A Comparative CT Study using 2 Different Invasive Application Routes of Contrast Material in the Detection of Liver Metastases before Surgery

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It was the a i m of this study to elucidate the value of CT arteriography (CTA) and CT during arterial portography (CTAP) in the detection of liver metastases before partial hepatectomy by comparing these diagnostic procedures directly. Method: We studied a total of 18 patients (pts) aged between 42 and 72 years. 16 pts suffered from colorectal carcinoma, 2 pts from other tumors. CTA and CTAP were performed at the same day using a CT Somatom DRH system. Immediately after angiography we performed CTA with injection of contrast material through an angiographic catheter placed in the hepatic artery. Directly after this procedure the patient was transferred for mesenteric arteriography, followed by CTAP with contrast material injection into the superior mesenteric artery. R e s u 1 t s: 14/18 pts showed focal hepatic masses. 50 lesions were detected by CTAP and 47 by CTA. Imaging results were confirmed in 3 cases by surgery and in the remaining pts by follow up. CTA of the liver shows the hepatic lesions due to their arterial enhancement as hyperattenuated masses compared with the normal hepatic parenchyma. This fact becomes a problem in lesions < 1 cm without central necrosis where the distinction between blood vessel and metastases is almost impossible. Especially for lesions <1 cm in diameter CTAP was more sensitive than CTA. Using CTAP hepatic lesions appear as low attenuation masses because nearly all primary and secondary tumors have larger arterial than portal blood supply. By directly comparing CTA with CTAP we c o n c 1 u d e that CTAP is superior in the detection of liver metastases.