crit Rev Diagn Imaging 9:337–385
Piquand G (1910) Recherches sur l’anatomie du tronc coeliaque et de ses branches. Bibliogr Anat 19:159–201
Koops A, Wojciechowski B, Broering DC et al (2004) Anatomic variations of the hepatic arteries in 604 selective celiac and superior mesenteric angiographies. Surg Radiol Anat 26:239–244
Michels NA (1966) Newer anatomy of the liver and its variant blood supply and collateral circulation. Am J Surg 112:337–347
Suzuki T, Nakayasu A, Kawabe K, Takeda H, Honjo I (1971) Surgical significance of anatomic variations of the hepatic artery. Am J Surg 122:505–512
Daly JM, Kemeny N, Oderman P, Botet J (1984) Long-term hepatic arterial infusion chemotherapy. Arch Surg 119:936–941
Rygaard H, Forrest M, Mygind T, Baden H (1986) Anatomic variants of the hepatic arteries. Acta Radiol Diagn 27:425–427
Chen CY, Lee RC, Tseng HS et al (1998) Normal and variant anatomy of hepatic arteries: angiographic experience. Chin Med J 61:17–23
De Santis M, Ariosi P, Calo GF, Romagnoli R (2000) Anatomia vascolare arteriosa epatica e sue varianti. Radiol Med 100:145–151
Bertelli E, Bertelli L, Di Gregorio F et al (1997) The arterial blood supply of the pancreas: a review. IV. The anterior inferior pancreaticoduodenal a., the posterior inferior pancreaticoduodenal a. and minor sources of blood supply for the head of the pancreas. An anatomic review and a radiologic study. Surg Radiol Anat 19:203–212
Donatini B (1990) A systematic study of the vascularization of the pancreas. Surg Radiol Anat 12:173–180
Murakami G, Hirata K Takamuro T et al (1999) Vascular anatomy of the pancreaticoduodenal region: a review. J Hepatobiliary Pancreat Surg 6:55–68
Shapiro AL, Robillard GL (1946) Morphology and variations of the duodenal vasculature. Arch Surg 52:571–602
Kornblith PL, Boley SJ, Whitehouse BS (1992) Anatomy of the splanchnic circulation. Surg Clin North Am 72:1–30
Toni R, Favero L, Mosca S et al (1988) Quantitative clinical anatomy of the pancreatic aa. Studied by selective celiac angiography. Surg Radiol Anat 10:53–60
Michels N (1955) Blood supply and anatomy of the upper abdominal organs. JB Lippincott, Philadelphia
Kadir S (1991) Atlas of normal and variant angiographic anatomy. WB Saunders, Philadelphia
VanDamme JP, Bonte J (1990) Vascular anatomy in abdominal surgery. Thieme Verlag, New York
Renner K, Ausch C, Rosen HR, Perik E (2003) Collateral circulation of the left colon: historic considerations and actual clinical significance. Chirurg 74:575–578
Sage M, Calmat A, Leguerrier A et al (1977) Vascularization of the transverse colon. Bull Assoc Anat 61:397–406
Geboes K, Geboes KP, Maleux G (2001) Vascular anatomy of the gastrointestinal tract. Best Practice & Research Clinical Gastroenterology 15:1–14
Lorenzini L, Bertelli L, Lorenzi M (1999) Arterial supply in the left colonic flexure. Ann Ital Chir 70:691–698
Michels N, Siddarth P, Kornblith P et al (1965) The variant blood supply to the descending colon, rectosigmoid and rectum based on 400 dissections. Dis Colon Rectum 8:251–256
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Ferrari, R., De Cecco, C.N., Iafrate, F. et al. Anatomical variations of the coeliac trunk and the mesenteric arteries evaluated with 64-row CT angiography. Radiol med 112, 988–998 (2007). https://doi.org/10.1007/s11547-007-0200-2
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DOI: https://doi.org/10.1007/s11547-007-0200-2