Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 6, 2019; 7(23): 3980-3989
Published online Dec 6, 2019. doi: 10.12998/wjcc.v7.i23.3980
Celiomesenteric trunk: New classification based on multidetector computed tomography angiographic findings and probable embryological mechanisms
Wei Tang, Jing Shi, Lian-Qin Kuang, Shuang-Yue Tang, Yi Wang
Wei Tang, Lian-Qin Kuang, Shuang-Yue Tang, Yi Wang, Department of Radiology, Daping Hospital, Army Medical University, Chongqing 400042, China
Wei Tang, Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
Jing Shi, Department of Nursing, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610072, Sichuan Province, China
Author contributions: Tang W and Shi J contributed equally to this work; Wang Y conceived the study; Tang W and Shi J designed the study, performed the data collection and wrote the manuscript; Tang W, Shi J and Kuang LQ contributed to analysis and interpretation of the data; Tang SY contributed to technical or material support; Wang Y obtained funding and revised the manuscript; all authors have read and approved the final version of this manuscript.
Supported by the National Natural Science Foundation of China, No. 81671943.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of Daping Hospital, Army Medical University, China.
Informed consent statement: The patients were not required to provide informed consent for the study because the analysis used anonymous clinical data that were obtained after the completion of treatment.
Conflict-of-interest statement: None of the authors have conflicts of interest that are related to the work submitted for consideration for publication. There are no commercial, personal, intellectual, political or religious interests by any of the authors.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Yi Wang, MD, PhD, Assistant Professor, Department of Radiology, Daping Hospital, Army Medical University, No. 10, Changjiangzhilu Daping, Yuzhong District, Chongqing 400042, China. ywhxl@qq.com
Telephone: +86-23-68757622 Fax: +86-23-68757620
Received: August 14, 2019
Peer-review started: August 14, 2019
First decision: September 10, 2019
Revised: October 21, 2019
Accepted: November 14, 2019
Article in press: November 14, 2019
Published online: December 6, 2019
Processing time: 114 Days and 7.8 Hours
Abstract
BACKGROUND

In previous studies, celiomesenteric trunk (CMT) was narrowly defined as a hepato-gastro-spleno-mesenteric (HGSM) trunk, but other possible types were ignored. With the widespread use of multidetector computed tomography (MDCT) angiography, it is easy to collect a large sampling of data on arterial anatomy of the abdomen in daily radiological practice. A new classification system for CMT may be created based on its MDCT angiographic findings and variation patterns.

AIM

To identify the spectrum and prevalence of CMT according to a new classification based on MDCT angiographic findings, and discuss the probable embryological mechanisms to explain the CMT variants.

METHODS

A retrospective study was carried out on 5580 abdominal MDCT angiography images. CMT was defined as a single common trunk arising from the aorta and its branches including the superior mesenteric artery and at least two major branches of the celiac trunk. Various types of CMT were investigated.

RESULTS

Of the 5580 patients, 171 (3.06%) were identified as having CMT. According to the new definitions and classification, the CMT variants included five types: I, II, III, IV and V, which were found in 96 (56.14%), 57 (33.33%), 4 (2.34%), 3 (1.75%) and 8 (4.68%) patients, respectively. The CMT variants also were classified as long type (106 patients, 61.99%) and short type (65 patients, 38.01%) based on the length of single common trunk. Further CMT classification was based on the origin of the left gastric artery: Type a (92 patients, 53.80%), type b (57 patients, 33.33%), type c (11 patients, 6.43%) and type d (8 patients, 4.68%).

CONCLUSION

We systematically classified CMT variants according to our new classification system based on MDCT angiographic findings. Dislocation interruption, incomplete interruption and persistence of the longitudinal anastomosis could all be embryological mechanisms of various types of CMT variants.

Keywords: Celiac artery; Mesenteric artery; superior; Anatomic variation; Classification; Computed tomography angiography

Core tip: A new definition and classification system for celiomesenteric trunk (CMT) was created in our study. CMT can be classified into various types according to its variation patterns, origins of left gastric artery and length of single common trunk on multidetector computed tomography angiographic images. CMT is not very rare in these observed patients and has wide-ranging health implications. Dislocation interruption, incomplete interruption and persistence of the longitudinal anastomosis could all be embryological mechanisms of various types of CMT variants.