title: Multidetector CT arteriography with volumetric three-dimensional rendering to evaluate patients with metastatic colorectal disease for placement of a floxuridine infusion pump.
abstract: OBJECTIVE
  We sought to evaluate the usefulness of multidetector CT (MDCT) arteriography with volumetric three-dimensional (3D) rendering to depict the hepatic vascular anatomy. Our study population was patients who had undergone arterial mapping in preparation for placement of a hepatic arterial floxuridine infusion pump for treatment of metastatic hepatic colorectal carcinoma.
  
  
  METHODS
  We retrospectively reviewed the medical records of 26 patients with hepatic colorectal metastases who had been scheduled for implantation of a hepatic artery pump. Before surgery, all patients underwent MDCT arteriography with volumetric 3D rendering of the hepatic vessels. The axial and 3D arteriograms were evaluated for their usefulness in depicting hepatic arterial anatomy. Subsequently, three patients also underwent catheter angiography. Twenty-two of the 26 patients imaged had a hepatic artery floxuridine infusion pump implanted. Results of the CT arteriography were correlated with findings at surgery or on catheter angiography if surgery was not performed.
  
  
  RESULTS
  MDCT arteriography correctly revealed hepatic arterial anatomy in all 25 patients with angiographic or surgical confirmation. One patient with aberrant hepatic arterial anatomy did not have angiographic or surgical confirmation. Classic hepatic arterial anatomy was identified in 16 (64%) of 25 patients. The following hepatic arterial variants were found in one patient each: the common hepatic artery arising directly from the aorta; a replaced left hepatic artery; an accessory right hepatic artery; a replaced left hepatic artery and accessory right hepatic artery; a replaced right hepatic artery; a right hepatic arterial branch arising early (before the origin of the gastroduodenal artery); and replaced right and left hepatic arteries. Three patients were not suitable candidates for placement of a hepatic artery floxuridine pump. The patient who had no angiographic or surgical confirmation was also not considered a good surgical candidate because of replaced right and left hepatic arteries. Two patients (8%) had an accessory left hepatic artery.
  
  
  CONCLUSIONS
  MDCT arteriography with volumetric 3D rendering is an accurate, noninvasive method of depicting hepatic arterial anatomy and, therefore, of selecting patients with colorectal metastatic disease who could benefit from hepatic artery pump implantation. Catheter angiography provides no additional information, and we have eliminated it as a routine preoperative imaging examination.
authors.affiliation: Division of Abdominal Imaging, Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St., Pittsburgh, PA 15213, USA.
authors.forename: Vibhu
authors.initials: V
authors.lastname: Kapoor
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Brancatelli
authors.forename: Michael P
authors.initials: MP
authors.lastname: Federle
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Katyal
authors.forename: J Wallis
authors.initials: JW
authors.lastname: Marsh
authors.forename: David A
authors.initials: DA
authors.lastname: Geller
mesh_terms: D000368:Aged; D015901:Angiography, Digital Subtraction; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage*; D002277:Carcinoma / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000556:secondary*; D015179:Colorectal Neoplasms / Q000473:pathology*; D005260:Female; D005467:Floxuridine / Q000008:administration & dosage*; D006499:Hepatic Artery / Q000000981:diagnostic imaging*; D006801:Humans; D021621:Imaging, Three-Dimensional; D015918:Infusion Pumps, Implantable; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000556:secondary*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
chemical_list: D000964:Antimetabolites, Antineoplastic; D005467:Floxuridine