జీర్ణకోశ & జీర్ణ వ్యవస్థ

నైరూప్య

Dual Phase 3D Angiography with 64 MDCT: The Evaluation of Vascular Anatomy before Laparoscopic Gastrectomy

Ali Önder Atça, Berrin Erok, Ebru Yılmaz, Sevil Fisekci Oktar, Erhun Eyuboglu and Turgut İpek

Objective: We evaluated the efficiency of 3-dimensional Computed Tomographic Angiography (3D CTA) performed with 64-channel Multidetector Computed Tomography (MDCT) to assess vascular anatomy before laparoscopic gastrectomy.
Materials and Methods: 20 patients with early gastric cancer scheduled for laparoscopic gastrectomy were evaluated. Dual phase IV contrast CTA was performed before laparoscopic gastrectomy. Arterial and venous phase images were obtained after rapid infusion of contrast agent with an interval of 15 seconds serially during single breath hold of 31 seconds.
Results: In all patients, 3D CTA showed Left Gastric Artery (LGA), Left Hepatic Artery (LHA), Right Gastric Artery (RGA) and Left Coronary Vein (LCV) with celiac trunk. Celiac trunk branching pattern was classified according to Michel’s method and in 18 cases, Michel’s type 1, in 2 cases Michel’s type 2 were identified. RGA was originated from Gastro Duodenal Artery (GDA) in 16 cases, from Superior Mesenteric Artery (SMA) in 2 cases and from Proper Hepatic Artery (PHA) in 2 cases. LCV was draining into Superior Mesenteric Vein (SMV) in 18 cases and into Portal Vein (PV) in 2 cases. In 12 of the cases LCV was coursing dorsal to PHA, Common Hepatic Artery (CHA) and Splenic Artery (SA), in 6 cases LCV was coursing ventral to these vessels and was joined to SMV. In 2 cases whose LCV was draining into PV, it was coursing ventral to CHA.
Conclusion: Dual phase CTA is successful to define perigastric vascular structures and reduces the risk of vascular injuries when performed before laparoscopic gastrectomy.