Sherif Mohamed Zaki

Citation:

Zaki, S. M., A. H. K. Abdelmaksoud, B. E. A. Khaled, and I. A. Abdel Kader, "Anatomical variations of hepatic artery using the multidetector CT angiography.", Folia morphologica, 2019.

Abstract:

BACKGROUND: the frequency of normal and aberrant hepatic arteries differs among ethnicities. The aim of our work was to study the frequency of normal and aberrant hepatic arteries among Egyptian using multidetector CT (MDCT) and to compare our prevalence with the prevalence of other nationalities. In addition, the gender differences of such variations were clarified. In addition, the arterial feeding of hepatic segment IV was determined.

MATERIALS AND METHODS: The present study was carried out on 500 patients (409 males and 91 females). Abdominal CT was performed using two MDCT systems, a 64-row, and a 256-slice system.

RESULTS: According to Michel's classification, the normal anatomy (type I) was observed in 369 cases (73.8%), while anomalous hepatic arterial pattern was detected in 131 cases (26.2%).These anomalies were distributed as the following; type II in 36 cases (7.2%) , type III in 60 cases (12%), types IV and V in 5 cases for each (1% each) , type VI in 14 (2.8%) and types VIII & IX in a single case for each (0.2% each). Neither type VII nor type X was detected. Nine unclassified cases (1.8 %) were observed. According to Hiaat's classification, the anomalies were distributed as the following; type II in 41 cases (8.2%), type III in 74 cases (14.8 %), type IV in 6 (1.2 %), type V in a single case (0.2%) and type VI in 2 cases (0.4%). Finally, seven unclassified cases (1.4 %) were observed. Common hepatic artery (CHA) originated from celiac trunk in 98% (79.8% males and 18.2% females). It originated from the abdominal aorta in 0.4% and from the superior mesenteric artery (SMA) in 0.4%. It was absent in 1.2%. Right hepatic artery (RHA) originated from the CHA in 86.6% (69.8% males and 16.8 % females) and from the SMA in 13.2% (11.8% males and 1.4% females) and from the abdominal aorta in 0.2% (a single male case). Left hepatic artery (LHA) originated from the CHA in 91.2% and from the left gastric artery (LGA) in 8.8%. The most common origin of the segment IV blood supply was the LHA in 60.8%, followed by the RHA in 35%. Less commonly, blood supply derived from the hepatic artery proper (HAP) in 1%. Combined supply derived from RHA and LHA in 0.8%, from the LHA and HAP in 2% and the least encountered was from the RHA and HAP in 0.4%.

CONCLUSIONS: Hepatic artery variations among Egyptians have a different distribution when compared to such variations among other species. The normal hepatic arterial pattern was observed in 73.8%, while the anomalous was detected in 26.2%. The CHA originated from the celiac trunk in 98%, the RHA originated from the CHA in 86.6% and the LHA originated from the CHA in 91.2%. The most common arterial supply of the hepatic segment IV is derived from the LHA (60.2%).