Utilizing 3D CT reconstructions to identify variant hepatic artery anatomy

Abstract

Introduction: Hepatic artery (HA) anatomy is highly variant and may be difficult to recognize on traditional CT axial imaging. 3D reconstructions can be used in conjunction with axial imaging to identify variants pre-operatively. Our purpose was to create a database of common variant HA anatomy which can be used to educate surgeons and surgery residents on radiographic identification of variant anatomy to aid in pre-operative planning. Method: A database of variant HA anatomy was made from patients at a single tertiary care center. Images were de-identified prior to their transformation to 3D reconstructions. Only CTA studies were used, as these provide the optimal timing of the contrast bolus to facilitate the 3D reconstruction. Images representing the most commonly described HA variants were included. Results: Eight common variant HA images were included. 3D reconstructions are presented alongside axial images with descriptions of the variants, clues to identify the variants on imaging, and their clinical relevance. The user is able to rotate the 3D images and scroll through the axial cuts side by side to gain a better understanding of the anatomy. Conclusions: Surgeons can increase their understanding of variant HA anatomy prior to embarking on foregut resections by studying representative 3D reconstructions alongside axial imaging.