Anatomic Variations Of The Hepatic Arteries: An Evaluation By Using128-slice MDCTA

ObjectiveTo evaluate the incidence of anatomic variation of hepatic arteries (detailedin segmental artery variation) by using MDCTA and image post-processingtechnology. Therefore we can provide valuable information to livertransplantation, liver cancer surgery, and interventional therapy.Materials and MethodsA total of691patients (472men;219women; mean age,59.0years) whounderwent abdominal MDCT angiography examination in Tai’an CentralHospital between April2012and December2012were enrolled andretrospectively analyzed. Image quality was graded by an ordinal scale. Hepaticanatomy was classified according to Michels’ classification, and the findingswere compared to other four studies for evaluation their differences. Makedetailed classification of the supplied arteries to the liver II, III, IV section andright hepatic lobe according to the origin and wandering of hepatic arteries’,therefore we can calculate their incidences and make an analysis of differentvariations in order to summarize their regularity. This study further clarified theimportant significance of mastering the knowledge of hepatic arterialanatomical variation in liver cancer surgery and interventional therapy.ResultsOf the691examined patients,103(14.91%) were excluded because ofsub-optimal image quality. Of the remaining588patients (396men;192women;age range,22-94years; mean age,59years;), anatomical variations weredetected in137cases (23.3%).4groups with similar data at home and abroadwere compared by Chi square, and there is no statistical significance (P<0.05).Through summarizing the hepatic artery pattern proposed by domestic andforeign literatures, we proposed a new classification to complete it. Made a comparation between CTA and DSA data of the cases who acceptedintervention therapy, χ2=0.003, P value=0.960, the result was not statisticallysignificant.We divided the arteries of liver segment II and III to two catergaries fromdetailed observation of588patients, the first type Normal LHA and the secondtype Aberrant LHA, which was called S2-Normal LHA type、 S2-Aberrant LHAtype/S3-Normal LHA type、S3-Aberrant LHA type, whose incidence was82.65%(486),17.35%(102),82.65%(486),17.35%(102) respectively. TheS2/S3-Normal LHA type was then divided into seven subtypes, S2/S3-AberrantLHA type was divided into six subtypes. Liver segment Ⅳartery (A4) wasdivided into five types namely LHA type, RHA type, PHA type, DHA type andTHA type according to the origin and number of the segment arteries, eachincidence was56.12%(330),28.57%(168),2.21%(13),12.76%(75),0.34%(2).The feeding arteries of right hepatic lobe were divided into seven typesaccording to the wandering line of the blood vessels (in Arabic numerals,1,2,3,4,5,6,7,8type), and their incidences were43.54%(256),15.14%(89),15.31%(90),1.7%(10),2.89%(17),6.29%(37),13.95%(82),1.19%(7)respectively.ConclusionThe results showed that128slice-MDCTA had an important significanceon the analysis of hepatic arterial anatomy, we can obtain DSA-like imageswith it. This study showed the presence of a relatively high incidence rate ofhepatic artery anatomical variations (23.30%) in the examined population.