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Dual-Phase 3D CT Angiography During a Single Breath-Hold Using 16-MDCT: Assessment of Vascular Anatomy Before Laparoscopic Gastrectomy

Mitsuru Matsuki1, Masato Tanikake1, Hiroyuki Kani1, Fuminari Tatsugami1, Shuji Kanazawa1, Takaaki Kanamoto1, Yuki Inada1, Syushi Yoshikawa1, Isamu Narabayashi1, Sang-Woong Lee2, Eiji Nomura2, Junji Okuda2 and Nobuhiko Tanigawa2

1 Department of Radiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka 569-8686, Japan.
2 Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki City, Osaka 569-8686, Japan.


Figure 1
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  		Fig. 1 —Drawing shows lymph node groups according to the Japanese classification of gastric cancer [11]: 1 = right cardinal, 2 = left cardinal, 3 = lesser curvature, 4 = greater curvature, 5 = suprapyloric, 6 = infrapyloric, 7 = left gastric artery, 8a = anterosuperior region of common hepatic artery, 9 = celiac artery. Red = artery, blue = vein.

 

Figure 2
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  		Fig. 2 —Diagram and drawings show timetable during contrast-enhanced CT examination of 56-year-old woman with early gastric cancer. During a single breath-hold of 31 sec, venous phase scanning of 8 sec was performed serially from arterial phase of 8 sec with 15-sec interval. Three-dimensional angiography images in arterial phase (arteriography [diagram a]) and venous phase (venography [diagram b]) were individually reconstructed using volume-rendering technique and were then fused. RGA = right gastric artery, LGA = left gastric artery, GDA = gastroduodenal artery, RGEA = right gastroepiploic artery, RGV = right gastric vein, LCV = left gastric coronary vein, RGEV = right gastroepiploic vein, ARCV = accessory right colic vein, GCT = Henle's gastrocolic vein, PV = portal vein.

 

Figure 3
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  		Fig. 3 —Fused image of 3D CT arteriography and venography images around stomach in 56-year-old woman with early gastric cancer simultaneously shows arteries (gold) and veins (blue) around stomach.

 

Figure 4
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  		Fig. 4 —Multiplanar reconstruction (MPR) image in venous phase fused with that of air-filled stomach in arterial phase. MPR image of air-filled stomach in arterial phase (red) is consistent with axial (image a), coronal (image b), and sagittal (image c) views in venous phase, which proves that single breath-hold had been performed and that stomach had not changed shape because of peristalsis between arterial and venous phases.

 

Figure 5
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  		Fig. 5A —53-year-old woman with early gastric cancer. Fused image of 3D CT arteriography (gold) and venography (blue) clearly shows right gastric artery (RGA) originating from gastroduodenal artery (GDA), left gastric artery (LGA) originating from celiac trunk, and left gastric coronary vein (LCV) joining splenic vein (Sp. V) after running along ventral side of common hepatic artery (CHA). RGV = right gastric vein, PV = portal vein.

 

Figure 6
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  		Fig. 5B —53-year-old woman with early gastric cancer. Intraoperative view shows LCV joining splenic vein after running along ventral side of CHA.

 

Figure 7
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  		Fig. 6A —59-year-old woman with early gastric cancer. Fused image of 3D CT arteriography (gold) and venography (blue) clearly shows right gastric artery (RGA) originating from left hepatic artery (LHA) and accessory right colic vein (ARCV) joining right gastroepiploic vein (RGEV). GCT = Henle's gastrocolic trunk, SMV = superior mesenteric vein, GDA = gastroduodenal artery, RGEA = right gastroepiploic artery.

 

Figure 8
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  		Fig. 6B —59-year-old woman with early gastric cancer. Intraoperative view shows ARCV joining RGEV. GCT = Henle's gastrocolic trunk, RGEA = right gastroepiploic artery.

 

Figure 9
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  		Fig. 7 —Diagrams of arteries and veins around stomach. Inset a shows left gastric coronary vein (LCV), which was first confirmed and ligated (solid red line) before dissection of lymph nodes in anterosuperior region of common hepatic artery (CHA) (8a) (dotted red line). Inset b shows right gastroepiploic vein (RGEV) distal to joining point of accessory right colic vein (ARCV), which was carefully ligated (solid red line) while preserving ARCV. Moreover, subpyloric lymph node (6) was carefully excised without causing injury to ARCV (dotted red line). GCT = Henle's gastrocolic trunk, RGEA = right gastroepiploic artery.

 

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