title: Identification of intra-hepatic communicating veins through the arch sign on CT-scan.
abstract: OBJECTIVE
  Knowledge of vascular outflow is essential in liver surgery. Communicating veins between the right hepatic vein (RHV) and the middle hepatic vein (MHV) have been described and allowed us to perform new surgical procedures. The aim of this study was to predict the existence of intra-hepatic venous anastomosis by identifying communicating veins on 2D CT-scan imaging.
  
  
  METHODS
  We retrospectively analysed data from 32 patients operated on for liver tumours between 2004 and 2013 who underwent a bisegmentectomy VI-VII enlarged to the RHV and/or a bisegmentectomy VII-VIII and/or a left hepatectomy enlarged to the MHV and who had pre and post-operative CT-scans. Patients with cirrhosis were excluded. We first analysed post-operative images and, in patients with a proven collateral vein, looked for evidence of this on pre-operative imaging. We then validated this pre-operative sign against post-operative imaging.
  
  
  RESULTS
  Collaterals from both the RHV and the MHV formed an arch visible on pre-operative imaging which predicted the development of intrahepatic venous anastomosis in 20 patients. In 14 patients, a perfect match between the arch sign and development of collaterals was observed (n = 28). Sensitivity, specificity, negative and positive predictive values were 87, 80, 80, and 87%, respectively. Positive and negative likelihood ratio tests were 4.3 and 0.16, respectively.
  
  
  CONCLUSIONS
  Communicating veins between the RHV and the MHV are frequent and can be predicted by the arch sign on 2D CT-scan. Hence the arch sign can be very useful when planning liver surgery.
authors: Department of Surgical Oncology, Centre Léon Bérard, 28 Rue Laennec, 69008, Lyon, France.|Laboratoire d'Anatomie de Rockfeller, Univ Lyon, Université Claude Bernard Lyon 1, 69003, Lyon, France.
authors: Alexandre
authors: A
authors: Morel
authors: Department of Surgical Oncology, Centre Léon Bérard, 28 Rue Laennec, 69008, Lyon, France.|Univ Lyon, Inserm, U1032 LabTau, 69003, Lyon, France.
authors: Michel
authors: M
authors: Rivoire
authors: Department of Surgical Oncology, Centre Léon Bérard, 28 Rue Laennec, 69008, Lyon, France.
authors: Valéria
authors: V
authors: Basso
authors: Department of Surgical Oncology, Centre Léon Bérard, 28 Rue Laennec, 69008, Lyon, France.
authors: Pierre
authors: P
authors: Meeus
authors: Department of Surgical Oncology, Centre Léon Bérard, 28 Rue Laennec, 69008, Lyon, France.
authors: Patrice
authors: P
authors: Peyrat
authors: Department of Surgical Oncology, Centre Léon Bérard, 28 Rue Laennec, 69008, Lyon, France. aurelien.dupre@lyon.unicancer.fr.|Univ Lyon, Inserm, U1032 LabTau, 69003, Lyon, France. aurelien.dupre@lyon.unicancer.fr.
authors: Aurélien
authors: http://orcid.org/0000-0002-5216-538X
authors: A
authors: Dupré
mesh_terms: D003097:Collateral Circulation; D003287:Contrast Media; D005260:Female; D006498:Hepatectomy / Q000379:methods; D006503:Hepatic Veins / Q000033:anatomy & histology* / Q000000981:diagnostic imaging*; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery; D008297:Male; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media
keywords: Anatomy; Communicating vein; Hepatectomy; Hepatic vein; Liver surgery; Vascular outflow