Dual-Phase 3D CT Angiography During a Single Breath-Hold Using 16-MDCT: Assessment of Vascular Anatomy Before Laparoscopic Gastrectomy

Matsuki, Mitsuru; Tanikake, Masato; Kani, Hiroyuki; Tatsugami, Fuminari; Kanazawa, Shuji; Kanamoto, Takaaki; Inada, Yuji; Yoshikawa, Syushi; Narabayashi, Isamu; Lee, Sang‐Woong; Nomura, Eiji; Okuda, Jun; Tanigawa, Nobuhiko

doi:10.2214/ajr.04.0733

Cited by 65 publications

(37 citation statements)

References 8 publications

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“…The technique of 3DCTA is reported to be useful for visualizing the anatomy of the vessels around the stomach [3][4][5][6][7][8]. However, 3DCTA is expensive, and it requires an additional CT scan using a substantial amount of contrast medium.…”

Section: Discussionmentioning

confidence: 99%

Multidetector computed tomography for preoperative identification of left gastric vein location in patients with gastric cancer

et al. 2010

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Background. The area near the left gastric vein (LGV) is a challenging site at which to perform dissection of the lymph nodes during gastrectomy. Therefore, knowledge of the precise location of the LGV is important. The objective of this study was to examine the usefulness of multidetector computed tomography (MDCT) for the identifi cation of the LGV. Methods. Eighty-one patients with gastric cancer underwent MDCT, which was performed with contrast media in 76 patients and without contrast media in 5 patients. A 5-mm thin slice of the frontal image was reconstructed. These images were examined preoperatively to detect the location of the LGV. Upon gastrectomy, the LGV was identifi ed and its location compared to that determined by MDCT. Results. The LGV was identifi ed by MDCT in 76 of the 81 patients (93.8%). The LGV was subsequently located during the operation in all 81 patients. The LGV was located dorsal to the common hepatic artery in 40 patients (49.4%), ventral to the common hepatic artery in 18 patients (22.2%), ventral to the splenic artery in 17 patients (21.0%), dorsal to the splenic artery in 2 patients (2.5%) and in other positions in 4 patients (4.9%). In all patients, the location of the LGV detected using MDCT was consistent with that identifi ed during gastrectomy. In the 4 patients with relatively unusual locations of the LGV, these 4 LGV variants were identifi ed preoperatively by MDCT. Conclusion. MDCT was useful for identifying the location of the LGV prior to gastrectomy.

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Section: Discussionmentioning

confidence: 99%

Multidetector computed tomography for preoperative identification of left gastric vein location in patients with gastric cancer

et al. 2010

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“…6 and no. 11p lymph nodes, respectively [9][10][11]. In the present patient, a vascular anomaly was diagnosed, in which the right hepatic artery branched directly from the celiac axis and ran posterior to the splenic vein; this vascular branching pattern made surgical resection possible.…”

Section: Discussionmentioning

confidence: 64%

Advanced gastric cancer with a duplicated hepatic artery: preoperative diagnostic value of multidetector-row computed tomography for surgical resection

et al. 2007

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In patients with T4 gastric cancer, curative surgery can be achieved with concomitant resection of the invaded organs. However, curative resection is not necessarily possible in all cases. In patients with advanced gastric cancer with infi ltration of the pancreatic head and common hepatic artery (CHA), curative surgery is usually impossible, because pancreaticoduodenectomy (PD) with CHA resection leads to an abrupt reduction in the arterial blood supply to the liver and results in severe liver damage. We experienced a case of advanced gastric cancer that infi ltrated these organs, i.e., the pancreatic head and CHA. We were able to perform curative surgery in this patient because preoperative multidetector-row computed tomography (MDCT) revealed the presence of a duplicated hepatic artery. Here, we present a very rare case of advanced gastric cancer in a patient with a duplicated hepatic artery, and we note the value of MDCT for preoperative diagnosis. Case reportA 63-year-old Japanese woman presented to her family physician with appetite loss and general fatigue in June 2003. Gastrointestinal fi berscopy and upper gastrointestinal (GI) series revealed type 2 advanced gastric cancer in the antrum, with pyloric stenosis and duodenal invasion (Fig. 1). The patient was referred to the Cancer Institute Hospital for further examination. Laboratory examination revealed severe anemia (hemoglobin, 8.0 g/ dl) and poor nutritional condition (albumin, 3.3 g/dl). Abdominal MDCT revealed massive gastric cancer directly invading the left hepatic lobe and pancreatic head as well as vascular anomaly. Metastasized lymph nodes also invaded the CHA directly (Fig. 2). Although paraaortic lymph nodes were identifi ed, CT did not reveal any distant metastasis. In general, PD with CHA resection is considered to be impossible, because it Abstract A 63-year-old woman with appetite loss and general fatigue underwent gastrointestinal fi berscopy, which revealed type 2 advanced gastric cancer. Multidetector-row computed tomography revealed a massive gastric cancer invading the left hepatic lobe, pancreatic head, and common hepatic artery, as well as revealing a duplicated hepatic artery in which the right hepatic artery branched directly from the celiac axis, and ran behind the splenic vein. On the other hand, the common hepatic artery ran anterior to the splenic vein. We were able to perform pancreaticoduodenectomy with common hepatic artery resection and left lobectomy as curative surgery because her duplicated hepatic artery enabled us to ligate the common hepatic artery. Her postoperative clinical course was uneventful, and she is in good health 3 years after the surgery, without recurrence. We consider that multidetector-row computed tomography is very useful for the diagnosis of vascular anomaly, preoperative staging and decision making on the appropriate surgical strategy.

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“…10 Therefore, to safely ligate the arterial origins and veins and to dissect the lymph nodes under laparoscopic guidance, 3D CTA before laparoscopic gastrectomy is considered to be useful. 7,9,11 With conventional 2D reformat images we could know the presence of vessel variation, but these have limitation that cannot clearly show the direction of complex vessels. Furthermore, Lee et al demonstrated that the mean operative time, mean blood loss and the rate of conversion to laparotomy due to uncontrollable hemorrhage tended to be lower in the preoperative 3D CT simulation group in comparison with the control group without the CT simulation.…”

Section: Discussionmentioning

confidence: 99%

Preoperative CT Navigation of Perigastric Vessel Anatomy for Gastrectomy

Baek¹,

Hyung²,

Lim³

2014

Journal of International Society for Simulation Surgery

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The aim of this report is showing the case that we could give exact navigation of perigastric vessels for gastrectomy with 3D CTA. A 74-year-old male patient visited hospital with gastric cancer. Early gastric cancer, type IIb was found at stomach antrum great curvature side. Before surgery, he underwent 3D CT angiography. 3D volume rendering images and MIP images were made by post processing. He had replaced Lt. hepatic artery arising from Lt. gastric artery. Surgeon could get patient's specific vascular anatomy before surgery including surgically relevant anatomical distance and direction and could finish gastrectomy within 4 hours and just 53ml blood loss.Key WordsZZMDCT ㆍLaparoscopic gastrectomy ㆍ3D CT angiography ㆍGastric cancer.

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Dual-Phase 3D CT Angiography During a Single Breath-Hold Using 16-MDCT: Assessment of Vascular Anatomy Before Laparoscopic Gastrectomy

Cited by 65 publications

References 8 publications

Multidetector computed tomography for preoperative identification of left gastric vein location in patients with gastric cancer

Multidetector computed tomography for preoperative identification of left gastric vein location in patients with gastric cancer

Advanced gastric cancer with a duplicated hepatic artery: preoperative diagnostic value of multidetector-row computed tomography for surgical resection

Preoperative CT Navigation of Perigastric Vessel Anatomy for Gastrectomy

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