Anatomical variations of hepatic arterial system, coeliac trunk and renal arteries: an analysis with multidetector CT angiography

Abstract

The purpose of our investigation was to determine the anatomical variations in the coeliac trunk-hepatic arterial system and the renal arteries in patients who underwent multidetector CT (MDCT) angiography of the abdominal aorta for various reasons. A total of 100 patients were analysed retrospectively. The coeliac trunk, hepatic arterial system and renal arteries were analysed individually and anatomical variations were recorded. Statistical analysis of the relationship between hepatocoeliac variations and renal artery variations was performed using a chi(2) test. There was a coeliac trunk trifurcation in 89% and bifurcation in 8% of the cases. Coeliac trunk was absent in 1%, a hepatosplenomesenteric trunk was seen in 1% and a splenomesenteric trunk was present in 1%. Hepatic artery variation was present in 48% of patients. Coeliac trunk and/or hepatic arterial variation was present in 23 (39.7%) of the 58 patients with normal renal arteries, and in 27 (64.3%) of the 42 patients with accessory renal arteries. There was a statistically significant correlation between renal artery variations and coeliac trunk-hepatic arterial system variations (p = 0.015). MDCT angiography permits a correct and detailed evaluation of hepatic and renal vascular anatomy. The prevalence of variations in the coeliac trunk and/or hepatic arteries is increased in people with accessory renal arteries. For that reason, when undertaking angiographic examinations directed towards any single organ, the possibility of variations in the vascular structure of other organs should be kept in mind.

Figure 1

Splenomesenteric trunk: the superior mesenteric artery (thin white arrows) and splenic artery (black arrow) originate from a common trunk as seen in (a) coronal MIP and (b) volume-rendered images. The common hepatic artery (thick white arrow) and left gastric artery (white arrowhead) originate from a separate trunk.

Figure 2

Right hepatic artery (white arrowhead) originating from the middle colic artery (thick white arrow) as seen in (a) coronal MIP and (b) volume-rendered images. Black arrows point out the superior mesenteric artery and the thin white arrow indicates the coeliac trunk.

Figure 3

Right hepatic artery originating from the abdominal aorta. Axial MIP images demonstrate that the right hepatic artery (thin white arrows) originates directly from the aorta. The thick white arrow indicates the coeliac trunk.

Figure 4

Right hepatic artery originating from the coeliac trunk. The left hepatic artery (thin black arrow) takes its origin from the common hepatic artery (thick white arrow), but the right hepatic artery (thin white arrows) originates directly from the coeliac trunk. The thick black arrow indicates the splenic artery.

Figure 5

Accessory renal arteries. This volume-rendered image shows two renal arteries on the right and three on the left. The accessory renal artery supplying the inferior pole of the right kidney (thick white arrows) has an aortic origin even lower than that of the inferior mesenteric artery (thin white arrow).