Calcification score versus arterial stenosis grading: comparison of two CT-based methods for risk assessment of anastomotic leakage after esophagectomy and gastric pull-up

Figures & data

Figure 1 Evaluation of vessel diameter in CE-CT.

Notes: (A) Parasagittal curved MPR of a proximal TC stenosis with location of the orthogonal cuts at the normal (1) and maximally stenosized (2) lumen. Orthogonal planes where the measurements are performed are presented in (B and C). Degree of stenosis (s) in (%) is calculated using the formula s = (a−b)/a × 100.
Abbreviations: CE-CT, contrast enhanced-computed tomography; MPR, multiplanar reconstruction; TC, celiac trunk.

Table 1 Definitions used to grade calcifications of the supplying arteries of the gastric tube seen on preoperative CT images by van Rossum et al⁹

Artery	Score 0	Score 1	Score 2
Aortaa	Absent	Minor calcifications: <9 foci and ≤3 foci extending over ≥3 sections	Major calcifications: >9 foci or >3 foci extending over ≥3 sections
Celiac axis	Absent	Minor calcifications: extending over <3 sections or MCSD of single focus ≤10 mm	Major calcifications: extending over ≥3 sections and MCSD of single focus >10 mm or involving both the proximal (aortoceliac) and distal (hepatosplenic bifurcation) parts
Right postceliac arteriesb	Absent	≥1 calcifications	Not applicable
Left postceliac arteriesc	Absent	≥1 calcifications	Not applicable

Notes:

a Aorta defined as descending part of thoracic aorta and abdominal part of aorta above celiac level.

b Right postceliac arteries defined as common hepatic artery, gastroduodenal artery and right gastroepiploic artery.

c Left postceliac arteries defined as splenic artery and left gastroepiploic artery. Adapted with permission from van Rossum PS, Haverkamp L, Verkooijen HM, et al. Calcification of arteries supplying the gastric tube: a new risk factor for anastomotic leakage after esophageal surgery. Radiology. 2015;274(1):124–132.⁹

Abbreviations: CT, computed tomography; MCSD, maximum cross-sectional diameter.

Figure 2 Degree of (A) TC and (B) SMA stenosis in patients with and without anastomotic insufficiency after esophagectomy and gastric pull-up.

Note: ^*Outliers with a distance from the box of more than 3xIQR.
Abbreviations: SMA, superior mesenteric artery; TC, celiac trunk.

Table 2 Frequency of calcification score of patients with/without AI

Score	Aorta		Celiac trunk		Right postceliac axis		Left postceliac axis
	AI		AI		AI		AI
	Yes	No	Yes	No	Yes	No	Yes	No
0	4 (28.6)	64 (42.7)	8 (57.1)	89 (59.3)	13 (92.9)	143 (95.3)	9 (64.3)	97 (65.1)
1	4 (28.6)	38 (25.3)	3 (21.4)	37 (24.7)	1 (7.1)	7 (4.7)	5 (35.7)	52 (34.9)
2	6 (42.9)	48 (32.0)	3 (21.4)	24 (16.0)	–	–	–	–

Note: Data are n (%).

Abbreviation: AI, anastomotic insufficiency.

Table 3 Histopathologic results and preoperative comorbidities in association with anastomotic leak

Common comorbidities	Total (N=42)	Without anastomotic leak (n=28)	With anastomotic leak (n=14)	p-value
Tumor entity
Adenocarcinoma	29	21 (72.4)	8 (27.6)	0.238a
Squamous cell carcinoma	13	7 (53.8)	6 (46.2)
BMI, in kg/m^2 (mean, SD)	26 (4.8)	26 (4.8)	26 (4.8)	1.000b
BMI ≥25	26 (61.9)	16 (57.1)	10 (71.4)	0.369a
Heart failure	8 (19.0)	5 (17.9)	3 (21.4)	0.781a
Diabetes mellitus	6 (14.3)	2 (7.1)	4 (28.6)	0.061a
Smoker	24 (57.1)	17 (60.7)	7 (50.0)	0.508a
Peripheral vascular disease	2 (4.8)	1 (3.6)	1 (7.1)	1.000a

Notes: Values in parentheses are percentages unless indicated otherwise.

a χ² test,

b Student’s t-test.

Abbreviation: BMI, body mass index.

van RossumPSHaverkampLVerkooijenHMvan LeeuwenMSvan HillegersbergRRuurdaJPCalcification of arteries supplying the gastric tube: a new risk factor for anastomotic leakage after esophageal surgeryRadiology2015274112413225119021

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