Ultrasound examination of the liver: Normal vascular anatomy

Draghi, Ferdinando; Rapaccini, G.L.; Fachinetti, Camilla; Matthaeis, Nicoletta De; Battaglia, Simone; Abbattista, T.; Busilacchi, P

doi:10.1016/j.jus.2007.02.002

Cited by 12 publications

(14 citation statements)

References 18 publications

(16 reference statements)

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“…The identification and localization of hepatic lesions represent an important part of routine clinical practice, and they require a thorough knowledge of the anatomical aspects of the liver [1,2]. The concept of the liver as an organ that can be divided into segments is now universally accepted.…”

Section: Discussionmentioning

confidence: 99%

“…The subdivision is based on hepatic vascularization, and the various segments are defined by the branches of the portal vein that they contain and by the hepatic veins that separate them [1,2,5].…”

Section: Discussionmentioning

confidence: 99%

“…The vascular anatomy of the liver is undeniably complex, and the situation is further complicated by the fact that, the inferior vena cava, the openings of the hepatic veins, and the main branches of the portal veins can always be visualized sonographically, but the intrasegmental vessels (portal branches, arterial branches, accessory hepatic veins) can rarely be identified [1]. Although superior results can undoubtedly be obtained with multislice CT or MRI, ultrasound is still the method of choice for use in a number of situations, and a thorough knowledge of the sonographic appearance of the normal hepatic vascular tree and its anatomic variants is absolutely indispensable.…”

Section: Discussionmentioning

confidence: 99%

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Ultrasound examination of the liver: Variations in the vascular anatomy

Battaglia

Fachinetti

Draghi

et al. 2010

Journal of Ultrasound

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The hepatic vasculature is highly complex. The hepatic artery (a branch of the celiac tripod) and the portal vein (formed by the confluence of the splenic and superior mesenteric veins) provide a dual blood supply while venous drainage is guaranteed by the hepatic veins. There are also numerous anatomic variants that can involve one or more of the system's three components.Hepatic artery variants are the least common. Ten types have been identified, including several that are fairly frequent and others that are quite rare, and the variation generally involves the extrahepatic portion of the vessel. Portal vein variants are found in around 20% of the population. They can involve the main portal trunk or segmental branches. Variants of the hepatic veins are the most common. They involve the number and course (supernumerary veins) or the number, course, and openings (accessory veins).Knowledge of portal vein and hepatic vein variants, which are extremely common, is of prime importance for precise localization of lesions. Hepatic artery variants are equally important for surgical treatment of hepatic disease, especially liver transplantation, where it is essential for preoperative workup and postoperative follow-up of the recipient as well as for assessment of potential donors.Sommario La vascolarizzazione del fegato è complessa: arteria epatica, ramo del tripode celiaco, e vena porta, costituita dalla confluenza delle vene splenica e mesenterica superiore, forniscono una doppia vascolarizzazione; mentre il drenaggio è assicurato dalle vene sovrepatiche, inoltre vi è un numero significativo di varianti che possono interessare separatamente o contemporaneamente i tre i sistemi.Le varianti dell'arteria epatica, meno frequenti rispetto alle altre, sono state classificate in dieci tipi di cui alcuni più comuni, altri del tutto eccezionali, riguardano principalmente il tratto extra-epatico del vaso. Quelle della vena porta, che si riscontrano in circa il 20% della popolazione, possono interessare sia i rami principali che i segmentari. Quelle delle vene sovrapatiche, le più frequenti, possono riguardare il numero ed il decorso (vene soprannumerarie) o il numero ed il decorso, ma anche lo sbocco (vene accessorie). La conoscenza delle varianti portali e delle vene sovrepatiche, estremamente frequenti, è di primaria importanza per la possibilità di localizzare con precisione eventuali lesioni; non meno importante è la conoscenza delle varianti dell'arteria epatica, in relazione alle terapie chirurgiche, in particolare per quello che riguarda i trapianti, sia nella fase pre-operatoria, sia nella valutazione del potenziale donatore, sia nel follow-up. ª

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Ultrasound examination of the liver: Variations in the vascular anatomy

Battaglia

Fachinetti

Draghi

et al. 2010

Journal of Ultrasound

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“…The same method was also used to determine the approximate length of each vessel generation

{L_G}

, measured from bifurcation to bifurcation, as summarized in Table 1 30,31 . These measurements and their corresponding uncertainties 32–34 were used to determine an approximate range of “reasonable” anatomic variability, tempered by the physiological stipulation that the total influx rate of blood to the liver was equal to the total outflux rate of blood from the liver.…”

Section: Methodsmentioning

confidence: 99%

Anatomically and physiologically informed computational model of hepatic contrast perfusion for virtual imaging trials

et al. 2022

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Purpose Virtual (in silico) imaging trials (VITs), involving computerized phantoms and models of the imaging process, provide a modern alternative to clinical imaging trials. VITs are faster, safer, and enable otherwise‐impossible investigations. Current phantoms used in VITs are limited in their ability to model functional behavior such as contrast perfusion which is an important determinant of dose and image quality in CT imaging. In our prior work with the XCAT computational phantoms, we determined and modeled inter‐organ (organ to organ) intravenous contrast concentration as a function of time from injection. However, intra‐organ concentration, heterogeneous distribution within a given organ, was not pursued. We extend our methods in this work to model intra‐organ concentration within the XCAT phantom with a specific focus on the liver. Methods Intra‐organ contrast perfusion depends on the organ's vessel network. We modeled the intricate vascular structures of the liver, informed by empirical and theoretical observations of anatomy and physiology. The developed vessel generation algorithm modeled a dual‐input‐single‐output vascular network as a series of bifurcating surfaces to optimally deliver flow within the bounding surface of a given XCAT liver. Using this network, contrast perfusion was simulated within voxelized versions of the phantom by using knowledge of the blood velocities in each vascular structure, vessel diameters and length, and the time since the contrast entered the hepatic artery. The utility of the enhanced phantom was demonstrated through a simulation study with the phantom voxelized prior to CT simulation with the relevant liver vasculature prepared to represent blood and iodinated contrast media. The spatial extent of the blood–contrast mixture was compared to clinical data. Results The vascular structures of the liver were generated with size and orientation which resulted in minimal energy expenditure required to maintain blood flow. Intravenous contrast was simulated as having known concentration and known total volume in the liver as calibrated from time–concentration curves. Measurements of simulated CT ROIs were found to agree with clinically observed values of early arterial phase contrast enhancement of the parenchyma (∼5$ \sim 5$ HU). Similarly, early enhancement in the hepatic artery was found to agree with average clinical enhancement false(180$(180$ HU). Conclusions The computational methods presented here furthered the development of the XCAT phantoms allowing for multi‐timepoint contrast perfusion simulations, enabling more anthropomorphic virtual clinical trials intended for optimization of current clinical imaging technologies and applications.

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“…On ultrasound, the inferior vena cava, the openings of the hepatic veins, and the main branch of the portal vein can always be visualized, but intrasegmental vessels (portal, arterial, accessory hepatic venous branches) can be only partially depicted and in some cases not at all. 4 In a wellconducted study of Battaglia et al, after acknowledging the superiority of multislice CT or MRI over ultrasound, it has been opined that ultrasonographic evaluation is still the method of choice for use in some situations, and a thorough knowledge of the sonographic appearance of the normal hepatic vasculature and its anatomic variants is an absolute requirement (Battaglia S et al). 6 Each meticulous scan performed by an expert Associate Profes- sor of Radiodiagnosis, which took median time of 18 minutes on an average to search for the probable variations of hepatic venous system.…”

Section: Definition Of Variationsmentioning

confidence: 99%

Study of the human liver by ultrasound examination to search for variations of venous anatomy.

Ain¹,

Roy²,

Meyur³

et al. 2021

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Introduction: Knowledge about venous patterns (especially portal and hepatic venous) and their variations are extremely crucial for liver transplantation and other surgical procedures on liver. Studies have been done at national or international level on variations of hepatic venous patterns by CT or MRI or by dissection on cadaveric liver. No definitive or authentic study on this topic could be noted in electronic and print media, as well as in standard textbook. Considering low cost and noninvasive nature, we utilized ultrasonography to bridge this lacuna. Aim: To estimate prevalence and types of anatomical variations of hepatic venous system and to determine association of among variations. Materials and methods: It is an observational cross-sectional study where ultrasonographic evaluation of hepatic venous pattern on adult population of either sex (consecutive sampling) without any major liver disorders was done in RG Kar Medical College and data were analyzed with appropriate statistical procedures. Results: Normal hepatic venous pattern along with normal portal venous pattern is much higher in our study, which is a unique finding. The proportion of normal portal venous pattern is more in extra hepatic bifurcation group. Variations of portal vein and normal hepatic venous pattern are more in case of intrahepatic bifurcation of portal venous branching group. Overall presence of intrahepatic bifurcation of portal vein is significantly higher than extrahepatic bifurcation. Conclusions: This study provides an updated database for the prevalence and distribution of anatomic variations of the hepatic venous and portal venous system.

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Ultrasound examination of the liver: Normal vascular anatomy

Cited by 12 publications

References 18 publications

Ultrasound examination of the liver: Variations in the vascular anatomy

Ultrasound examination of the liver: Variations in the vascular anatomy

Anatomically and physiologically informed computational model of hepatic contrast perfusion for virtual imaging trials

Study of the human liver by ultrasound examination to search for variations of venous anatomy.

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