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CT Angiography for Delineation of Celiac and Superior Mesenteric Artery Variants in Patients Undergoing Hepatobiliary and Pancreatic Surgery

¹ Department of Radiology, Memorial Sloan-Kettering Cancer Center, 160 E 53rd St., 8th Fl., New York, NY 10022.
² Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA 19107.
³ Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY

View larger version (82K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1 —Classic hepatic arterial anatomy in 58-year-old man with metastatic colon cancer to liver. Volume-rendered 3D image created from axial contrast-enhanced CT data reveals classic branching arterial anatomy. Celiac axis (short solid arrow) trifurcates into splenic artery, common hepatic artery (long solid arrow), and left gastric artery. Common hepatic artery gives rise to gastroduodenal artery (open arrowhead) and proper hepatic artery (solid arrowhead). Right hepatic artery (long open arrow) and left hepatic artery (short open arrow) originate from proper hepatic artery.

View larger version (99K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —Replaced right hepatic artery in 69-year-old woman. Volume-rendered 3D image created from axial contrast-enhanced CT data reveals right hepatic artery (small open arrow) originating from superior mesenteric artery (SMA) (large solid arrow). Right hepatic artery courses posterior to stent (large open arrow) located within common bile duct. Note left hepatic artery (small solid arrow) originating from left gastric artery.

View larger version (98K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —Replaced right hepatic artery in 69-year-old woman. Thin-slab maximum-intensity-projection axial image reveals right hepatic artery (small solid arrow) originating from SMA (small open arrow). Right hepatic artery courses through portacaval space, between portal vein (large open arrow) and inferior vena cava (large solid arrow).

View larger version (104K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —Replaced left hepatic artery originating from left gastric artery in 73-year-old woman. Volume-rendered 3D image created from axial contrast-enhanced CT data reveals replaced left hepatic artery (small arrow) originating from left gastric artery (arrowhead). Common hepatic artery (large arrow) arises from celiac axis.

View larger version (94K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —Replaced left hepatic artery originating from left gastric artery in 73-year-old woman. Thin-slab axial maximum-intensity-projection image reveals replaced left hepatic artery (arrow) coursing through fissure for ligamentum venosum to perfuse left hepatic lobe.

View larger version (89K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —Variation in origin of common hepatic artery. Common hepatic artery originates from superior mesenteric artery (SMA) in 62-year-old man. Volume-rendered 3D image created from axial contrast-enhanced CT data reveals common hepatic artery (small open arrow) originates from SMA (large solid arrow). Gastroduodenal artery (large open arrow) originates from common hepatic artery. Note accessory left hepatic artery (small solid arrow) originating from left gastric artery.

View larger version (53K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —Variation in origin of common hepatic artery. Common hepatic artery originates directly from aorta in 68-year-old woman who also has trifurcation of common hepatic artery. Volume-rendered 3D image created from axial contrast-enhanced CT data reveals common hepatic artery (small open arrow) originates directly from abdominal aorta. Common hepatic artery trifurcates into right hepatic artery (large solid arrow), left hepatic artery (small solid arrow), and gastroduodenal artery (large open arrow).

View larger version (54K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —Double hepatic artery. Double hepatic artery in 62-year-old woman. Right hepatic artery originates from celiac axis. Steep oblique volume-rendered 3D image created from axial contrast-enhanced CT data image viewed from below reveals right hepatic artery (thick arrow) originates from celiac axis (arrowhead). Right hepatic artery extends posterior to stent (thin arrow) that is located within common bile duct.

View larger version (68K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —Double hepatic artery. Double hepatic artery in 62-year-old woman. Right hepatic artery originates from celiac axis. Volume-rendered 3D image created from axial contrast-enhanced CT data reveals right hepatic artery (small arrow) originates from celiac axis (arrowhead) proximal to origin of common hepatic artery (large arrow).

View larger version (125K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5C —Double hepatic artery. Double hepatic artery in 71-year-old woman. Right hepatic artery originates from aorta. Thick-slab maximum-intensity-projection image obtained from axial contrast-enhanced CT data reveals right hepatic artery (long arrow) originates directly from abdominal aorta, parallel to origin of superior mesenteric artery (SMA) (short arrow). Arrowhead indicates celiac axis.

View larger version (51K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5D —Double hepatic artery. Double hepatic artery in 77-year-old woman. Left hepatic artery originates from celiac axis. Volume-rendered 3D image created from axial contrast-enhanced CT data reveals origin (small open arrow) of left hepatic artery (large open arrow) directly from celiac axis. Common hepatic artery (large solid arrow) originates from celiac axis. Origin of SMA (small solid arrow) is obscured by splenic artery.

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