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.

摘要

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 x 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.