title: Accuracy of routine multidetector computed tomography to identify arterial variants in patients scheduled for pancreaticoduodenectomy.
abstract: OBJECTIVE
  To assess the efficacy of cross-sectional multidetector computed tomography (MDCT) imaging without arterial reconstruction to identify aberrant right hepatic artery (RHA) and celiac artery stenosis (CAS) in patients scheduled for pancreaticoduodenectomy.
  
  
  METHODS
  Patients with peri-ampullary and pancreatic head tumors who underwent routine preoperative MDCT and subsequent computed tomography (CT) angiography (CTA), conventional angiography or pancreaticoduodenectomy between September 2007 and August 2013 were identified. Retrospective analysis of imaging data was undertaken using CTA, conventional angiographic and surgical findings as the reference standards. The accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of MDCT in evaluation of aberrant RHA and CAS were calculated.
  
  
  RESULTS
  A group of 458 patients met the inclusion criteria of this study to detect aberrant RHA, and 181 cases were included to identify CAS. Fifty-four (11.8%) patients were confirmed to have aberrant RHA, while 12 (6.6%) patients with CAS were demonstrated. MDCT yielded an accuracy of 98.5%, sensitivity of 96.3% and specificity of 98.8% in the detection of aberrant RHA. The sensitivity, specificity, PPV and NPV of MDCT for detecting CAS were 58.3%, 98.2%, 70% and 97.1%, respectively.
  
  
  CONCLUSIONS
  Routine MDCT is recommended such that surgeons and radiologists be alerted to the importance of arterial variants on preoperative CT scans in patients scheduled for pancreaticoduodenectomy.
authors.affiliation: Feng Yang, Yang Di, Ji Li, Xiao-Yi Wang, Lie Yao, Si-Jie Hao, Yong-Jian Jiang, Chen Jin, De-Liang Fu, Department of Pancreatic Surgery, Pancreatic Disease Institute, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China.
authors.forename: Feng
authors.initials: F
authors.lastname: Yang
authors.affiliation: Feng Yang, Yang Di, Ji Li, Xiao-Yi Wang, Lie Yao, Si-Jie Hao, Yong-Jian Jiang, Chen Jin, De-Liang Fu, Department of Pancreatic Surgery, Pancreatic Disease Institute, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Di
authors.affiliation: Feng Yang, Yang Di, Ji Li, Xiao-Yi Wang, Lie Yao, Si-Jie Hao, Yong-Jian Jiang, Chen Jin, De-Liang Fu, Department of Pancreatic Surgery, Pancreatic Disease Institute, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China.
authors.forename: Ji
authors.initials: J
authors.lastname: Li
authors.affiliation: Feng Yang, Yang Di, Ji Li, Xiao-Yi Wang, Lie Yao, Si-Jie Hao, Yong-Jian Jiang, Chen Jin, De-Liang Fu, Department of Pancreatic Surgery, Pancreatic Disease Institute, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China.
authors.forename: Xiao-Yi
authors.initials: XY
authors.lastname: Wang
authors.affiliation: Feng Yang, Yang Di, Ji Li, Xiao-Yi Wang, Lie Yao, Si-Jie Hao, Yong-Jian Jiang, Chen Jin, De-Liang Fu, Department of Pancreatic Surgery, Pancreatic Disease Institute, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China.
authors.forename: Lie
authors.initials: L
authors.lastname: Yao
authors.affiliation: Feng Yang, Yang Di, Ji Li, Xiao-Yi Wang, Lie Yao, Si-Jie Hao, Yong-Jian Jiang, Chen Jin, De-Liang Fu, Department of Pancreatic Surgery, Pancreatic Disease Institute, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China.
authors.forename: Si-Jie
authors.initials: SJ
authors.lastname: Hao
authors.affiliation: Feng Yang, Yang Di, Ji Li, Xiao-Yi Wang, Lie Yao, Si-Jie Hao, Yong-Jian Jiang, Chen Jin, De-Liang Fu, Department of Pancreatic Surgery, Pancreatic Disease Institute, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China.
authors.forename: Yong-Jian
authors.initials: YJ
authors.lastname: Jiang
authors.affiliation: Feng Yang, Yang Di, Ji Li, Xiao-Yi Wang, Lie Yao, Si-Jie Hao, Yong-Jian Jiang, Chen Jin, De-Liang Fu, Department of Pancreatic Surgery, Pancreatic Disease Institute, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China.
authors.forename: Chen
authors.initials: C
authors.lastname: Jin
authors.affiliation: Feng Yang, Yang Di, Ji Li, Xiao-Yi Wang, Lie Yao, Si-Jie Hao, Yong-Jian Jiang, Chen Jin, De-Liang Fu, Department of Pancreatic Surgery, Pancreatic Disease Institute, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China.
authors.forename: De-Liang
authors.initials: DL
authors.lastname: Fu
mesh_terms: D000368:Aged; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging*; D002445:Celiac Artery / Q000000981:diagnostic imaging*; D003251:Constriction, Pathologic; D005260:Female; D006499:Hepatic Artery / Q000002:abnormalities / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000009:adverse effects; D018579:Patient Selection; D011237:Predictive Value of Tests; D011300:Preoperative Care; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D054079:Vascular Malformations / Q000000981:diagnostic imaging*
keywords: Aberrant hepatic artery; Angiography; Celiac artery stenosis; Multidetector computed tomography; Pancreaticoduodenectomy