Evaluation of the venous drainage pattern of the splenic flexure by preoperative three‐dimensional computed tomography

Abstract Background In hepatectomy, the preservation of portal perfusion and venous drainage in the remnant liver is important for securing postoperative hepatic function. Right hepatectomy is generally indicated when a hepatic tumor involves the right hepatic vein (RHV). However, if a sizable inferior RHV (IRHV) exists, hepatectomy with preservation of the IRHV territory may be another option. In this case, we verified the clinical feasibility of anatomical bisegmentectomy 7 and 8 with RHV ligation, averting the right hepatic parenchyma from venous congestion, utilizing the presence of the IRHV. Case presentation A 70-year-old man was presented with a large hepatic tumor infiltrating the RHV on computed tomography during a medical checkup. The patient was diagnosed with hepatocellular carcinoma (HCC), T2N0M0, stage III. Right hepatectomy was first considered, but multi-detector computed tomography (MDCT) also revealed a large IRHV draining almost all of segments 5 and 6, suggesting that IRHV-preserving liver resection may be another option. The calculated future remnant liver volumes were 382 mL (26.1% of the total volume) after right hepatectomy and 755 mL (51.7% of the total volume) after anatomical bisegmentectomy 7 and 8; therefore, we scheduled IRHV-preserving anatomical bisegmentectomy 7 and 8 considering the prevention of postoperative liver failure and increased chance of performing repeat resections in cases of recurrence. Preoperative three-dimensional simulation using MDCT clearly revealed the portal perfusion area and venous drainage territories by the RHV and IRHV. There was an issue with invisibility of the anatomical resection line of segments 7 and 8, which was completely dissolved by intraoperative ultrasonography using Sonazoid and the portal dye injection technique with counter staining. The postoperative course in the patient was uneventful, without recurrence of HCC, for 30 months after hepatectomy. Conclusions IRHV-preserving anatomical bisegmentectomy 7 and 8 is a safe and feasible procedure utilizing the three-dimensional simulation of the portal perfusion area and venous drainage territories and the portal dye injection technique.

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Hepatic Venous Drainage: How Much Can We Learn From Imaging Studies? Anatomic-Functional Classification Derived From Three-Dimensional Computed Tomography Reconstructions

Transplantation Journal ◽

10.1097/tp.0b013e3181dd6bac ◽

2010 ◽

Vol 89 (12) ◽

pp. 1518-1525 ◽

Cited By ~ 19

Author(s):

Arnold Radtke ◽

Georgios C. Sotiropoulos ◽

George Sgourakis ◽

Ernesto P. Molmenti ◽

Tobias Schroeder ◽

...

Keyword(s):

Computed Tomography ◽

Three Dimensional ◽

Venous Drainage ◽

Functional Classification ◽

Imaging Studies

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Portal Supply and Venous Drainage of the Caudate Lobe in the Healthy Human Liver: Virtual Three-Dimensional Computed Tomography Volume Study

World Journal of Surgery ◽

10.1007/s00268-016-3791-8 ◽

2016 ◽

Vol 41 (3) ◽

pp. 817-824 ◽

Cited By ~ 3

Author(s):

T. Benkö ◽

G. Sgourakis ◽

E. P. Molmenti ◽

H. O. Peitgen ◽

A. Paul ◽

...

Keyword(s):

Computed Tomography ◽

Human Liver ◽

Three Dimensional ◽

Venous Drainage ◽

Caudate Lobe ◽

Healthy Human

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Evaluation of anterior third of superior sagittal sinus in normal population: Identifying the subgroup with dominant drainage

Journal of Neurosciences in Rural Practice ◽

10.4103/0976-3147.176201 ◽

2016 ◽

Vol 07 (02) ◽

pp. 257-261 ◽

Cited By ~ 2

Author(s):

Sushanta K. Sahoo ◽

Mandeep S. Ghuman ◽

Pravin Salunke ◽

Sameer Vyas ◽

Rahat Bhar ◽

...

Keyword(s):

Frontal Lobe ◽

Superior Sagittal Sinus ◽

Normal Population ◽

Three Dimensional ◽

Venous Drainage ◽

Anatomical Variations ◽

Frontal Lobes ◽

Drainage Pattern ◽

Sagittal Sinus ◽

Drainage Patterns

ABSTRACT Background/Object: The ligation and transection of anterior third of superior sagittal sinus (AT-SSS) is an important step to approach anterior skull base lesions. Some clinical studies have shown frontal lobe venous infarct following such surgical procedures questioning the safety of its ligation. We have studied the variations in venous drainage patterns to AT-SSS in the normal population using postcontrast magnetic resonance venogram (MRV). A novel scoring system to recognize the subgroup with dominant venous drainage from frontal lobes has been described. Materials and Methods: In this study, 60 three-dimensional contrast-enhanced (CE) MRVs were obtained from those cases being evaluated for a headache not harboring any intracranial mass lesion. The AT-SSS with all its draining veins was studied in detail. Morphology of individual veins such as length, caliber, tributaries, and angulation with AT-SSS was studied, and a numerical value of 0 or 1 was assigned for each of the above parameters. Summing up these scores derived from the individual cortical veins quantified the drainage of AT-SSS. Results: There are 3–4 veins on either side draining to AT-SSS. Barely, 3% of the veins had > 3 tributaries. Only 6.6% of veins had a caliber >3 mm, and 16.5% drained at acute angles to AT-SSS. About 26% of the veins did cross at least half of the lateral frontal lobe. We found in 26 individuals the AT-SSS score was 0–2, in 22 it was 3–5 and, in only in 12 (20%) the score was 6 or more (dominant drainage). Conclusion: There are anatomical variations in venous drainage of frontal lobes into AT-SSS. Those with dominant drainage are likely to develop venous congestion and complications if sacrificed. It is possible to identify these individuals on the basis of venous drainage pattern as shown in CE-MRV.

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Evaluation of vascular anatomy for colon cancer located in the splenic flexure using the preoperative three-dimensional computed tomography angiography with colonography

International Journal of Colorectal Disease ◽

10.1007/s00384-020-03773-x ◽

2020 ◽

Author(s):

K. Iguchi ◽

H. Mushiake ◽

S. Hasegawa ◽

T. Fukushima ◽

M. Numata ◽

...

Keyword(s):

Computed Tomography ◽

Colon Cancer ◽

Computed Tomography Angiography ◽

Splenic Flexure ◽

Three Dimensional ◽

Vascular Anatomy

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X-ray microtomography

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100107058 ◽

1988 ◽

Vol 46 ◽

pp. 998-999

Author(s):

H.W. Deckman ◽

B.F. Flannery ◽

J.H. Dunsmuir ◽

K.D' Amico

Keyword(s):

Computed Tomography ◽

Internal Structure ◽

Imaging Technique ◽

Three Dimensional ◽

Tissue Structure ◽

Individual Element ◽

X Ray ◽

Non Invasive ◽

Panoramic Imaging ◽

Three Dimensional Images

We have developed a new X-ray microscope which produces complete three dimensional images of samples. The microscope operates by performing X-ray tomography with unprecedented resolution. Tomography is a non-invasive imaging technique that creates maps of the internal structure of samples from measurement of the attenuation of penetrating radiation. As conventionally practiced in medical Computed Tomography (CT), radiologists produce maps of bone and tissue structure in several planar sections that reveal features with 1mm resolution and 1% contrast. Microtomography extends the capability of CT in several ways. First, the resolution which approaches one micron, is one thousand times higher than that of the medical CT. Second, our approach acquires and analyses the data in a panoramic imaging format that directly produces three-dimensional maps in a series of contiguous stacked planes. Typical maps available today consist of three hundred planar sections each containing 512x512 pixels. Finally, and perhaps of most import scientifically, microtomography using a synchrotron X-ray source, allows us to generate maps of individual element.

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