Application value of a novel classification of the celiac axis for preoperative CT angiography

Objective To investigate the application value of a novel classification of the celiac axis for preoperative computed tomography angiography (CTA).

Methods The retrospective cohort study was conducted. The clinical data of 747 patients who underwent abdominal multi‑slice spiral CTA in 3 medical centers, including 616 cases at The Fourth Hospital of Harbin, 80 cases at Heilongjiang Provincial Hospital, and 51 cases at The Fourth Hospital of Harbin, from August 2020 to December 2022 were collected. There were 493 males and 254 females, aged (63±13) years. All 747 pati-ents underwent routine three‑dimensional reconstruction of the abdominal artery. Data of patients from two clinical studies on celiac axis classification of 425 cases and 639 cases were collected. Accor-ding to different classification methods, the classification of celiac axis can be divided into the novel classification and the classic classifications (Deng Shengjun classification and Clement classification). Observation indicators: (1) comparison of different classifications of celiac axis based on the novel classification; (2) comparison of different classifications of celiac axis based on the classic classifi-cation. Measurement data with normal distribution were represented as Mean±SD. Comparison of count data between groups was conducted using the chi‑square test. The Kappa test was used to evaluate the consistency of CTA results between two physicians.

Results (1) Comparison of different classifications of celiac axis based on the classic classification: using the novel classification of celiac axis as standard, all 747 patients were distributed as 555 cases of type Ⅰa, 141 cases of type Ⅰb, 46 cases of type Ⅱa, 4 cases of type Ⅱb, 0 case of type Ⅲa, and 1 case of type Ⅲb, respectively. For the 425 patients included in the Deng Shengjun classification, there were 159 cases of type Ⅰa, 242 cases of type Ⅰb, 23 cases of type Ⅱa, 0 case of type Ⅱb, 1 case of type Ⅲa, and 0 case of type Ⅲb, respectively. For the 639 patients included in the Clement classification, there were 573 cases of type Ⅰa, 5 cases of type Ⅰb, 61 cases of type Ⅱa, 0 case of type Ⅱb, 0 case of type Ⅲa, and 0 case of type Ⅲb, respectively. The novel classification of celiac axis can cover all patients included in the Deng Shengjun classification and Clement classification. The Kappa value for the consistency verification of the novel classification of celiac axis was 0.871 (P<0.05), indicating a high degree of consistency in the two physicians. Of the 747 patients, cases classified as dangerous subtype Ⅱa in the novel classification of celiac axis accounting for the highest proportion as 6.16%(46/747).(2) Comparison of different classifications of celiac axis based on the novel classification: using the Deng Shengjun classification as standard, all 747 patients were distributed as 117 cases of type Ⅰa, 12 cases of type Ⅰb, 1 case of type Ⅰc, 555 cases of type Ⅱ, 27 cases of type Ⅲa, 15 cases of type Ⅲb, 4 cases of type Ⅲc, 11 cases of type Ⅳ, and 1 case of type Ⅴ, respectively. All 425 patients included in the Deng Shengjun classifica-tion were distributed as 168 cases of type Ⅰa, 67 cases of type Ⅰb, 5 cases of type Ⅰc, 159 cases of type Ⅱ, 9 cases of type Ⅲa, 14 cases of type Ⅲb, 0 case of type Ⅲc, 2 cases of type Ⅳ, and 1 case of type Ⅴ, respectively. There was a significant difference in the distribution of patients between the novel classification of celiac axis and the Deng Shengjun classification (χ²=218.61, P<0.05). Of the 747 patients, 743 cases were included in the Deng Shengjun classification, and 4 cases were not included who were classified as type Ⅱb in the novel classification of celiac axis, as Deng Shengjun classification did not include cases of subtypes with two main branches and additional arteries. Using the Clement classification as standard, all 747 patients were distributed as 439 cases of type Ⅰa, 116 cases of type Ⅰb, 117 cases of type Ⅰc, 15 cases of type Ⅱa, 27 cases of type Ⅱb, 4 cases of type Ⅱc, 0 case of type Ⅲ, and 11 cases of type Ⅳ, respectively. All 639 patients included in the Clement classification were distributed as 368 cases of type Ⅰa, 205 cases of type Ⅰb, 5 cases of type Ⅰc, 29 cases of type Ⅱa, 32 cases of type Ⅱb, 0 case of type Ⅱc, 0 case of type Ⅲ, and 0 case of type Ⅳ, respectively. There was a significant difference in the distribution of patients between the novel classification of celiac axis and the Clement classification (χ²=148.34, P<0.05). Of the 747 patients, 729 cases were included in the Clement classification, 18 cases were not included, including 13 cases classified as type Ⅰb in the novel classification of celiac axis as Clement classification did not include cases of subtypes with three main branches and additional ≥2 arteries, 4 cases of classified as type Ⅱb in the novel classification of celiac axis as Clement classification did not include cases of subtypes with two main branches and additional arteries, and 1 case classified as type Ⅲb in the novel classification of celiac axis as Clement classification did not include cases of subtypes with arterial anastomosis channel.

Conclusions Compared with the Deng Shengjun classification and Clement classifications, the novel classification of celiac axis is more simpler, and covers a wider range of anatomical variants of celiac axis. The novel classification of celiac axis can be applied in preoperative CTA assessment.