Arterial Portography Research Articles

Nonpathological focal enhancements on spiral CT hepatic angiography.

To assess the frequency and characteristics of nonpathological focal enhancements seen on spiral computed tomographic (CT) hepatic angiography (CTA). Spiral CTA and spiral CT arterial portography (CTAP) were performed in 31 patients with suspected liver malignancy prior to potential liver resection. The CTA images were retrospectively reviewed for focal enhancements by two radiologists. After determining nonpathological focal enhancements on CTA images based on the other radiographic tests, surgical exploration including intraoperative sonography, follow-up imagings, the frequency, size, site, and shape of nonpathological focal enhancements with CTA were assessed. Thirty-six nonpathological focal enhancements with CTA from 4 to 23 (mean = 11. 4) mm were seen in 14 (45.2%) of 31 patients. Thirteen (36.1%) of 36 nonpathological focal enhancements with CTA were not depicted with CTAP. Nonpathological focal enhancements with CTA were frequent in Couinaud segments III (27.8%), V (22.2%), and VI (19.4%). Twenty-three (63.9%) of 36 nonpathological focal enhancements were located in the edge of the liver. Shapes of 36 nonpathological focal enhancements with CTA included circular (n = 16), worm (n = 7), irregular (n = 6), dot (n = 6), and wedge (n = 1). In nearly half of patients, spiral CTA shows various shapes of small nonpathological focal enhancements more frequently in the liver edge.

CT Arterial Portography and CT Arteriography with a Triple-Lumen Balloon Catheter

CT Arterial Portography and CT Arteriography with a Triple-Lumen Balloon Catheter

Influence of liver cirrhosis on pseudolesions in liver at CT during arterial portography.

Pseudolesions are sometimes seen around the falciform ligament, around the gallbladder, or at the posterior edge of the medical segment on CT during arterial portography. The purpose of this study was to investigate the influence of liver cirrhosis on these pseudolesions. The basis of this study was 33 patients with liver cirrhosis or hepatitis (group A) and 43 with neither (group B). The standard for diagnosis was surgical findings. We investigated whether there was a difference in the frequency of each pseudolesion between groups A and B. When tumors were seen in each location, they were excluded from statistical analysis. Pseudolesion around the falciform ligament was seen in none of 32 patients in group A and in 18 of 40 in group B (4 cases were excluded), around the gallbladder in 14 of 30 in group A and 16 of 42 in group B (4 cases were excluded), and at the posterior edge of the medial segment in 13 of 33 in group A and 16 of 42 in group B (1 case was excluded). There was a statistically significant difference in the frequency of pseudolesion around the falciform ligament (p < 0.001, Fisher test), but not around the gallbladder or posterior edge of the medial segment. Liver cirrhosis decreases the frequency of pseudolesions around the falciform ligament, but not around the gallbladder or posterior edge of the medial segment.

Portal Vein Evaluation with US: Comparison to Angiography Combined with CT Arterial Portography

Portal Vein Evaluation with US: Comparison to Angiography Combined with CT Arterial Portography

Hepatic lobar atrophy: association with ipsilateral portal vein obstruction.

This study was performed to evaluate the association between hepatic lobar atrophy, bile duct obstruction, and portal vein obstruction. Thirty cases of hepatic lobar atrophy identified on angiography with CT during arterial portography from August 1992 to March 1995 were retrospectively reviewed by two independent observers. Cases were evaluated for vascular patency and bile duct obstruction. Malignant diagnoses were present in 28 of 30 patients. Twenty-two patients (73%) had atrophy in the left lobe and eight patients (27%) had right lobar atrophy. Portal vein obstruction was unilateral and confined to the atrophic lobe in 26 patients (87%). In contrast, bile duct obstruction was bilateral in 23 patients (77%) and in only four patients (13%) was it isolated to the atrophic lobe. The correlation between atrophy and portal vein obstruction was significant, with 90% sensitivity, 97% specificity, and 96% positive predictive value (p < .00001). For the correlation between atrophy and biliary obstruction, the sensitivity of angiography with CT during arterial portography was 90%, specificity was 23%, and positive predictive value was 54% (p = .17). Hepatic lobar atrophy usually occurs in the setting of combined biliary and portal vein obstruction. A significant correlation exists between hepatic lobar atrophy and ipsilateral portal vein obstruction.

Comparison of CT arterioportography and spiral CT arterioportography in malignant lesions of the liver

To determine the value of spiral CT during arterial portography (SCTAP) in detecting and localising focal liver lesions we compared the SCTAP findings to those gained by conventional CT during arterial portography (CTAP). We evaluated a total of CT scans of 128 patients with 162 malignant lesions of the liver. 45 patients underwent SCTAP and 83 patients CTAP. Results of radiological studies were compared with surgical and pathological findings. The overall sensitivity of SCTAP was 93% with a sensitivity of 80% for lesions of less than 1 cm diameter. For CTAP the overall sensitivity was 88%, but the sensitivity for lesions smaller than 1 cm was only 53%. Although with SCTAP examination of hepatic vasculature and liver parenchyma was continuous, we found no advantage in the localisation of lesions to the liver segments compared to CTAP, and the sensitivity of localisation did not correlate with the size of lesions. In our study SCTAP turned out to be a reliable radiological method in the preoperative detection of focal liver lesions, with a high overall sensitivity. SCTAP showed improved sensitivity in the detection of small malignant lesions (< 1 cm) in comparison to CTAP.

Spiral CT during arterial portography.

Spiral computed tomography (CT) performed during arterial portography offers several advantages compared with portographic studies based on conventional CT technique. Because all hepatic images are derived from a volume data set acquired during a single 24-32-second breath hold timed to coincide with the phase of peak hepatic enhancement, motion artifacts and section misregistration are eliminated and high liver-to-lesion attenuation value differences are present on all sections. These factors, in conjunction with the ability to retrospectively acquire thin, overlapping axial sections, result in improved lesion detection. The ability to produce high vein-to-liver attenuation value differences and two-dimensional multiplanar reconstructions simplifies the identification of hepatic segments and therefore lesion localization. A limitation of all CT portographic methods is the frequent occurrence of nontumorous perfusion defects that, in most cases, demonstrate characteristic locations and appearances. Performing delayed CT following portography is one method by which such pseudolesions may be characterized and differentiated from focal pathologic entities.

CT during arterial portography.

CT during arterial portography (CTAP) is based on portal enhancement of the liver by infusion of contrast material through the superior mesenteric or splenic artery. This technique provides high degrees of enhancement of the portal vein and intrahepatic vessels, allowing reliable segmental localisation of tumours and accurate assessment of relationships between tumours and intrahepatic vessels. Because of its invasiveness, CTAP must be limited to patients for whom non-invasive preoperative imaging suggests resectable tumour. In the majority of cases, CTAP is performed in patients with hepatic metastases from colorectal cancer, but other types of hepatic tumour (either primary or secondary) and pancreatic tumour may be an indication for CTAP. Visualisation of non-tumorous perfusion defects is a limitation of this technique, but such defects have been well described and have characteristic locations and appearance. In difficult cases, correlation with sonographic, CT and MRI findings helps characterise portal perfusion defects. CTAP is the most sensitive technique for the detection of intrahepatic tumours, and the recent use of spiral technology shows promise in the performance of CTAP. CTAP data can be viewed as multiplanar and three-dimensional reconstructions that allow preoperative planning of the extent of resection and determination of the volume of the remaining liver after resection.

CT during arterial portography: comparison of injection into the splenic versus superior mesenteric artery.

To determine whether the diagnostic quality of computed tomography (CT) during arterial portography (CTAP) performed via the splenic artery (SA) is better than that performed via the superior mesenteric artery (SMA). The authors evaluated CTAP images obtained in 98 patients from 1991 to 1994; 47 examinations were performed via the SA and 51 were performed via the SMA. Images were reviewed, by consensus, by three radiologists blinded to catheter location. Hepatic enhancement was quantitatively assessed in 53 patients (31 in the SA group, 22 in the SMA group). The numbers of low-attenuation non-tumor-related perfusion defects (19 in the SA group, 17 in the SMA group), high-attenuation non-tumor-related perfusion defects (six in the SA group, six in the SMA group), diffuse mottled perfusion abnormalities (six in the SA group, five in the SMA group), and portal venous flow defects (20 in the SA group, 20 in the SMA group) were similar in both groups (P > .05). Peak hepatic enhancement was similar in both groups (SMA group = 111 HU; SA group = 112 HU) (P > .05). There is no difference in quality between CTAP performed via the SA versus CTAP performed via the SMA.

Ciliated foregut cyst in cirrhotic liver

We encountered a patient with a ciliated hepatic foregut cyst with accompanying liver cirrhosis, which was hard to distinguish from well-differentiated hepatocellular carcinoma. A lesion 2 cm in diameter was found in the subcapsular region of the medial segment of the liver. It was slightly hypoechoic on ultrasonography, of high attenuation on nonenhanced computed tomography (CT), of high intensity on T1-weighted spin echo images of magnetic resonance imaging (MRI), and of isointensity on T2-weighted spin echo images. It was not enhanced in the arterial phase images of MRI, and was shown as a complete perfusion defect on CT arterial portography. The cyst was enucleated and found to be filled with bloody mucinous fluid.

Radiologic diagnosis of hepatocellular carcinoma.

Recent developments in medical imaging technology and their clinical application for the diagnosis and management of hepatocellular carcinoma (HCC) are reviewed. Real-time ultrasound is effective for the screening of HCC in high-risk patients with liver cirrhosis. Information on blood flow is available by color Doppler or power Doppler technique. Dynamic computed tomography (CT) using a fast scanner and the modified contrast administration technique is useful for detection, differential diagnosis, and staging of HCC. Application of magnetic resonance (MR) imaging is increasing with rapid improvements in speed of image acquisition and resolution. Dynamic MR imaging and MR angiography have also been available. Diagnostic and interventional hepatic angiography are now performed less invasively, more safely, and more quickly with modern technologies of digital subtraction angiography (DSA) and catheters. CT during hepatic arteriography (CT arteriography) and arterial portography (CTAP) are used for evaluation of small focal nodules in the cirrhotic liver.

MR arterial portography with gadolinium-DOTA: analysis of nontumoral perfusion abnormalities.

The purpose of this article was to determine the frequency and imaging characteristics of nontumoral perfusion abnormalities observed on magnetic resonance imaging (MRI) obtained during arterial portography (MRAP). MRAP examinations done in 23 consecutive patients with malignant hepatic tumors were retrospectively and blindly reviewed by two readers for the presence of nontumoral perfusion abnormalities. MR Images were assessed for the presence, location, shape, and type of nontumoral perfusion abnormalities, and correlated with intraoperative findings or follow-up imaging studies. Fourteen nontumoral perfusion abnormalities were found in 10 patients (43%). Nontumoral perfusion abnormalities were categorized into these five types: triangular nontumoral perfusion defects not associated with a more proximal tumor (n = 6), triangular nontumoral perfusion abnormalities distal to a tumor (n = 2), hypoperfusion involving 1 or >1 segment (n = 2), hyperenhancement of the posterior part of the right hemiliver (n = 2), and gravity-effect-related perfusion abnormality (n = 2). Nontumoral perfusion abnormalities are seen frequently on MRAP examination. Recognition of these abnormalities remains crucial to avoid misdiagnosis.

Malignant Hepatic Hilar Tumors: Can Ultrasonography be Used as an Alternative to Angiography with CT Arterial Portography for Determination of Resectability?

Malignant Hepatic Hilar Tumors: Can Ultrasonography be Used as an Alternative to Angiography with CT Arterial Portography for Determination of Resectability?

Hepatocellular carcinoma: detection with double-phase helical CT during arterial portography.

Retrospective analysis of findings at double-phase helical computed tomography (CT) during arterial portography was performed in 42 hepatocellular carcinomas (HCCs) in 31 patients. Phase 1 scanning started 30-35 seconds after the beginning of injection of contrast material; phase 2 scanning started 10-18 seconds after the end of phase 1. The overall detection rate for HCCs was 83% (35 of 42) in phase 1, 81% (34 of 42) in phase 2, and 90% (38 of 42) for combined phase 1 and 2 findings.

51.小肝細胞癌に対する肝動脈血流阻血下CTAPの有用性(第24回秋季学術大会 一般研究発表予稿集)

51.小肝細胞癌に対する肝動脈血流阻血下CTAPの有用性(第24回秋季学術大会 一般研究発表予稿集)

The frequency, appearance, and significance of splenic perfusion defects in CT arterial portography.

The purpose of this study was to determine the frequency, appearance, and significance of splenic perfusion defects on computed tomographic arterial portography (CTAP). CTAP was performed with dynamic scanning at 1-cm increments on 46 consecutive patients prior to laparotomy. Two readers retrospectively reviewed these studies in consensus and recorded the number, size, and shape of focal splenic perfusion defects. These defects were later correlated with surgical findings and at least one of the following imaging modalities: delayed CT 4-6 h after CTAP, intravenously enhanced CT, sonography, or magnetic resonance imaging (MRI). Splenic perfusion defects were present in 14 of 46 CTAP studies (30%), and in seven patients these defects were multiple. Most defects were wedge-shaped and peripherally located, although several round defects simulating metastases were also present. The spleen was normal at surgery in all patients, and comparison imaging revealed only a small splenic infarct in one patient on MRI. Splenic perfusion defects occur in about one-third of patients referred for CTAP, are usually wedge-shaped but may be round, and should not be interpreted as metastases without other evidence of a space-occupying mass.

Malignant hepatic hilar tumors: can ultrasonography be used as an alternative to angiography with CT arterial portography for determination of resectability?

Nineteen consecutive patients with malignant hilar obstruction were imaged with angiography, CT portography, and ultrasonography with color and spectral Doppler technique; all had surgical pathologic correlation. At surgery, 12 of 19 patients (63%) were found to have portal vein involvement; 15 of 19 (79%) had parenchymal invasion; and 11 of 19 (58%) had lobar atrophy. Level of biliary obstruction was determined in seven of 19 patients (37%) without drainage catheters. No difference was found between ultrasonography and angiography with CT portography for diagnosis of atrophy, level of bile duct obstruction, hepatic involvement, or venous invasion. Extrahepatic metastases in nine of 19 patients (47%) were poorly predicted by both CT portography and ultrasonography.

Correlation of perfusion abnormalities on CTAP and immediate postintravenous gadolinium-enhanced gradient echo MRI.

The purpose of this study was to evaluate patients with wedge-shaped perfusion defects seen on spiral CT arterial portography for the presence of transient increased wedge-shaped enhancement on dynamic gadolinium-enhanced gradient echo MR images. Nineteen patients underwent CTAP and MRI within a 2-week interval. All patients with wedge-shaped perfusion defects on CT arterial portography were evaluated in a separate review session for the presence of transient increased segmental hepatic enhancement on dynamic gadolinium-enhanced spoiled gradient echo (SGE) MR images. Eight patients were identified to have subsegmental, segmental, or lobar wedge-shaped perfusion defects by CT arterial portography. In 8/8 patients, there was transient wedge-shaped increased hepatic enhancement on MR images which corresponded to the perfusion defects identified on CT arterial portography. Transient increased enhancement on MR images was observed on immediate postgadolinium images as high-signal intensity of the involved subsegment, segment, or lobe. This relatively high-signal area faded to near isointensity in all cases on images obtained at 45 s. Wedge-shaped perfusion defects demonstrated by CT arterial portography corresponded to wedge-shaped increased hepatic enhancement following gadolinium administration on SGE MR images.

Detection of Hepatocelluar Carcinoma in MR Arterial Portography; Diagnostic Significance as a Pre-Operative Evaluation

Detection of Hepatocelluar Carcinoma in MR Arterial Portography; Diagnostic Significance as a Pre-Operative Evaluation

Malignant hepatic hilar tumors: can ultrasonography be used as an alternative to angiography with CT arterial portography for determination of resectability?

Nineteen consecutive patients with malignant hilar obstruction were imaged with angiography, CT portography, and ultrasonography with color and spectral Doppler technique; all had surgical pathologic correlation. At surgery, 12 of 19 patients (63%) were found to have portal vein involvement; 15 of 19 (79%) had parenchymal invasion; and 11 of 19 (58%) had lobar atrophy. Level of biliary obstruction was determined in seven of 19 patients (37%) without drainage catheters. No difference was found between ultrasonography and angiography with CT portography for diagnosis of atrophy, level of bile duct obstruction, hepatic involvement, or venous invasion. Extrahepatic metastases in nine of 19 patients (47%) were poorly predicted by both CT portography and ultrasonography.