Yang Feng, Di Yang, Li Ji, Wang Xiao-Yi, Yao Lie, Hao Si-Jie, Jiang Yong-Jian, Jin Chen, Fu De-Liang
Feng Yang, Yang Di, Ji Li, Xiao-Yi Wang, Lie Yao, Si-Jie Hao, Yong-Jian Jiang, Chen Jin, De-Liang Fu, Department of Pancreatic Surgery, Pancreatic Disease Institute, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China.
World J Gastroenterol. 2015 Jan 21;21(3):969-76. doi: 10.3748/wjg.v21.i3.969.
To assess the efficacy of cross-sectional multidetector computed tomography (MDCT) imaging without arterial reconstruction to identify aberrant right hepatic artery (RHA) and celiac artery stenosis (CAS) in patients scheduled for pancreaticoduodenectomy.
Patients with peri-ampullary and pancreatic head tumors who underwent routine preoperative MDCT and subsequent computed tomography (CT) angiography (CTA), conventional angiography or pancreaticoduodenectomy between September 2007 and August 2013 were identified. Retrospective analysis of imaging data was undertaken using CTA, conventional angiographic and surgical findings as the reference standards. The accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of MDCT in evaluation of aberrant RHA and CAS were calculated.
A group of 458 patients met the inclusion criteria of this study to detect aberrant RHA, and 181 cases were included to identify CAS. Fifty-four (11.8%) patients were confirmed to have aberrant RHA, while 12 (6.6%) patients with CAS were demonstrated. MDCT yielded an accuracy of 98.5%, sensitivity of 96.3% and specificity of 98.8% in the detection of aberrant RHA. The sensitivity, specificity, PPV and NPV of MDCT for detecting CAS were 58.3%, 98.2%, 70% and 97.1%, respectively.
Routine MDCT is recommended such that surgeons and radiologists be alerted to the importance of arterial variants on preoperative CT scans in patients scheduled for pancreaticoduodenectomy.
评估在计划行胰十二指肠切除术的患者中，未进行动脉重建的横断面多排螺旋计算机断层扫描（MDCT）成像识别变异型右肝动脉（RHA）和腹腔干狭窄（CAS）的效能。
确定2007年9月至2013年8月期间接受常规术前MDCT及随后的计算机断层血管造影（CTA）、传统血管造影或胰十二指肠切除术的壶腹周围和胰头肿瘤患者。以CTA、传统血管造影和手术结果作为参考标准，对影像数据进行回顾性分析。计算MDCT评估变异型RHA和CAS的准确性、敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。
一组458例患者符合本研究检测变异型RHA的纳入标准，181例患者纳入识别CAS。54例（11.8%）患者被证实存在变异型RHA，12例（6.6%）患者存在CAS。MDCT检测变异型RHA的准确性为98.5%，敏感性为96.3%，特异性为98.8%。MDCT检测CAS的敏感性、特异性、PPV和NPV分别为58.3%、98.2%、70%和97.1%。
建议进行常规MDCT检查，以便外科医生和放射科医生在计划行胰十二指肠切除术的患者术前CT扫描时，注意动脉变异的重要性。
