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CT Image Fusion for 3D Depiction of Anatomic Abnormalities of the Hepatic Hilum

¹ All authors: Department of Radiology, Kurume University School of Medicine, 67 Asahi-Machi, Kurume City, Fukuoka, 830-0011, Japan.

View larger version (36K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1 —Schematic shows anatomic features of hepatic hilum. RHA = right hepatic artery, LHA = left hepatic artery, GB = gallbladder, PHA = proper hepatic artery, CBD = common bile duct, PV = portal vein, CHA = common hepatic artery.

View larger version (40K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —53-year-old woman with diffuse adenomyomatosis of gallbladder. CT cholangiogram shows anomalous right posterior segmental duct draining into common hepatic duct (arrow).

View larger version (163K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —53-year-old woman with diffuse adenomyomatosis of gallbladder. Fused CT angiographic–CT cholangiographic image shows anatomic relations of portal vein, hepatic artery, and common hepatic duct in hepatic hilum. Configurations of cystic artery (curved arrow), cystic duct (arrowhead), and anomalous right posterior segmental duct (straight arrow) are evident. Pink indicates artery; yellow, bile duct; dark blue, portal vein; olive green, liver parenchyma.

View larger version (51K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —63-year-old woman with cholelithiasis. CT cholangiogram shows anomalous cystic duct draining into right hepatic duct (arrow).

View larger version (170K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —63-year-old woman with cholelithiasis. CT angiogram shows cystic artery origin of right hepatic artery (arrow). Liver parenchyma is 90% transparent. Pink indicates artery; dark blue, portal vein; light blue, renal vein; olive green, liver parenchyma.

View larger version (183K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C —63-year-old woman with cholelithiasis. Fused CT angiographic–CT cholangiographic image shows anatomic relations of anomalous cystic duct, hepatic bile duct, hepatic artery, and portal vein of hepatic hilum. Pink indicates artery; yellow, bile duct; dark blue, portal vein; light blue, renal vein; olive green, liver parenchyma, which is 90% transparent.

View larger version (145K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —66-year-old woman with gallbladder polyps. CT angiogram shows entire celiac trunk arising from superior mesenteric artery (curved white arrow), cystic artery (arrowhead) origin of right hepatic artery (straight white arrow), and left hepatic artery arising from left gastric artery (black arrow). Pink indicates artery.

View larger version (161K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —66-year-old woman with gallbladder polyps. CT angiogram shows right hepatic artery is anterior to portal vein and cystic artery is anterior to right portal vein (arrowhead). Pink indicates artery; blue, portal vein.

View larger version (167K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4C —66-year-old woman with gallbladder polyps. Fused CT angiographic–CT cholangiographic image shows anatomic relations of portal vein, right hepatic artery, cystic artery (arrowhead), and cystic duct (arrow) in hepatic hilum. Pink indicates artery; yellow, bile duct; blue, portal vein; olive green, liver parenchyma.

View larger version (149K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —62-year-old man with hepatocellular carcinoma. CT angiogram shows anomalous origin of right hepatic artery from superior mesenteric artery (arrows). Celiac and superior mesenteric arteries are joined and have common trunk (arrowhead). Pink indicates artery.

View larger version (174K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —62-year-old man with hepatocellular carcinoma. CT angiogram shows that right hepatic artery (arrows) is posterior to superior mesenteric vein, runs along portal vein for short distance, and enters liver parenchyma from left side of tumor (arrowheads). Pink indicates artery; blue, portal vein; olive green, liver parenchyma; emerald green, liver tumor.

View larger version (178K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5C —62-year-old man with hepatocellular carcinoma. Fused CT angiographic–CT cholangiographic image shows anatomic relations of portal vein, anomalous hepatic artery, liver tumor (segment V), and common hepatic duct in hepatic hilum. Liver parenchyma is 90% transparent. Pink indicates artery; yellow, bile duct; dark blue, portal vein; light blue, renal and hepatic veins; olive green, liver parenchyma; emerald green, liver tumor.

View larger version (146K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6A —67-year-old man with intrahepatic cholangiocarcinoma. CT angiogram shows anomalous origin of left hepatic artery from left gastric artery (arrowheads). Pink indicates artery.

View larger version (144K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6B —67-year-old man with intrahepatic cholangiocarcinoma. CT angiogram shows left hepatic artery runs into tumor (arrowheads). Tumor is supplied by left hepatic artery. Pink indicates artery; green, liver tumor.

View larger version (99K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6C —67-year-old man with intrahepatic cholangiocarcinoma. Fused CT angiographic–CT cholangiographic image shows focal defect (arrowheads) of left hepatic bile duct with proximal segmental dilatation and occlusion of left portal vein (arrow). Yellow indicates bile duct; blue, portal vein.

View larger version (167K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6D —67-year-old man with intrahepatic cholangiocarcinoma. Fused image depicts relations of liver tumor, anomalous hepatic artery, hepatic bile duct, and portal vein. Understanding of hilar anatomy and course of bile duct and hepatic vessels is crucial. After studying images, surgeons planned left hepatectomy. Pink indicates artery; yellow, bile duct; blue, portal vein; olive green, liver parenchyma; emerald green, liver tumor.

View larger version (128K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7A —68-year-old woman with gallbladder carcinoma. CT angiogram shows anomalous origin of right hepatic artery from superior mesenteric artery (arrows). Pink indicates artery.

View larger version (48K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7B —68-year-old woman with gallbladder carcinoma. CT cholangiogram shows anomalous right posterior segmental duct draining into common hepatic duct (arrow).

View larger version (140K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7C —68-year-old woman with gallbladder carcinoma. Fused image shows right hepatic artery (straight arrow) runs along right side of portal vein in course partly dorsal to hepatic duct, configuration of cystic duct (curved arrow), and anomalous right posterior segmental duct (arrowhead). Pink indicates artery; yellow, bile duct; dark blue, portal vein; light blue, renal and hepatic veins; olive green, liver parenchyma.

View larger version (156K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7D —68-year-old woman with gallbladder carcinoma. Intraoperative photograph shows findings concordant with those of image fusion. Straight arrow indicates right hepatic artery; curved arrow, cystic duct; arrowhead, right posterior duct.

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