Pictorial essay: Multidetector CT of hepatic artery pathologies

Abstract

Imaging of the visceral vascular structures non-invasively with the development of MDCT is one of the most important forward leaps in radiology in the last decade. With the improvement of the MDCT technology any arterial and venous vascular structure of the abdomen can be easily detected and treatment planning can be done in a straightforward manner. Compared to conventional catheter angiography, MDCT imaging of the vascular tree is sometimes more contributory to the patient's treatment plan. Pathologies of the hepatic artery are not rare and in some specific situations may be utmost important for the patient's morbidity and even mortality. In this manuscript, we have tried to provide an overview to pathologies of the hepatic artery in terms of MDCT findings. Anatomical variationsExact delineation of the hepatic artery and its branches is a significant factor for the success of liver transplantation, especially for the grafts from living donors. Sufficient arterial flow via the hepatic artery is one of the most important factors for the survival of the graft. MDCT is increasingly being used for the evaluation of the hepatic artery in the pre-transplant phase (1). With the use of the MDCT, other vascular structures related to the liver can artery arising from the left gastric artery and the replaced right hepatic artery from the superior mesenteric artery are the most common arterial variations (i.e. Michel's type II and III, respectively) and may be seen in 10% and 11% of the subjects. Hepatic artery originating directly from the abdominal aorta is an uncommon presentation (0.2-3%) but an important finding for the surgeon (2-4) (Fig. 2). Apart from these anatomical variations, a replaced right hepatic artery can give rise to splenic artery (Fig. 3). For pre-transplant imaging, the calibration of the hepatic arteries may also be easily evaluated. also be quickly examined in a single imaging study within a remarkably short period of time. Michel's classification is the conventional method for the evaluation the vascular variations, and in this system only 55% of the hepatic arteries show the classic branching (1) (Fig. 1). Left hepatic JBR-BTR, 2012, 95: 345-349. The hepatic artery can be involved by a variety of pathology and diseases. Today MDCT enables high quality imaging of the hepatic artery using axial, MIP and volume rendered images. We illustrate MDCT findings of anatomical variations, aneurysm, dilatation, dissection, arteriovenous fistula, thrombosis and stenosis. Aneurysms can be saccular, fusiform and multiple and may develop due to atherosclerosis, vasculitis, trauma and biopsy. Dilatation of hepatic artery can be seen in portal hypertension, Osler-Weber-Rendu disease and hemangiomatosis. Hepatic artery can be occluded after trauma and transplantation. Dissection develops due to atherosclerosis, Marfan and Ehler Danlos syndromes and during pregnancy. Arteriovenous fistula can be congenital and acquired. We conclude that various hepatic artery pathologies can be confidently diagnosed by MDCT. PICTOR...

Atherosclerosis of the right posterior hepatic artery in a patient with hilar cholangiocarcinoma undergoing left trisectionectomy: a case report of a therapeutic pitfall

“…MDCT in combination with CPR analysis was quite sensitive to identify stenosis of the RPHA, and atherosclerosis was confirmed by IVUS. Because it has been reported that atherosclerosis of the hepatic artery is related to arterial dissection, aneurysm, and thrombosis [ 5 ], we performed prophylactic stent placement to prevent postoperative arterial complications. Although the diagnostic and therapeutic procedures were successful, the patient suffered from multiple pyogenic liver abscesses 4 months after liver surgery.…”

Variations of the hepatic artery

“…It can be detected during routine abdominal CT performed during the follow-up of this group of patients. We read the article titled as 'Multidetector CT of hepatic artery pathologies' by Karaosmanoglu et al (1), published in JBR-BTR (95: 345-349, 2012) with a great interest. This article will be a useful guide for radiologists in their future experiences.…”