Segmental anatomy of the liver under the right diaphragmatic dome: evaluation with axial CT.

Ohashi, Isamu; Ina, Hiroyasu; Okada, Yoshitaka; Yoshida, Tsukasa; Gomi, Noriyuki; Himeno, Yoshiro; Hanafusa, Kaoru; Shibuya, Hitoshi

doi:10.1148/radiology.200.3.8756931

Cited by 29 publications

(23 citation statements)

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“…According to our results, the right and middle vertical plane angles and the S8-longitudinal angle in the S8-dominant type was more oblique and wider than in the S7-dominant type, indicating the dominant segment of the dome area of the right lobe was segment 8 in the S8-dominant type. This observation corresponded well to the findins described by Ohashi et al (10). Fasel et al (1) have described that the discrepancy of the segmental boundaries between the conventional segmentation method and the real segmental anatomy, as divided by the portal venous supply, on the axial images varied and this discrepancy was as large as 40 mm maximally.…”

Section: Discussionsupporting

confidence: 90%

Analysis of the Hepatic Segments on the Isotropic Multi-planar Reformatted CT Images

Yim

Lee

Jeon

et al. 2005

J Korean Radiol Soc

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Purpose:We wanted to evaluate the diverse distribution and relation of the hepatic segments, as divided by the portal venous territories, on the isotropic multi-planar reformatted (MPR) CT images and we wanted to find their correlation to the intrahepatic venous structures. Materials and Methods: Fifty adult patients who underwent portal phase CT images and who had the normal liver contours at CT were included in our study. The portal phase images were obtained with a slice collimation and reconstruction interval of 1.25 mm, and they were reformatted in the coronal and sagittal planes with a slab thickness of 3 mm. For analysis of these MPR images, various terms were newly defined according to the portal venous territories (e.g., three vertical planes [right, middle and left] and one transverse plane and their plane angles, the transverse and longitudinal angles). Also, the dominant segments of the right lobe were newly divided into the S7-and S8-dominant types by comparing the transverse angles. The imaging analysis was then conducted for the following: (1) the diversity of the three vertical planes and the one transverse plane and their plane angles, (2) the proportion of the dominant segments of the right lobe and their relation with the plane angles, and (3) the correlation between the dominant segments and the intrahepatic venous structures. Results: The number of the S7-and the S8-dominant types was 21 and 29, respectively. The vertical and transverse planes were undulating and diverse according to the dominant segments as follows: the plane angles of the right vertical and middle vertical planes were more vertical in the S7-dominant type than in the S8-dominant type (p < 0.001). The right transverse plane angle was more horizontal in the S8-dominant type (p < 0.05). The left transverse plane angle seemed to be rather vertical than horizontal. For the intrahepatic venous structures, despite of our limited data, the anomalous intrahepatic venous structures might have some correlation with the dominant segments. Conclusion: According to our results, we suggest that the isotropic MPR images could successfully depict the vertical and transverse planes of the real hepatic segments, as divided by the portal venous territories, which were diverse according to their dominant types.

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Section: Discussionsupporting

confidence: 90%

Analysis of the Hepatic Segments on the Isotropic Multi-planar Reformatted CT Images

Yim

Lee

Jeon

et al. 2005

J Korean Radiol Soc

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“…This model is a comprehensive topographical concept of functional liver anatomy that is easily interpretable and can be applied in most patients. However, an increasing body of evidence suggests that this concept may be an oversimplification [27][28][29][30][31]. Anatomical and radiological investigations have confirmed that the segmental boundaries, as indicated by the hepatic veins and the level of the right portal trunk, do Aberrant left and right hepatic arteries not consistently coincide with the exact location of the true portal scissurae in individual patients [28,29,31].…”

Section: Aberrant Left Hepatic Arteriesmentioning

confidence: 99%

Hepatic Arterial Configuration in Relation to the Segmental Anatomy of the Liver; Observations on MDCT and DSA Relevant to Radioembolization Treatment

Hoven

Leeuwen

Lam

et al. 2014

Cardiovasc Intervent Radiol

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Purpose Current anatomical classifications do not include all variants relevant for radioembolization (RE). The purpose of this study was to assess the individual hepatic arterial configuration and segmental vascularization pattern and to develop an individualized RE treatment strategy based on an extended classification. Methods The hepatic vascular anatomy was assessed on MDCT and DSA in patients who received a workup for RE between February 2009 and November 2012. Reconstructed MDCT studies were assessed to determine the hepatic arterial configuration (origin of every hepatic arterial branch, branching pattern and anatomical course) and the hepatic segmental vascularization territory of all branches. Aberrant hepatic arteries were defined as hepatic arterial branches that did not originate from the celiac axis/CHA/PHA. Early branching patterns were defined as hepatic arterial branches originating from the celiac axis/CHA. Results The hepatic arterial configuration and segmental vascularization pattern could be assessed in 110 of 133 patients. In 59 patients (54 %), no aberrant hepatic arteries or early branching was observed. Fourteen patients without aberrant hepatic arteries (13 %) had an early branching pattern. In the 37 patients (34 %) with aberrant hepatic arteries, five also had an early branching pattern. Sixteen different hepatic arterial segmental vascularization patterns were identified and described, differing by the presence of aberrant hepatic arteries, their respective vascular territory, and origin of the artery vascularizing segment four. Conclusions The hepatic arterial configuration and segmental vascularization pattern show marked individual variability beyond well-known classifications of anatomical variants. We developed an individualized RE treatment strategy based on an extended anatomical classification.

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“…In addition, Ohashi et al [18] observed discrepancies between the imaginary intersegmental boundaries and the margins of the areas actually enhanced with contrast material on axial CT arteriograms obtained with selective injections, especially in the region under the right side of the diaphragm. Lines drawn from the IVC straight through the middle or right hepatic vein did not correspond to the boundaries between the right and left lobes, which is the main (middle) longitudinal scissura, or the boundary between the anterior and posterior sectors (segments 8 and 7), which is the right longitudinal scissura (Fig.…”

Section: Limitations Of Couinaud's Conceptmentioning

confidence: 99%

“…In three-dimensional perspective with mental reconstruction from the axial images, segment 8 was revealed to overhang the right hepatic vein (Figs. 9, 10, 11, 12) [18].…”

Section: Limitations Of Couinaud's Conceptmentioning

confidence: 99%

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Limitations and pitfalls of Couinaud's segmentation of the liver in transaxial Imaging

et al. 2003

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The segmental anatomy of the human liver has become a matter of increasing interest to the radiologist, especially in view of the need for an accurate preoperative localization of focal hepatic lesions. In this review article first an overview of the different classical concepts for delineating segmental and subsegmental anatomy on US, transaxial CT, and MR images is given. Essentially, these procedures are based on Couinaud's concept of three vertical planes that divide the liver into four segments and of a transverse scissura that further subdivides the segments into two subsegments each. In a second part, the limitations of these methods are delineated and discussed with the conclusion that if exact preoperative localization of hepatic lesions is needed, tumor must be located relative to the avascular planes between the different portal territories.

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Segmental anatomy of the liver under the right diaphragmatic dome: evaluation with axial CT.

Abstract: The line that extends beyond the middle or right hepatic vein from the inferior vena cava does not coincide with the main or right longitudinal scissura on axial images of the upper portion of the liver.

Cited by 29 publications

References 0 publications

Analysis of the Hepatic Segments on the Isotropic Multi-planar Reformatted CT Images

Analysis of the Hepatic Segments on the Isotropic Multi-planar Reformatted CT Images

Hepatic Arterial Configuration in Relation to the Segmental Anatomy of the Liver; Observations on MDCT and DSA Relevant to Radioembolization Treatment

Limitations and pitfalls of Couinaud's segmentation of the liver in transaxial Imaging

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