Venous anatomy of the pancreatic head: normal CT appearance in cadavers and patients.

Abstract

This study was conducted to define the normal CT appearance of the four pancreaticoduodenal veins (anterior and posterior superior, and anterior and posterior inferior) in the head of the pancreas in injected cadaveric specimens and to assess the frequency with which these normal vessels are seen on dynamic contrast-enhanced CT scans. The appearance of the four pancreaticoduodenal veins was studied on CT scans of four cadavers in which the portal veins were injected in situ with radiopaque solutions. A computer-generated three-dimensional model of the pancreatic head and its venous drainage was then produced from one cadaveric examination to show the venous anatomy. After definition of the venous anatomy in the cadaveric specimen, the anterior superior pancreaticoduodenal vein, posterior superior pancreaticoduodenal vein, and gastrocolic trunk were analyzed retrospectively on dynamic bolus contrast-enhanced abdominal CT scans of 100 consecutive patients who had no evidence of pancreatic disease. The anterior and posterior superior pancreaticoduodenal veins were seen on 98% and 88% of scans, respectively. The veins had mean diameters of 2.1 mm. The gastrocolic trunk was seen on 89% of scans and had a mean diameter of 4.7 mm. The inferior pancreaticoduodenal veins are small and were not identified definitively. The anterior and posterior superior pancreaticoduodenal veins and gastrocolic trunk are routinely visualized on CT scans of patients without pancreatic disease. Consequently, assessment of the veins may be useful in staging pancreatic carcinoma.