title: Preoperative dual-phase 3D CT angiography assessment of the right hepatic artery before gastrectomy.
abstract: OBJECTIVE
  In the current study, we evaluated the efficacy of dual-phase three-dimensional (3D) CT angiography (CTA) in the assessment of the vascular anatomy, especially the right hepatic artery (RHA), before gastrectomy.
  
  
  METHODS
  The study initially included 714 consecutive patients being treated for gastric cancer. A dual-phase contrast-enhanced CT scan using 32-multi detector-row CT was performed for all patients.
  
  
  RESULTS
  Among the 714 patients, 3D CTA clearly identified anomalies with the RHA arising from the superior mesenteric artery (SMA) in 49 cases (6.9 %). In Michels' classification type IX, the common hepatic artery (CHA) originates only from the SMA. Such cases exhibit defective anatomy for the CHA in conjunction with the celiac-splenic artery system, resulting in direct exposure of the portal vein beneath the #8a lymph node station, which was retrospectively confirmed by video in laparoscopic gastrectomy cases. Fused images of both 3D angiography and venography were obtained, and could have predicted the risk preoperatively, and the surgical finding confirmed its usefulness.
  
  
  CONCLUSIONS
  Preoperative evaluations using 3D CTA can provide more accurate information about the vessel anatomy. The fused images from 3D CTA have the potential to reduce the intraoperative risks for injuries to critical vessel, such as the portal vein, during gastrectomy.
authors: Department of Surgery, Kitasato University School of Medicine, Asamizodai 2-1-1, Minami-ku, Sagamihara, Kanagawa, 252-0380, Japan, keishi23@med.kitasato-u.ac.jp.
authors: Keishi
authors: K
authors: Yamashita
authors: Shinichi
authors: S
authors: Sakuramoto
authors: Hiroaki
authors: H
authors: Mieno
authors: Tomotaka
authors: T
authors: Shibata
authors: Masayuki
authors: M
authors: Nemoto
authors: Natsuya
authors: N
authors: Katada
authors: Shiro
authors: S
authors: Kikuchi
authors: Masahiko
authors: M
authors: Watanabe
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000379:methods*; D005260:Female; D005743:Gastrectomy; D006499:Hepatic Artery / Q000000981:diagnostic imaging*; D006801:Humans; D021621:Imaging, Three-Dimensional; D020706:Laparoscopes; D008297:Male; D008875:Middle Aged; D057234:Preoperative Period; D013270:Stomach / Q000098:blood supply; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*