Multislice CT study of pancreatic head arterial dominance.
OBJECTIVE
When a pancreatoduodenectomy is to be conducted, preoperative understanding of the vascular anatomy of the pancreatic head is important in order to reduce intraoperative bleeding. Using multislice computed tomography (MS-CT), we investigated the depiction rate and branching of the inferior pancreaticoduodenal artery (IPDA) and dorsal pancreatic artery (DPA), afferent arteries to the pancreatic head.


METHODS
In 109 patients (68 with pancreatic cancer, 21 with biliary tract cancer, 15 with intraductal papillary mucinous tumor of the pancreas, and 5 others), images were taken, using 64-row MS-CT, in the early and late arterial phases.


RESULTS
The depiction rates were 98.2% for the IPDA and 96.3% for the DPA. Branching of the IPDA was categorized into three types: a type in which the IPDA formed a common vessel with the first jejunal branch (72.0%), a type in which the IPDA branched directly from the superior mesenteric artery (18.7%), and a type in which the anterior inferior pancreaticoduodenal artery (AIPDA) and posterior inferior pancreaticoduodenal artery (PIPDA) branched separately (9.3%). DPA branching was categorized into five types, in which the DPA branched from the splenic artery (40.0%), from the common hepatic artery (25.7%), from the superior mesenteric artery (20.0%), and from the celiac artery (8.6%), and a type in which the DPA branching did not follow any of the above patterns (5.7%).


CONCLUSIONS
MS-CT images of vascular architecture enable evaluation from any angle, which is not possible with conventional angiography, making MS-CT a useful diagnostic imaging technique for understanding the vascular anatomy of the pancreatic head prior to conducting pancreatoduodenectomy for diseases of the pancreatic head region.
Second Department of Gastroenterological Surgery, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Japan.
Akihiko
A
Horiguchi
Shin
S
Ishihara
Masahiro
M
Ito
Hideo
H
Nagata
Yukio
Y
Asano
Toshiyuki
T
Yamamoto
Ryoichi
R
Kato
Kazuhiro
K
Katada
Shuichi
S
Miyakawa
D001650:Bile Duct Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging; D044584:Carcinoma, Ductal / Q000098:blood supply / Q000000981:diagnostic imaging; D002291:Carcinoma, Papillary / Q000098:blood supply / Q000000981:diagnostic imaging; D006801:Humans; D010179:Pancreas / Q000098:blood supply* / Q000000981:diagnostic imaging; D010190:Pancreatic Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed / Q000379:methods*