Preoperative Assessment of Vascular Anatomy Around the Stomach by 3D Imaging Using MDCT Before Laparoscopy-Assisted Gastrectomy
AJR 2004; 183:145-151.
Matsuki M, Kani H, Tatsugami F, Yoshikawa S, Narabayashi I, Lee SW, Shinohara H, Nomura E, Tanigawa N.
OBJECTIVE: Our aim was to evaluate the efficacy of 3D imaging using MDCT in the preoperative assessment of the vascular anatomy around the stomach before laparoscopy-assisted gastrectomy.
SUBJECTS AND METHODS: Thirty-six consecutive patients scheduled for laparos-copy-assisted distal gastrectomy were evaluated on MDCT. CT was performed at the arterial phase after a bolus IV injection of contrast material. Three-dimensional CT angiography (3D CTA) of the arterial and venous systems was reconstructed separately using a volume-rendering algorithm, and the images were fused. Three dimensional CTA for the left gastric, right gastric, and replaced left hepatic arteries and the left gastric coronary vein was evaluated pro-spectively by three reviewers, and then a surgical correlation was made.
RESULTS: In all 36 cases, the left gastric artery was correctly identified on 3D CTA. In 35 of 36 cases, the right gastric artery was correctly identified, whereas in one case, the right gastric artery could not be visualized on 3D CTA because of its small size. In 35 of 36 cases (i.e., one case with agenesis of the left gastric coronary vein was excluded), the left gastric coronary vein was correctly identified. In six cases, the replaced left hepatic artery was correctly identified on 3D CTA. All 36 cases underwent successful laparoscopy-assisted distal gastrectomy on the basis of the 3D CTA. Both the sensitivity and positive predictive values of 3D CTA revealed 100% correct determination of the left gastric artery, replaced left hepatic artery, and left gastric coronary vein. The sensitivity and positive predictive values for the right gastric artery were 97% and 100%, respectively.
CONCLUSION: Three-dimensional CTA using MDCT clearly revealed individual vascular anatomies around the stomach and could play an important role in safely facilitating the laparoscopy-assisted gastrectomy procedure.