Clinical anatomy of hepatic vessels by computed tomography angiography: A minireview

Abstract

The liver has a complex vascular anatomy with a unique dual blood supply. Clinical conditions of the liver vary widely and include disorders originating in the vascular and biliary systems as well as the parenchyma. In most vascular disorders, the effects on the liver are generally subclinical because of its abundant blood supply. However, early diagnosis of such vascular diseases can significantly reduce patient morbidity and mortality. Because imaging findings of vascular disease are not always readily apparent, diagnosis can be difficult. Computed tomography angiography is an excellent imaging modality for visualizing the vascular anatomy of patients for treatment planning. In this review article, we focus on the vascular anatomy of the liver and the imaging findings in some acute hepatic vascular diseases.

Keywords: Computed tomography angiography; Hepatic artery; Periportal region; Portal triad; Portal vein; Sinusoid.

Figure 1

Image examination. A: Axial computed tomography (CT) shows portal vein thrombosis; B: Separate origins of the common hepatic artery and the splenic artery. Coronal volume rendered image of a 44-year-old female presenting with right lumber pain demonstrates a hepatic arterial variation as the common hepatic artery (blue arrow) and the splenic artery (white arrow) originating directly from the abdominal aorta separately; C: The common hepatic artery directly originating from the abdominal aorta. Axial contrast-enhanced CT of a 55-year-old male patient with known peripheral vascular disease presenting direct origin of the common hepatic artery (arrow) from the abdominal aorta; D: Hepatic artery pseudoaneurysm. Axial contrast-enhanced arterial phase CT image of a 42-year-old man, suffering from epigastric pain and presenting with hemobilia and elevated liver enzymes, shows an 8 mm diameter pseudoaneurysm (arrow); E: High grade stenosis of the common hepatic artery. Coronal volume rendered CT image of a 76-year-old male with the diagnosis of vasculitis demonstrates severe stenosis (arrow); F: Occlusion of all hepatic veins consistent with Budd-Chiari syndrome. Venous phase axial CT scan shows thrombosed hepatic veins (arrows).