Skip main navigation
Close Drawer MenuOpen Drawer Menu
Search
Quick Search in Journals
Quick Search anywhere
Advanced Search
Menu
  • Information
    • Previous
    Next
    Original Research

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

    Published Online:Jul 1 2008https://doi.org/10.1148/radiol.2481071156

    Abstract

    Purpose: 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.

    Materials and Methods: 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.

    Results: 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.

    Conclusion: The configuration of the cystic duct and cystic arteries can be depicted preoperatively with 64–detector row CT in patients scheduled to undergo cholecystectomy.

    © RSNA, 2008

    References

    • 1 Suzuki M, Akaishi S, Rikiyama T, Naitoh T, Rahman MM, Matsuno S. Laparoscopic cholecystectomy, Calot's triangle, and variations in cystic arterial supply. Surg Endosc 2000; 14: 141–144. Crossref, Medline, Google Scholar
    • 2 Hugh TB, Kelly MD, Li B. Laparoscopic anatomy of the cystic artery. Am J Surg 1992;163:593–595. Crossref, Medline, Google Scholar
    • 3 Balija M, Huis M, Nikolic V, Stulhofer M. Laparoscopic visualization of the cystic artery anatomy. World J Surg 1999;23:703–707. Crossref, Medline, Google Scholar
    • 4 Scott-Conner CE, Hall TJ. Variant arterial anatomy in laparoscopic cholecystectomy. Am J Surg 1992;163:590–592. Crossref, Medline, Google Scholar
    • 5 Ata AH. Cystic artery identification during laparoscopic cholecystectomy. J Laparoendosc Surg 1991;1:313–318. Crossref, Medline, Google Scholar
    • 6 Bergey E, Einstein DM, Herts BR. Cystic artery pseudoaneurysm as a complication of laparoscopic cholecystectomy. Abdom Imaging 1995;20:75–77. Crossref, Medline, Google Scholar
    • 7 Mahatharadol V. Bile duct injuries during laparoscopic cholecystectomy: an audit of 1522 cases. Hepatogastroenterology 2004;51:12–14. Medline, Google Scholar
    • 8 MacFadyen BV Jr, Vecchio R, Ricardo AE, Mathis CR. Bile duct injury after laparoscopic cholecystectomy: the United States experience. Surg Endosc 1998;12:315–321. Crossref, Medline, Google Scholar
    • 9 Jan YY, Chen HM, Wang CS, Chen MF. Biliary complications during and after laparoscopic cholecystectomy. Hepatogastroenterology 1997;44:370–375. Medline, Google Scholar
    • 10 Sekido H, Matsuo K, Morioka D, et al. Surgical strategy for the management of biliary injury in laparoscopic cholecystectomy. Hepatogastroenterology 2004;51:357–361. Medline, Google Scholar
    • 11 Nordin A, Halme L, Makisalo H, Isoniemi H, Hockerstedt K. Management and outcome of major bile duct injuries after laparoscopic cholecystectomy: from therapeutic endoscopy to liver transplantation. Liver Transpl 2002;8:1036–1043. Crossref, Medline, Google Scholar
    • 12 Ward EM, LeRoy AJ, Bender CE, Donohue JH, Hughes RW. Imaging of complications of laparoscopic cholecystectomy. Abdom Imaging 1993;18:150–155. Medline, Google Scholar
    • 13 Bacha EA, Stieber AC, Galloway JR, Hunter JG. Non-biliary complication of laparoscopic cholecystectomy. Lancet 1994;344:896–897. Crossref, Google Scholar
    • 14 Mathisen O, Soreide O, Bergan A. Laparoscopic cholecystectomy: bile duct and vascular injuries—management and outcome. Scand J Gastroenterol 2002;37:476–481. Crossref, Medline, Google Scholar
    • 15 Tzovaras G, Dervenis C. Vascular injuries in laparoscopic cholecystectomy: an underestimated problem. Dig Surg 2006;23:370–374. Crossref, Medline, Google Scholar
    • 16 Fathy O, Zeid MA, Abdallah T, et al. Laparoscopic cholecystectomy: a report on 2000 cases. Hepatogastroenterology 2003;50:967–971. Medline, Google Scholar
    • 17 Kitami M, Takase K, Murakami G, et al. Types and frequencies of biliary tract variations associated with a major portal venous anomaly: analysis with multi–detector row CT cholangiography. Radiology 2006;238:156–166. Link, Google Scholar
    • 18 Van Beers BE, Lacrosse M, Trigaux JP, de Canniere L, Ronde TD, Pringot J. Noninvasive imaging of the biliary tree before or after laparoscopic cholecystectomy: use of three-dimensional spiral CT cholangiography. AJR Am J Roentgenol 1994;162:1331–1335. Crossref, Medline, Google Scholar
    • 19 Kamel IR, Liapi E, Fishman EK. Liver and biliary system: evaluation by multidetector CT. Radiol Clin North Am 2005;43:977–997. Crossref, Medline, Google Scholar
    • 20 Kwon AH, Inui H, Imamura A, Uetsuji S, Kamiyama Y. Preoperative assessment for laparoscopic cholecystectomy: feasibility of using spiral computed tomography. Ann Surg 1998;227:351–356. Crossref, Medline, Google Scholar
    • 21 Ota H, Takase K, Igarashi K, et al. MDCT compared with digital subtraction angiography for assessment of lower extremity arterial occlusive disease: importance of reviewing cross-sectional images. AJR Am J Roentgenol 2004;182:201–209. Crossref, Medline, Google Scholar
    • 22 Takase K, Sawamura Y, Igarashi K, et al. Demonstration of the artery of Adamkiewicz at multi–detector row helical CT. Radiology 2002;223:39–45. Link, Google Scholar
    • 23 Remy-Jardin M, Bouaziz N, Dumont P, Brillet PY, Bruzzi J, Remy J. Bronchial and nonbronchial systemic arteries at multi-detector row CT angiography: comparison with conventional angiography. Radiology 2004;233:741–749. Link, Google Scholar
    • 24 Matsuki M, Kani H, Tatsugami F, et al. Preoperative assessment of vascular anatomy around the stomach by 3D imaging using MDCT before laparoscopy-assisted gastrectomy. AJR Am J Roentgenol 2004;183:145–151. Crossref, Medline, Google Scholar
    • 25 Takahashi S, Murakami T, Takamura M, et al. Multi–detector row helical CT angiography of hepatic vessels: depiction with dual-arterial phase acquisition during single breath hold. Radiology 2002;222:81–88. Link, Google Scholar
    • 26 Zandrino F, Benzi L, Ferretti ML, Ferrando R, Reggiani G, Musante F. Multislice CT cholangiography without biliary contrast agent: technique and initial clinical results in the assessment of patients with biliary obstruction. Eur Radiol 2002;12:1155–1161. Crossref, Medline, Google Scholar
    • 27 Kielar A, Toa H, Sekar A, Mimeault R, Jaffey J. Comparison of CT duodeno-cholangiopancreatography to ERCP for assessing biliary obstruction. J Comput Assist Tomogr 2005;29:596–601. Crossref, Medline, Google Scholar
    • 28 Ichii H, Takada M, Kashiwagi R, et al. Three-dimensional reconstruction of biliary tract using spiral computed tomography for laparoscopic cholecystectomy. World J Surg 2002;26:608–611. Crossref, Medline, Google Scholar
    • 29 Tebala GD, Innocenti P, Ciani R, et al. Identification of gallbladder pedicle anatomy during laparoscopic cholecystectomy [in Italian]. Chir Ital 2004;56:389–396. Medline, Google Scholar
    • 30 Benson EA, Page RE. A practical reappraisal of the anatomy of the extrahepatic bile ducts and arteries. Br J Surg 1976;63:853–860. Crossref, Medline, Google Scholar

    Article History

    Published in print: 2008