Preoperative Evaluation of Perigastric Vascular Anatomy by 3-Dimensional Computed Tomographic Angiography Using 16-Channel Multidetector-Row Computed Tomography for Laparoscopic Gastrectomy in Patients With Early Gastric Cancer

Purpose: The purpose of this study was to evaluate the efficacy of 3-dimensional computed tomographic angiography (3D CTA) using 16-channel multidetector-row helical computed tomography (MDCT) in the preoperative visualization of laparoscopic gastrectomy for early gastric cancer. Materials and Methods: Twenty consecutive patients with early gastric cancer who underwent computed tomographic (CT) examination using 16-channel MDCT (0.625 mm × 16) before surgery were included in this study. At a rate of 4 mL/s, 2 mL/kg of 300 mg I/mL contrast material was intravenously injected. Timing for arterial phase scanning was determined by using a test bolus injection. Portal phase imaging was performed 70 seconds after the start of bolus injection. By using volume rendering and maximum intensity projection techniques, 3D CT angiograms of perigastric vessels were reconstructed from CT images of 0.625-mm thickness on computer workstations. Results: In all cases, the left gastric artery (LGA) and the right gastric artery were correctly identified on 3D CTA, and the left gastric vein was also depicted on 3D CTA in all cases. In 2 cases, the aberrant left hepatic artery from LGA was correctly identified on 3D CTA. In 1 case, the accessory LGA from the left hepatic artery was correctly identified on 3D CTA. The variations of the veins included the left gastric vein flowing into the portal vein in 10 cases: the splenic vein in 9 and the junction of the portal and splenic veins in 1. Conclusions: A 3D CTA reconstructed from 16-channel MDCT images clearly revealed perigastric vascular anatomy in all cases, which is important for laparoscopic gastrectomy. Three-dimensional CTA is useful for the preoperative visualization of laparoscopic gastrectomy.

[1]  Fuminari Tatsugami,et al.  Preoperative assessment of vascular anatomy around the stomach by 3D imaging using MDCT before laparoscopy-assisted gastrectomy. , 2004, AJR. American journal of roentgenology.

[2]  K. Horton,et al.  Multidetector CT angiography for preoperative evaluation of living laparoscopic kidney donors. , 2003, AJR. American journal of roentgenology.

[3]  Junji Okuda,et al.  Preoperative simulation of vascular anatomy by three-dimensional computed tomography imaging in laparoscopic gastric cancer surgery. , 2003, Journal of the American College of Surgeons.

[4]  Y. Panis,et al.  Detection of hypovascular hepatic metastases at triple-phase helical CT: sensitivity of phases and comparison with surgical and histopathologic findings. , 2004, Radiology.

[5]  M. Hori,et al.  Laparoscopic lymph node dissection for gastric cancer with intraoperative navigation using three-dimensional angio computed tomography images reconstructed as laparoscopic view , 2003, Surgical Endoscopy And Other Interventional Techniques.

[6]  Leo P Lawler,et al.  CT angiography: principles, techniques and study optimization using 16-slice multidetector CT with isotropic datasets and 3D volume visualization. , 2004, Critical reviews in computed tomography.

[7]  S. Goldberg,et al.  Multi-detector row CT of relevant vascular anatomy of the surgical plane in split-liver transplantation. , 2003, Radiology.

[8]  Andrew D. Smith,et al.  Assessment of 100 live potential renal donors for laparoscopic nephrectomy with multi-detector row helical CT. , 2005, Radiology.

[9]  Carlo Catalano,et al.  T staging of gastric cancer: role of multi-detector row CT. , 2005, Radiology.

[10]  T. Kim,et al.  Evaluation of the Hepatic Artery in Potential Donors for Living Donor Liver Transplantation by Computed Tomography Angiography Using Multidetector-row Computed Tomography: Comparison of Volume Rendering and Maximum Intensity Projection Techniques , 2003, Journal of computer assisted tomography.

[11]  M. Catarci,et al.  Laparoscopic Billroth II distal subtotal gastrectomy with gastric stump suspension for gastric malignancies. , 1996, American journal of surgery.

[12]  K Sugimachi,et al.  Laparoscopy-assisted Billroth I gastrectomy. , 1994, Surgical laparoscopy & endoscopy.

[13]  N. Michels,et al.  Blood supply and anatomy of the upper abdominal organs, with a descriptive atlas , 1955 .

[14]  G. Adam,et al.  Anatomic variations of the hepatic arteries in 604 selective celiac and superior mesenteric angiographies , 2004, Surgical and Radiologic Anatomy.

[15]  K. Choe,et al.  Lymph node metastasis in early gastric cancer with submucosal invasion: feasibility of minimally invasive surgery. , 2004, World journal of gastroenterology.

[16]  P. Kim,et al.  Gastric cancer staging at multi-detector row CT gastrography: comparison of transverse and volumetric CT scanning. , 2005, Radiology.

[17]  H. Shimada,et al.  Appropriate lymph node dissection for early gastric cancer based on lymph node metastases. , 2001, Surgery.

[18]  Cristiano G S Huscher,et al.  Laparoscopic Versus Open Subtotal Gastrectomy for Distal Gastric Cancer: Five-Year Results of a Randomized Prospective Trial , 2005, Annals of surgery.

[19]  T. Murakami,et al.  Hypervascular hepatocellular carcinoma: detection with double arterial phase multi-detector row helical CT. , 2001, Radiology.

[20]  Takamichi Murakami,et al.  Multi-detector row helical CT angiography of hepatic vessels: depiction with dual-arterial phase acquisition during single breath hold. , 2002, Radiology.

[21]  J. L. Craven,et al.  Laparoscopic Billroth II gastrectomy for early gastric cancer , 1995, The British journal of surgery.

[22]  W. Foley,et al.  Multiphase hepatic CT with a multirow detector CT scanner. , 2000, AJR. American journal of roentgenology.