Department of Radiology, Hanyang University College of Medicine, Hanyang University Hospital, Seoul, Republic of Korea.
Radiology. 2010 Apr;255(1):278-88. doi: 10.1148/radiol.09090389.
To identify and evaluate the spectrum and prevalence of celiac axis (CA) and common hepatic artery (CHA) variations by using spiral computed tomography (CT) and digital subtraction angiography (DSA).
Institutional review board approval was obtained, and the requirement for informed patient consent was waived. The findings in 5002 patients who underwent spiral CT and DSA were retrospectively evaluated. CHA was defined as an arterial trunk containing at least one segmental hepatic artery and the gastroduodenal artery. The pattern of the aortic origin of the branches of the CA and superior mesenteric arteries was analyzed. The CHA anatomy was then investigated.
Of 15 possible types of CA variation, 13 types were identified. A normal CA was noted in 4457 (89.1%) of the 5002 patients. Twelve types of CA variation were identified in 482 (9.64%) patients. In the remaining 63 (1.26%) patients, the CA anatomy was classified as ambiguous because the CHA was absent owing to separate origins of the hepatic arteries and the gastroduodenal artery (n = 55) or because the origin of the CHA could not be determined owing to persistent anastomotic channels (n = 8). Seven CHAs originating from the normal CA had a retroportal (n = 6) or transpancreatic (n = 1) course. All eight CHAs originating from the left gastric artery passed the fissure of the ligamentum venosum. The 148 CHAs originating from the superior mesenteric artery showed diverse relationships with the pancreas--being supra-, trans-, or infrapancreatic--and the superior mesenteric-portal venous axis--being pre- or retroportal. The 20 CHAs originating from the aorta had a normal suprapancreatic preportal course.
Known or newly found CA and CHA variations could be systematically described in detail. The authors propose a hypothetical anatomic model for summarizing the observed CHA variations.
利用螺旋 CT（computed tomography）和数字减影血管造影（digital subtraction angiography）来识别和评估腹腔干（celiac axis，CA）和肝总动脉（common hepatic artery，CHA）的变异类型和发生率。
本研究获得了机构审查委员会的批准，并豁免了患者知情同意的要求。回顾性分析了 5002 例行螺旋 CT 和 DSA 的患者的检查结果。CHA 定义为包含至少一个节段性肝动脉和胃十二指肠动脉的动脉干。分析了 CA 和肠系膜上动脉分支的主动脉起始模式。然后研究了 CHA 的解剖结构。
在 15 种可能的 CA 变异类型中，发现了 13 种类型。在 5002 例患者中，4457 例（89.1%）的 CA 正常。在 482 例（9.64%）患者中发现了 12 种 CA 变异类型。在其余 63 例（1.26%）患者中，由于肝动脉和胃十二指肠动脉分别起源（n = 55）或由于持续存在吻合通道而无法确定 CHA 起源（n = 8），导致 CHA 缺失，因此 CA 解剖结构被归类为不明确。7 支起源于正常 CA 的 CHA 呈门静脉后（n = 6）或胰后（n = 1）走行。所有 8 支起源于左胃动脉的 CHA 均穿过静脉韧带裂。起源于肠系膜上动脉的 148 支 CHA 与胰腺的关系多种多样——位于胰腺上、胰腺间或胰腺下，与肠系膜上静脉-门静脉轴的关系也多种多样——位于门静脉前或门静脉后。起源于主动脉的 20 支 CHA 呈正常胰上门静脉前走行。
可以系统地详细描述已知或新发现的 CA 和 CHA 变异。作者提出了一个假设的解剖模型来总结观察到的 CHA 变异。
