Cystic Artery and Cystic Duct Assessment with 64–Detector Row CT before Laparoscopic Cholecystectomy

Abstract

To retrospectively assess 64-detector row computed tomography (CT) in the preoperative depiction of the cystic duct and cystic arteries in and around the Calot triangle. Institutional review board approval was obtained, with waiver of informed consent. A total of 245 consecutive patients (133 men, 112 women), including 48 patients who subsequently underwent cholecystectomy, were examined. Two independent observers evaluated the CT data set on the basis of axial sections, coronal and sagittal multiplanar reformations, and three-dimensional volume rendering. The relationship between the cystic arteries and the Calot triangle--which is bordered by the undersurface of the liver, common hepatic duct, and cystic duct--was also evaluated, and each patient was classified on the basis of the origin of the cystic arteries and the course to the Calot triangle. Statistical analysis was performed, and percentages and confidence intervals were calculated. The cystic arteries were delineated in 234 of the 245 patients. Both the Calot triangle and the cystic arteries were delineated in 223 patients. One cystic artery was seen in the Calot triangle in 173 patients, and two cystic arteries were seen in the Calot triangle in 12. One artery in the Calot triangle with accessory arteries from different origins outside the Calot triangle was seen in 18 patients, and no cystic artery was identified in 20. Cystic arteries were seen in 42 (92%; 95% confidence interval: 87%, 98%) of the 48 patients who subsequently underwent cholecystectomy. The relationship between the cystic arteries and the Calot triangle was in agreement with the surgical records for all patients. The configuration of the cystic duct and cystic arteries can be depicted preoperatively with 64-detector row CT in patients scheduled to undergo cholecystectomy.