Table 1.
Dynamic liver CT scan parameters.
Fig 1.
VR images of patients with aberrant RHAs.
a) Type 1: RHA (arrowhead) arising from the GDA (arrow). b) Type 2: RHA (arrowhead) originating from the SMA (arrow). c) Type 3: RHA (arrowhead) branching from the CA (arrow). d) Type 4: CHA (white arrowhead) originating from the SMA (short white arrow), trifurcating GDA (white long arrow), PHA (yellow arrowhead), and RGEA (yellow arrow). e) Type 5: LHA (short arrow) and RHA (long arrow) separately originating from the CHA (arrowhead). VR, volume rendering; RHA, right hepatic artery; GDA, gastroduodenal artery; SMA, superior mesenteric artery; CA, celiac axis; CHA, common hepatic artery; PHA, proper hepatic artery; RGEA, right gastroepiploic artery; LHA, left hepatic artery.
Fig 2.
Three-dimensional reconstruction images of aRHAs obtained using Synapse Vincent® (Fujifilm, Tokyo, Japan).
a) Type 1: LAO 3D view. RHA (arrowheads) ascending the retroportal way after branching from the GDA (arrow), which runs anteriorly to the pancreas. b) Type 2: LAO 3D view. After originating from the SMA (long arrow), the RHA (arrowheads) courses the dorsal side of the PV. c) Type 3: RL 3D view. RHA (starting from the yellow arrowheads and continuing along the white arrowheads) arising from the CA (arrow), which runs behind the PV. d) Type 4: LAO 3D view. CHA (white arrowheads) originating from the SMA (white long arrow) at the dorsal of the PV, then ascending just behind the PV and finally bifurcating the GDA (white short arrow) and PHA (yellow arrowhead). The RHA (yellow arrow) runs posterior to the PV. e) Type 5: LPO 3D view. LHA (short arrow) branching from the proximal CHA (long arrow) and RHA (arrowheads) from the distal CHA. The RHA courses anterior to the PV. LAO, left anterior oblique; RL, right-left; LPO, left posterior oblique; RHA, right hepatic artery; LHA, left hepatic artery; GDA, gastroduodenal artery; SMA, superior mesenteric artery; PV, portal vein; CA, celiac axis; CHA, common hepatic artery; PHA, proper hepatic artery.
Table 2.
aRHA classification with and without rLHA and schematic representation of the MHA origin.
Fig 3.
The embryology of hepatic arteries and visceral arteries.
a) Three embryonic hepatic arteries and their branches with the respective Couinaud’s segment in the liver. Segment II is supplied by the eLHA (arrowhead), segments III, IV, V, and VIII are supplied by the embryonic MHA (short arrow), and segments VI and VII by the embryonic RHA (long arrow). The embryonic MHA courses anterior to the PV, and the embryonic RHA ascends the retroportal way. The embryonic LHA arises from the LGA, the embryonic MHA from the CHA, and the embryonic RHA from the SMA. The embryonic RHA and embryonic LHA regress during development. b) Schematic presentation of the RHA arising from the GDA. When the anastomosis between the peripheral embryonic RHA (arrow) and GDA (arrowhead) is made, the aRHA from the GDA is formed. c) aRHA formation from the CA. When the embryonic RHA (arrow) with medial courses anastomose with the proximal portion of the CHA (arrowhead), the aRHA from the CA is formed. PV, portal vein; LGA, left gastric artery; CHA, common hepatic artery; SMA, superior mesenteric artery; GDA, gastroduodenal artery; CA, celiac axis; aRHA, aberrant hepatic artery. d) Tandler’s embryological model of the visceral arteries. The CA consists of three primitive roots: the LGA, SA, and CHA. The SMA derives from the fourth root. They are joined by longitudinal anastomosis. e) The formation of hepatomesenteric trunk. When the longitudinal anastomosis between the second and the third roots is interrupted, and the third and fourth roots are subsequently joined, the hepatomesenteric trunk is formed. f) Completed form of the hepatomesenteric trunk. The CA bifurcates only the LGA and SA. The CHA arises from the SMA. CA, celiac axis; LGA, left gastric artery; SA, splenic artery; CHA, common hepatic artery; SMA, superior mesenteric artery.
Fig 4.
a) Oblique coronal MIP image. The MHA (arrowhead) arises from the first branch of the LHA (arrow) at the hepatic hilum. b) Three-dimensional reconstruction image using Synapse Vincent® (Fujifilm, Tokyo, Japan). The MHA (arrowhead) courses outside the liver to the right of the umbilical part of the left portal vein (arrow). MIP, maximum intensity projection; HA, hepatic artery; MHA, middle hepatic artery; LHA, left hepatic artery.
Fig 5.
The artery to hepatic segment IV originating from the left hepatic artery inside the umbilical fissure.
a) VR image of the RHA arising from the SMA with the rLHA. The rLHA (short arrow) originates from the LGA (long arrow) and then branches the MHA (arrowhead). b) Oblique coronal MIP image showing how the MHA (arrowhead) originates from the rLHA inside the umbilical fissure (arrow). c) Three-dimensional reconstruction image using Synapse Vincent® (Fujifilm, Tokyo). The MHA (arrowhead) courses inside the umbilical fissure after branching from the rLHA (arrow). VR, volume rendering; MIP, maximum intensity projection; RHA, right hepatic artery; MHA, middle hepatic artery; LHA, left hepatic artery; rLHA, replaced LHA; LGA, left gastric artery; SMA, superior mesenteric artery.