To assess the accuracy of sixteen-row multidetector computed tomography angiography (MDCTA) in preoperative evaluation of hepatic vascular anatomy, 52 liver donors, 12 liver recipients and 11 patients for hepatic resection underwent MDCTA with sixteen-row CT scanner during 11-month period. 0.625 mm. axial images were acquired in arterial, portal and hepatic venous phases with 50% overlap. Post-processing included multiplanar reconstructions, maximum-intensity projection and volume-rendering techniques. Findings were analyzed by two radiologists and compared with surgical findings in 23 patients. MDCTA examinations were technically satisfactory in all patients for arterial scan but for venous phases in only 47 (90.4%) donors, 5 (41.7%) recipients and 10 (90.9%) patients for hepatic resection. Arteries up to tertiary branches were identified in 73 (97.3%) patients. Segment IV artery was seen originating from right hepatic artery in 26 (34.7%) patients. 21 (28%) patients showed right hepatic artery arising from superior mesenteric artery while 13 (17.3%) had an accessory artery from superior mesenteric artery to segment IV. Thin accessory arteries measuring <3mm. in diameter were seen arising from aorta, celiac trunk / gastroepiploic artery in 8 (10.7%). 41 (66.1%) patients had accessory hepatic veins larger than 3mm. of which 7 (17.1%) drained into inferior vena cava. 35 (56.4%) patients showed common origin of the right/middle hepatic veins. Trifurcation of main portal vein was seen in 18 (29%) patients. There was one-to-one correlation between the MDCTA findings of the arterial anatomy and per-operative findings while small accessory hepatic veins draining segments VI and VIII were missed on MDCTA in 3 (0.05%) patients. In conclusion, Sixteen-row MDCTA provides precise information of hepatic vascular anatomy as well as vascular variations and is an indispensable tool for planning liver surgery.
Volume : 6
Issue : 4
Pages : 15
Organ Transplantation Program, Central Hospital, Tripoli, Libya