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Using Multidetector CT for Preoperative Vascular Evaluation of Liver Neoplasms: Technique and Results

¹ Department of Radiology, Division of Abdominal Imaging and Intervention, Massachusetts General Hospital, Ellison 234-E, 55 Fruit St., Boston, MA 02114.
² Decision Analysis and Technology Assessment Group, Massachusetts General Hospital, Boston, MA 02114.
³ Department of Surgical Oncology, Massachusetts General Hospital, Boston, MA 02114.

View larger version (120K): [in a new window]   Fig. 1A. —Multidetector CT scan of replaced right hepatic artery in 39-year-old woman operated on in past for colon cancer who now presents with liver metastases. CT angiography and catheter angiography were performed as part of preoperative workup. Maximum-intensity-projection CT angiogram shows replaced right hepatic artery from superior mesenteric artery. LH = left hepatic artery, SM = superior mesenteric artery, GD = gastroduodenal artery, RH = right hepatic artery.

View larger version (120K): [in a new window]   Fig. 1B. —Multidetector CT scan of replaced right hepatic artery in 39-year-old woman operated on in past for colon cancer who now presents with liver metastases. CT angiography and catheter angiography were performed as part of preoperative workup. Catheter angiogram confirms findings shown in A (arrow).

View larger version (148K): [in a new window]   Fig. 2A. —Accessory right hepatic artery in 64-year-old woman with liver metastases from colon cancer. Coronal subvolume maximum-intensity-projection (A) and curved reformation CT (B) angiograms show accessory right hepatic artery originating from superior mesenteric artery (SMA) (arrow, A).

View larger version (165K): [in a new window]   Fig. 2B. —Accessory right hepatic artery in 64-year-old woman with liver metastases from colon cancer. Coronal subvolume maximum-intensity-projection (A) and curved reformation CT (B) angiograms show accessory right hepatic artery originating from superior mesenteric artery (SMA) (arrow, A).

View larger version (128K): [in a new window]   Fig. 2C. —Accessory right hepatic artery in 64-year-old woman with liver metastases from colon cancer. Catheter angiogram confirms findings (arrow) shown in A and B.

View larger version (157K): [in a new window]   Fig. 3A. —Replaced left hepatic artery in 66-year-old man with liver metastases. Axial CT angiogram shows replaced left hepatic artery (arrow) from left gastric artery.

View larger version (104K): [in a new window]   Fig. 3B. —Replaced left hepatic artery in 66-year-old man with liver metastases. Catheter angiogram confirms findings (arrow) shown in A.

View larger version (134K): [in a new window]   Fig. 4A. —Common origin for celiac and superior mesenteric arteries in 72-year-old man with right lobe liver metastases. Axial (A), coronal (B), and sagittal (C) CT angiograms show common trunk of celiac and superior mesenteric arteries (arrow) from aorta.

View larger version (128K): [in a new window]   Fig. 4B. —Common origin for celiac and superior mesenteric arteries in 72-year-old man with right lobe liver metastases. Axial (A), coronal (B), and sagittal (C) CT angiograms show common trunk of celiac and superior mesenteric arteries (arrow) from aorta.

View larger version (116K): [in a new window]   Fig. 4C. —Common origin for celiac and superior mesenteric arteries in 72-year-old man with right lobe liver metastases. Axial (A), coronal (B), and sagittal (C) CT angiograms show common trunk of celiac and superior mesenteric arteries (arrow) from aorta.

View larger version (149K): [in a new window]   Fig. 4D. —Common origin for celiac and superior mesenteric arteries in 72-year-old man with right lobe liver metastases. Catheter angiogram confirms findings (arrow) shown in A—C.

View larger version (173K): [in a new window]   Fig. 5. —55-year-old man with liver metastasis. Axial portal venous phase CT scan shows early right posterior branch from main portal vein before its bifurcation (arrow). This finding was confirmed on intraoperative sonography and at surgery.

View larger version (183K): [in a new window]   Fig. 6A. —62-year-old man with multifocal hepatocellular carcinoma and portal vein thrombosis. Axial CT scan obtained in portal venous phase shows cirrhotic liver with multiple lesions (arrows) in left lobe and thrombus in left portal vein. Note adjacent arterial collaterals.

View larger version (134K): [in a new window]   Fig. 6B. —62-year-old man with multifocal hepatocellular carcinoma and portal vein thrombosis. Catheter angiogram shows filling defect (arrow) in expanded left portal vein.

View larger version (148K): [in a new window]   Fig. 7. —Liver metastases from colon cancer in 65-year-old woman. Axial CT scan shows large mass in right lobe of liver that involves right hepatic vein (not seen in this image). Contiguous tumor extension is shown encasing middle hepatic vein (arrow) and inferior vena cava. Note tumor extension into segment IV. This finding was confirmed on intraoperative sonography (not shown) and at surgery.

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