Abstract
BACKGROUND: The superior mesenteric artery (SMA) has numerous branches and a high rate of anatomical variation, making it challenging to manage during surgery. This study aimed to evaluate the clinical utility of dual energy computed tomography (CT) three-dimensional (3D) reconstruction combined with arteriovenous image fusion technology for assessing SMA variations. The goal is to aid in surgical planning for laparoscopic radical resection of right colon cancer, using the SMA as the primary surgical approach. METHODS: We performed a retrospective analysis of clinical and imaging data from patients with right colon cancer who underwent enhanced spectral CT of the abdomen and pelvis before surgery at Nantong University Affiliated Hospital from January 2020 to June 2024. Using post-processing techniques to reconstruct SMA images, the study evaluated the SMA root position, measured the distance between the roots of the right branches of the SMA, analyzed their relationship with patient gender and body mass index (BMI), and summarized the types of right branches of the SMA. Additionally, the relationship between the middle colic artery (MCA), right colic artery (RCA), ileocolic artery (ICA), and the superior mesenteric vein (SMV) positions were analyzed in relation to patient clinical characteristics. RESULTS: The SMA root was mostly located at the L1 vertebral level (74.68%, 236/316), with a vertebral range between T12-L2. The distance from the SMA root to the abdominal aorta (D(SMA-AB)) was 115.97±11.82 mm, and this distance increased with higher BMI in males. Type I SMA (presence of RCA) accounted for 39.87% (126/316), Type II (absence of RCA) accounted for 60.13% (190/316), with the distance between the root of the MCA and the ICA (d(MCA-ICA)) being longer in type II. 91.27% (115/126) of the RCA was anterior to the SMV. When the RCA was posterior, the ICA was always posterior to the SMV. The ICA was anterior to the SMV in about 50.63% (160/316) of cases, with a higher incidence in males and those with a shorter d(MCA-ICA). CONCLUSIONS: Spectral CT 3D reconstruction and arteriovenous image fusion technology can accurately assess the anatomical features of the SMA and the relationship between the right branch vessels and the SMV, helping to develop reasonable surgical plans for laparoscopic radical right hemicolectomy in patients with right colon cancer using an "SMA-prioritized approach".