Angiographically assisted helical CT of the liver.

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T he sensitivity of CT in the detection of liver tumors is high when contrast material is directly delivered to either the liver parenchyma or the tumors using an angiographic technique I I , 2]. CT hepatic arteriography alone has not been established as a routine preoperative examination because of the high prevalence of perfusion abnormalities resulting from replaced or anomalous hepatic arteries or from hemodynamic changes caused by hepatic neoplasms or cirrhosis I 11. Researchers have described the usefulness OfCT during arterial portography (CTAP) in the preoperative workup of patients with suspected liver malignancy 121.Although the recent development of helical biphasic contrast-enhanced CT with IV bolus injection of contrast material has obviated the need for more invasive angiographically assisted CT in many patients with unresectable malignant tumors or benign lesions, we still believe that angiographic CT is indispensable in patients before potential liver resection. The superiority of CTAP to helical biphasic contrast-enhanced CT in the diagnosis of hepatocellular carcinoma (HCC) has been described [31. Angiographically assisted CT has the ability to show subtly altered vascularity in tumors, which is not satisfactorily shown with helical biphasic contrast-enhanced CT. However, CTAP has limitations, especially regarding detection of HCC in patients with cirrhosis. The accuracy of angiographically assisted CT for liver tumors is improved by the use of Cf arteriography and CTAP combined [4, 51This pictorial essay points out potential diagnostic pitfalls and shows findings of CT arteriography and CTAP combined for imaging various neoplastic processes ofthe liver.