The evaluation of the right inferior phrenic artery diameter in cirrhotic patients

A morphological study of the inferior phrenic arteries on multidetector computed tomography and angiography

INTRODUCTION

The inferior phrenic artery is a paired artery with a variable origin and course, primarily supplying the diaphragm, but also the suprarenal glands, inferior vena cava, stomach, and oesophagus. The aim of this study is to investigate the origin and course of the inferior phrenic arteries on multidetector computed tomography and angiography.

MATERIALS AND METHODS

The anatomy of the inferior phrenic artery was analysed on 2449 multidetector computed tomography scans. Three-dimensional reconstructions were made of the main variations. Additionally, the course and branching pattern of the inferior phrenic artery were descriptively analysed in a cohort of 28 angiograms.

RESULTS

In 565 (23.1%) cases the inferior phrenic arteries arose as a common trunk and in 1884 (76.9%) cases as individual vessels. The most common origins of a common trunk were the coeliac trunk (n=303; 53.6%) and abdominal aorta (n=255; 45.1%). The most common origins of the right inferior phrenic artery were the coeliac trunk (n=965; 51.2%), abdominal aorta (n=562; 29.8%) and renal arteries (n=214; 11.4%). The most common origins of the left inferior phrenic artery were the coeliac trunk (n=1293; 68.6%) and abdominal aorta (n=403; 21.4%).

CONCLUSION

The inferior phrenic artery has a very variable anatomy. The most common origins of the inferior phrenic artery are the coeliac trunk and its branches, the abdominal aorta, and the renal arteries.

Hypertrophied Right Inferior Phrenic Artery in Cirrhotic Patients without Hepatocellular Carcinoma: An Interesting Observation on 256 Slice Multidetector Computed Tomography

Aim To evaluate whether right inferior phrenic artery (RIPA) is a source of extrahepatic arterial supply to the liver in cirrhotic patients without hepatocellular carcinoma (HCC) using 256 slice computed tomography (CT).

Materials and Methods Institutional review board approval was obtained for this retrospective study. A total of 262 consecutive cirrhotic patients (male:female–172:90; mean age 56.45 ± 12.96 years) without HCC and hepatic vascular invasion, and who underwent technically successful multiphase CT, were included in the study. Additionally, 280 noncirrhotic patients (male:female–169:111; mean age 54.56 ± 14.21 years) who underwent abdominal multiphase CT scans for indications other than liver disease and did not have focal liver lesions or hepatic vascular disease were included as a control group. The RIPA and left inferior phrenic artery (LIPA) diameters were measured at the level of the ascending segment of IPA located anterior to the diaphragmatic crus. The relationship between RIPA diameters and Child–Pugh score was assessed.

Results The cirrhotic patient group and control group were matched for age (p = 0.11) and gender (p = 0.20). The mean diameter of RIPA in the cirrhotic group (1.93 ± 0.4 mm) was significantly higher than in the control group (1.50 ± 0.5 mm), p < 0.001. The mean diameter of LIPA in the cirrhotic group (1.34 ± 0.5 mm) was not significantly higher than in the control group (1.30 ± 0.5 mm), p = 0.32. We found a statistically linear and moderate degree relationship between RIPA diameter values and Child–Pugh scores (p = 0.002, r = 0.593).

Conclusion RIPA is hypertrophied in patients with cirrhosis without HCC. It may be an important contributor to the blood flow to the liver in cirrhotic patients even without HCC, especially with portal hypertension.