Abstract:
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Purpose: Gastric arteries and veins can vary between patients, therefore, it requires much time to ligate arteries, and veins can be damaged during regional lymph node excision under laparoscopic guidance. We evaluate the efficacy of multiphase fusion technique for three-dimensional imaging of gastric arteries and veins using multislice CT (MSCT) in preoperative simulation and intraoperative navigation of laparoscopy-assisted gastrectomy (LAG).
Methods and Materials: Forty consecutive patients with gastric cancer were evaluated by MSCT. CT scans were acquired at arterial and venous phases after i.v. injection of contrast material (300mgI Iohexol, total dosage: body weight (kg) x2ml, rate: 5ml/sec) at a collimation of 1-mm, rotation time of 500-msec, slice width and reconstruction index of 1-mm. We instructed the patients to stop breathing at the same level in two phases. 3D images of the arterial system at the arterial phase and the venous system at the venous phase were demonstrated separately using the volume-rendering algorithm and the images were then fused (multiphase fusion image). The items examined were as follows. 1) The levels at which patients stopped breathing at the arterial phase and the venous phase were compared. 2) The detectability of the left gastric artery (LGA) and right gastric artery (RGA) at the arterial phase was investigated. 3) The detectability of the left gastric coronary vein (LCV) and right gastric vein (RGV), Henle's gastrocolic trunk (GCT) by 3D CT angiography (3D-CTA) was investigated. 4) In intraoperative navigation, the clinical usefulness of multiphase fusion imaging was evaluated.
Results: 1)Thirty-seven of 40 patients (93%) stopped breathing at the same level at the arterial and venous phases. 2) The LGA was depicted in all of 37 cases (100%) and the RGA in 35 of 37 cases (95%). 3) The LCV, RGV and GCT were depicted in 35 (95%), 34 (92%) and 35 (95%) of 37 cases. 4) In 34 of 40 cases (85%), multiphase fusion imaging clearly demonstrated the gastric arteries and veins simultaneously. We could arrange and rotate the image to correspond to the operative view, which was very useful in the intraoperative navigation of LAG.
Conclusion: Multiphase fusion imaging using MSCT clearly revealed the vascular anatomy of the stomach, which enabled us to ligate the arterial bases and veins, and to excise lymph nodes fast and safely. Moreover, the imaging technique plays an important role in intraoperative navigation of LAG. In the future, we consider that the multiphase fusion images will be utilized in mapping of robotic surgery.
Matsuki MD, M,
Usefulness of Multiphase Fusion Technique for Three-dimensional Imaging of Gastric Arteries and Veins Using Multislice CT in Preoperative Simulation and Intraoperative Navigation of Laparoscopy-assisted Gastrectomy. Radiological Society of North America 2003 Scientific Assembly and Annual Meeting, November 30 - December 5, 2003 ,Chicago IL.
http://archive.rsna.org/2003/3104883.html
