Korean J Radiol.  2017 Apr;18(2):336-344. 10.3348/kjr.2017.18.2.336.

Variations in the Origin of Inferior Phrenic Arteries and Their Relationship to Celiac Axis Variations on CT Angiography

• Aslaner R
• Pekcevik Y
• Sahin H
• Toka O

• KMID: 2427945
• DOI: http://doi.org/10.3348/kjr.2017.18.2.336

Abstract

OBJECTIVE
Knowing the origin of the inferior phrenic artery (IPA) is important prior to surgical interventions and interventional radiological procedures related to IPA. We aimed to identify variations in the origin of IPA and to investigate the relationship between the origin of IPA and celiac axis variations using computed tomography angiography (CTA).
MATERIALS AND METHODS
The CTA images of 1000 patients (737 male and 263 female, the mean age 60, range 18-94 years) were reviewed in an analysis of IPA and celiac axis variations. The origin of IPA was divided into two groups, those originating as a common trunk and those originating independently without a truncus. The relationship between the origin of IPA and celiac axis variation was analyzed using Pearson's chi-square test.
RESULTS
Both IPAs originated from a common trunk in 295 (29.5%) patients. From which the majority of the common trunk originated from the aorta. Contrastingly, the inferior phrenic arteries originated from different origins in 705 (70.5%) patients. The majority of the right inferior phrenic artery (RIPA) and the left inferior phrenic artery (LIPA) originated independently from the celiac axis. Variation in the celiac axis were detected in 110 (11%) patients. The origin of IPA was found to be significantly different in the presence of celiac axis variation.
CONCLUSION
The majority of IPA originated from the aorta in patients with a common IPA trunk, while the majority of RIPA and LIPA originating from the celiac axis in patients without a common IPA trunk. Thus, the origin of IPA may widely differ in the presence of celiac axis variation.

Keyword

Abdomen; Arteries; CT angiography; Normal variants; Vascular; Inferior phrenic artery; Celiac axis variation; Extrahepatic collateral arterial supply; Transarterial chemoembolization; TACE

MeSH Terms

Adolescent
Adult
Aged
Aged, 80 and over
Aorta/anatomy & histology/*diagnostic imaging
Celiac Artery/anatomy & histology/*diagnostic imaging
*Computed Tomography Angiography
Contrast Media/chemistry
Female
Humans
Imaging, Three-Dimensional
Iodine/chemistry
Male
Middle Aged
Retrospective Studies
Young Adult
Contrast Media
Iodine

Figure

• 

  Fig. 1 Flowchart shows study population and patient selection process. CTA = computed tomography angiography, HCC = hepatocellular carcinoma, IPA = inferior phrenic artery

• 

  Fig. 2 Schematic representation of origin of inferior phrenic arteries with common trunk. A = aorta, CA = celiac axis, LGA = left gastric artery, LIPA = left inferior phrenic artery, LRA = left renal artery, RIPA = right inferior phrenic artery, RRA = right renal artery

• 

  Fig. 3 CT angiography MIP images show inferior phrenic artery (IPA) originating aorta (A), celiac axis (B), and right renal artery (C) as common trunk (arrowheads). White arrows: right IPA, black arrows: left IPA. MIP = maximum intensity projections

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  Fig. 4 Schematic representation of origin of inferior phrenic arteries without common trunk. A = aorta, CA = celiac artery, CHA = common hepatic artery, LGA = left gastric artery, LIPA = left inferior phrenic artery, LRA = left renal artery, RIPA = right inferior phrenic artery, RRA = right renal artery, SA = splenic artery

• 

  Fig. 5 CT angiography MIP images show right inferior phrenic artery (RIPA, white arrow) and left inferior phrenic artery (LIPA, black arrow) originating separately without truncus. A. Both RIPA and LIPA originate from celiac axis (black arrowhead). B. RIPA originates from right renal artery and LIPA from aorta. C. RIPA originates from left gastric artery (white arrowhead) and LIPA from celiac axis (not shown). MIP = maximum intensity projections

• 

  Fig. 6 CT angiography MIP image shows left inferior phrenic artery (black arrow) arising from back of aorta. MIP = maximum intensity projections

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  Fig. 7 CT angiography MIP image demonstrates right inferior phrenic artery (white arrow) originates from right superior polar renal artery. MIP = maximum intensity projections

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  Fig. 8 CT angiography images of patient with celiac axis variation. A. CT angiography MIP image demonstrates no celiac truncus and common hepatic artery (black arrowhead), splenic artery (white arrowhead) and left gastric artery originate from aorta rather than celiac trifurcation. B. CT angiography 3D volume-rendered image shows that right inferior phrenic artery (white arrows) arising from common hepatic artery (black arrowhead). White arrowhead indicates splenic artery and black arrow shows left inferior phrenic artery, arising from aorta. MIP = maximum intensity projections

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