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PubMed1994

Focal hepatic masses: comparison of detection during arterial portography with MR imaging and CT.

PURPOSE: A prospective study was performed to compare the sensitivity and specificity of magnetic resonance (MR) imaging and computed tomography (CT) both performed during arterial portography in depicting focal hepatic masses. MATERIALS AND METHODS: Eleven patients with 31 pathologically proved focal hepatic masses were prospectively evaluated. MR arterial portography was performed with 4 mL of a 0.5 mmol/kg solution of gadolinium tetraazacyclododecanetetraacetic acid (DOTA) injected through a catheter into the superior mesenteric artery during multisection gradient-echo imaging. RESULTS: MR arterial portography depicted 29 of the 31 masses (sensitivity, 94%). CT arterial portography depicted 27 of the 31 masses (sensitivity, 87%). Two masses not depicted with either CT or MR had a diameter of 3 and 7 mm, respectively. Neither MR nor CT demonstrated a false-positive finding (specificity, 100%). The difference in sensitivity and specificity between the two techniques was not statistically significant. CONCLUSION: MR arterial portography does not enable detection of significantly more focal hepatic masses than does CT arterial portography.

Female↗
PubMed1983

Comparison of the diagnosis of oesophageal varices by oesophagoscopy and transhepatic portography.

We compared the diagnosis of oesophageal varices obtained by oesophagoscopy and percutaneous transhepatic portography in 78 patients with hepatic cirrhosis who were suspected of having oesophageal varices because of ascites and/or preceding upper gastrointestinal haemorrhage. Portograms were evaluated independently of the clinical and endoscopical findings. Endoscopy showed varices in 59 patients and portography in 54 patients. The two methods agreed on the presence of varices only in 46 patients (59%), on the absence of varices in 11 patients (14%), and disagreed in 21 patients (27%). Among the patients showing varices by endoscopy, portography agreed on the diagnosis in 78%, and among patients without endoscopical varices, portography agreed in 58%. The corresponding rates of agreement expected by chance alone are 69% and 31%, respectively. The free portal pressure was lowest in patients with no varices according to both techniques, highest in patients with varices by both techniques and intermediate in patients in whom there was disagreement on the diagnosis. Modification of the criteria for endoscopical and portographical diagnosis of varices and distinction between patients with and without ascites and preceding haemorrhage had no appreciable effect on the agreement. We conclude that endoscopy and portography show only moderate agreement in the diagnosis of oesophageal varices.

Adult↗
PubMed2003

Preoperative evaluation of hepatocellular carcinoma: combined use of CT with arterial portography and hepatic arteriography.

OBJECTIVE: This study was undertaken to determine the usefulness of combined CT during arterial portography and CT hepatic arteriography in the preoperative evaluation of patients with known or suspected hepatocellular carcinoma and to describe the findings on CT during arterial portography and CT hepatic arteriography by which hepatocellular carcinomas may be differentiated from pseudolesions. SUBJECTS AND METHODS: This study included 137 patients who underwent combined CT during arterial portography and CT hepatic arteriography for the preoperative evaluation of known or suspected hepatocellular carcinoma. The images were prospectively evaluated to identify focal hepatic lesions and their differential diagnoses (hepatocellular carcinoma versus pseudolesion). We assessed the diagnostic accuracy of our prospective interpretation by comparing the interpretations with the results of histopathology or follow-up imaging. We also retrospectively analyzed imaging features seen on CT during arterial portography and CT hepatic arteriography-the size, shape, and location of the lesion within the liver; attenuation of the lesion; and opacification of the peripheral portal vein branches on CT hepatic arteriography. RESULTS: One hundred and forty-nine hepatocellular carcinomas (75 lesions confirmed at histopathology and 74 lesions on follow-up imaging) were found in 120 patients, and 104 pseudolesions (15 lesions confirmed at histopathology and 89 lesions on follow-up imaging) were found in 91 patients. The sensitivity of our prospective interpretations was 98.7%, and the specificity of our prospective interpretations was 90.4%. Our positive and negative predictive values were 93.6% and 97.9%, respectively. We found that hepatocellular carcinomas were larger, more frequently nodular, and more likely to be located intraparenchymally than were the pseudolesions (p < 0.01). Opacification of the peripheral portal vein branches on CT hepatic arteriography was detected in 36 pseudolesions (34.6%) but in none of the hepatocellular carcinomas (p < 0.01). CONCLUSION: Combining CT during arterial portography and CT hepatic arteriography is useful for the preoperative evaluation of patients with known or suspected hepatocellular carcinoma. Familiarity with the imaging features of hepatocellular carcinomas and pseudolesions can help in the accurate differentiation of hepatocellular carcinomas from pseudolesions.

Adult↗
PubMed2005

Gadolinium-enhanced phase-contrast magnetic resonance portography.

PURPOSE: The purpose of this study was to investigate the effect and usefulness of gadolinium-chelated contrast medium in phase-contrast magnetic resonance (MR) portography. METHODS: Twenty-six patients (21 men, 5 women; aged 34 to 79 years, mean 62 years) underwent respiratory-triggered 3-dimensional phase-contrast portography before and after administration of gadolinium in a 1.5T MR unit. Coronal maximum intensity projection (MIP) images of the portal vein were reconstructed and compared to conventional arterial portograms regarding visualization. Signal-to-noise ratio (SNR) and portal vein-to-liver contrast-to-noise ratios (CNR) of main, right, right anterior, right posterior, left portal veins, and umbilical portion were measured on both non-enhanced and gadolinium-enhanced images and compared. RESULTS: Portal veins and branches were more clearly visualized on the gadolinium-enhanced than on the non-enhanced images. Compared to arterial portography, gadolinium-enhanced portography showed similar performances in visualization, except in the right posterior branch and left portal vein. No severe image degradation from respiration was experienced. SNR was significantly higher on the gadolinium-enhanced than on non-enhanced images except in the right anterior branch. CNR was significantly higher on the gadolinium-enhanced than on the non-enhanced images at all measured locations. CONCLUSIONS: Administration of gadolinium improves the SNR and CNR of phase-contrast portography and visualization of the portal vein. The phase-contrast technique with gadolinium enhancement can be used to evaluate the portal vein as a supplemental technique.

Adult↗
PubMedDate not supplied

Evaluation of CT during arterial portography for preoperative diagnosis of intrahepatic cholangiocarcinoma.

BACKGROUND/AIMS: To evaluate computed tomography during arterial portography for preoperative evaluation in patients with intrahepatic cholangiocarcinoma. METHODOLOGY: Computed tomography during arterial portography was performed in 11 intrahepatic cholangiocarcinoma patients undergoing hepatectomy. Segmental perfusion defect, sensitivity of the main tumor, and sensitivity of intrahepatic metastasis on computed tomography during arterial portography were retrospectively evaluated. RESULTS: In 9 of 11 patients (81.8%), a segmental perfusion defect was seen. The sensitivities for detecting the main tumor and intrahepatic metastasis were 81.8% and 20%, respectively. In 2 patients, the main tumors existed in segmental perfusion defects and thus were not depicted. In 4 false-negative cases, intrahepatic metastatic lesions existed in the segments that were the counterparts of segmental perfusion defects on computed tomography during arterial portography. CONCLUSIONS: The sensitivity of computed tomography during arterial portography for diagnosing intrahepatic cholangiocarcinoma and its intrahepatic metastasis was low due to segmental perfusion defect. It is necessary for intrahepatic cholangiocarcinoma to be subjected to systematic segmentectomy including all areas corresponding to the segmental perfusion defect.

Adult↗
PubMed1989

[CT portography in malignant space-occupying lesions of the liver].

CT portography was performed in 32 patients with liver tumours and in four patients with cirrhosis of the liver, but without evidence of tumour, after angiographic injection of contrast into the superior mesenteric or splenic arteries. Compared with CT using no contrast, or contrast by intravenous injection, CT portography has the following advantages: better tumour detection, better detection of tumour size, better demarcation and localisation of tumours, better demonstration of the portal system, more inhomogeneity of the parenchyma. Of 12 patients with a number of tumours shown on CT, CT portography demonstrated tumours in four cases, which could not be shown by any other imaging method. Problems concerning CT portography in patients with cirrhosis of the liver are discussed.

Adult↗
PubMed1993

False-positive CT portography: correlation with pathologic findings.

OBJECTIVE: A retrospective study was performed to determine the causes of false-positive diagnoses based on CT findings obtained during superior mesenteric arterial portography (CT portography) and to correlate the imaging characteristics of the incorrectly diagnosed lesions with their pathologic findings. MATERIALS AND METHODS: In a series of 52 patients who had CT portography before surgical exploration of the liver, eight had a total of 10 false-positive findings, yielding a false-positive diagnosis rate of 15%. In eight cases, the false-positive findings from CT portography were correlated with the histologic material obtained during partial hepatic resection or intraoperative biopsies at the corresponding sites. RESULTS: Of the 10 false-positive findings on CT portograms, seven led to false-positive diagnoses of hepatic tumors. Conversely, three nontumorous false-positive findings were erroneously considered to be portal perfusion defects. The final diagnoses based on pathologic findings included focal fatty infiltration of the liver (three), cirrhosis (two), and portal perfusion defect (three). Two false-positive findings for which no histologic correlation was possible were considered to be portal perfusion defects on the basis of intraoperative findings. CONCLUSION: Recognition of false-positive findings is crucial in the preoperative evaluation of hepatic tumors because the findings may be interpreted as contraindications for surgery in patients who have operable tumors. The pathologic correlations show that several different entities can cause diagnoses based on CT portographic findings to be false-positive. However, differentiating between those entities remains a diagnostic challenge.

Adult↗
PubMedDate not supplied

Intravenous three-dimensional CT portography using multi-detector row CT in patients with hepatic cirrhosis: evaluation of scan timing and image quality.

PURPOSE: To evaluate the scan timing and image quality of intravenous three-dimensional (3D) CT portography using multi-detector row CT (MDCT) and to assess the influence of patients' body weight on enhancement of the portal vein (PV). METHODS: One hundred nine patients with hepatic cirrhosis underwent triple-phase contrast enhanced CT using MDCT. The early, portal, and late phases were started at 30 sec, 60 sec, and 90 sec, respectively, after the beginning of intravenous injection of contrast medium (300 mgI/mL, 100 mL total). The CT value of the PV was assessed in the three phases: precontrast, portal phase, and late phase. 3D-portography of the MIP image was evaluated by three-point scale based on vessel visualization. The relationship between these data and body weight was investigated. RESULTS: The mean CT value of PV at 60 sec was 172.01+/-25.94 HU, which was significantly higher than that at 90 sec. Good or excellent 3D-CT portography was obtained in 97/109 patients (89%). Heavy patients tended to show less opacification of PV. CONCLUSIONS: Intravenous 3D-CT portography using MDCT at a 60 sec delay provided adequate PV images for patients with hepatic cirrhosis. Enhancement of PV was affected by patients' body weight.

Aged↗
PubMedDate not supplied

Hepatic primary and secondary malignancies: comparison of helical CT and helical CT during arterial portography.

BACKGROUND/AIMS: To compare the sensitivity of helical CT to that of helical CT arterial portography in the detection of hepatic primary or secondary malignancies, in 20 patients who subsequently underwent surgery to confirm findings. METHODOLOGY: Twenty patients with suspected primary hepatic or secondary malignancies who all underwent helical CT and helical CT arterial portography preoperatively were prospectively evaluated. All the images were reviewed by two radiologists. The results were subsequently correlated with surgical and pathological findings. The sensitivity and the positive predictive values for lesion detection were determined for each modality. RESULTS: There were 39 pathologically confirmed hepatic malignant lesions. The overall sensitivity and positive predictive value of helical CT arterial portography were 87.1% and 82.5%, respectively, while of helical CT were 84.6% and 94.2%, respectively. CONCLUSIONS: Helical CT arterial portography and helical CT of the liver were approximately equivalent for lesion detection in patients who were evaluated preoperatively for resection of liver malignancies. The lower cost and non-invasive nature of helical CT suggest that it should be the preferred modality.

Adenocarcinoma↗
PubMed1995

[Effect of nicardipine at different dose levels on arterial portography].

Portography via the superior mesenteric artery (SMA) with preinjection of nicardipine (NCR) into the SMA as a vasodilator at doses of 1.0 mg, 1/4 mg, 1/16 mg or 1/64 mg was compared with control portography without NCR in 30 patients. Mesenteric blood flow and portal enhancement correlated with dose levels of NCR. At least 1/4 mg of NCR was needed in arterial portography adequately to shorten the time between portal visualization and the injection of contrast medium, and to obtain well-contrasted portography without reflux of contrast medium into the aorta.

Dose-Response Relationship, Drug↗
PubMed1993

Computed tomographic percutaneous transsplenic portography.

The diagnosis of liver tumors should be utilized for determination of not only the number of lesions, but also their size, segmental location and extent, and the relationship of the mass or masses to the hepatic vasculature. CT during arterial portography (CTAP) is the most sensitive imaging modality for precise diagnosis of hepatocellular carcinoma. CTAP is thus widely used as a diagnostic imaging technique, particularly for the detection of small hepatocellular carcinomas. Conventional splenic portography has been carried out for many years using a wide diameter needle, a large amount of contrast medium and a film-screen system. Since the development of arterial portography, fewer splenoportograms have been performed due to the high incidence of bleeding and other complications. In this study a 0.6-mm (23 gauge) thin needle was used for splenic puncture and CT was used as a detector instead of a film-screen system. With this technique CT during percutaneous transsplenic portography may be performed on an outpatient basis.

Aged↗
PubMedDate not supplied

Helical computed tomographic portography in ten normal dogs and ten dogs with a portosystemic shunt.

Contrast enhanced helical computed tomography (CT) of the liver and portal system is routinely performed in human patients. The purpose of this project is to develop a practical protocol for helical CT portography in the dog. Ten clinically normal dogs were initially evaluated to develop a protocol. Using this protocol, ten dogs with confirmed portosystemic shunts (PSS) were then evaluated. Each patient was anesthetized, and a test dose of sodium iothalamate (400 mg I/ml) at 0.55 ml/kg was injected. Serial images were acquired at the level of T12-13 or T13-L1. The time to maximum enhancement of the portal vein was determined. This time period was used as the period between the second injection (2.2 ml/kg) and the start of the helical examination of the cranial abdomen. Delay times for normal dogs ranged from 34.5 s-66.0 s (median: 43.5 s) or 1.41 s/kg-4.12 s/kg (median: 2.09 s/kg). For patients with a PSS, the delay times were 16.5-70.5 s (median: 34.5 s) or 1.47-19.17 s/kg (median: 3.39 s/kg). The aorta, caudal vena cava, portal vein, shunt vessels, and their respective branches were well visualized on the CT images. Clinical case results were surgically confirmed. The surgeons reported that the information gained from the CT portography resulted in a subjective decrease in surgical time and degree of dissection necessary compared with similar surgeries performed without angiographic information. We believe that helical CT portography in the dog will be a useful adjunct in the diagnosis of PSS. The use of helical CT portography may allow clinicians to give clients a more accurate prognosis prior to surgery and will allow patients with lesions that are not surgically correctable to avoid a costly and invasive procedure.

Animals↗
PubMed1996

Laparoscopic liver sonography: preliminary experience in liver metastases compared with CT portography.

This study evaluated the ability of laparoscopic ultrasonography to detect, localize, and characterize focal liver masses. Laparoscopic ultrasonography and CT portography of the liver were performed in 13 patients with known or suspected malignancy. Laparoscopic ultrasonography directly influenced surgical management in four (31%) cases; three by detection of small focal masses and one by exclusion of masses suspected on CT portography. Laparoscopic ultrasonography provided guidance for biopsy or added important anatomic information in three cases. Laparoscopic ultrasonography was complementary to CT portography but added no additional information in three cases, and it failed to provide any information in two cases. Laparoscopic ultrasonography was falsely negative in one case. In this preliminary series, laparoscopic ultrasonography assisted surgeons in critical decision-making by either providing important new information, clarifying questionable areas, or complementing CT portography.

Adult↗
PubMed1999

[Clinical usefulness of half-dose gadolinium-enhanced MR angiography of portal venous system (MR portography)--combined use with conventional dynamic MR imaging].

The clinical usefulness of half-dose Gadolinium-enhanced MR portography combined with the conventional full-dose dynamic MR imaging was evaluated on normal volunteers and patients. Half-dose MR portography was performed immediately following conventional full-dose Gd-enhanced dynamic MR imaging. The visualization of the extrahepatic portal system was either good or excellent in most cases excluding the splenic vein which was poor in 20.7%. That of the right and left main portal branches was also excellent. As for segmental branches, the visualization was poor of the left lobe. The comparison with digital subtraction angiography showed that the visualization of the right and left main portal branches was mostly equal. That of the splenic vein alone was worse on MR portography. We conclude that half-dose Gadolinium-enhanced MR portography is useful for the overall assessment of the portal venous system and can be added to the conventional dynamic MR imaging.

Adult↗
PubMedDate not supplied

Indirect portography enhanced by nicardipine versus prostaglandin E1.

PURPOSE: To compare nicardipine (NCR) and prostaglandin E1 (PGE1) for portal venous contrast enhancement on indirect portography in a retrospective study. METHODS: One milligram of NCR, a calcium antagonist, was injected into the superior mesenteric artery just prior to portography in 18 patients who had undergone otherwise identical portography using 20 micrograms PGE1 36-279 (mean 133) days before. All 18 patients had liver tumors and showed no changes in portal vein status in the interim. RESULTS: Using conventional film/screen angiography, NCR provided equally good portograms as PGE1 with respect to image density and image contrast. Systemic effects on blood pressure and heart rate were minimal and no other side effects were observed with NCR. CONCLUSION: NCR is an inexpensive drug and is expected to provide well-contrasted, indirect portograms on conventional film/screen angiography.

Alprostadil↗
PubMedDate not supplied

The optimal dose of nicardipine for enhancement of indirect portography.

PURPOSE: To determine the optimal dose of nicardipine (NCR) for enhancement of indirect portography. METHODS: Forty-eight patients underwent conventional film indirect portography via the superior mesenteric artery (SMA) first without and then with preinjection of 1/64-2 mg of NCR into the SMA. RESULTS: NCR (1/8-2 mg) shortened the arterial phase to 50% and the portal appearance time to 60% of control without reflux of contrast medium into the aorta. Portal enhancement was excellent at doses of 1/32 mg or more. Blood pressures and pulse rate showed no significant change at 1/4 mg or less. CONCLUSION: NCR (1/8-1/4 mg) into the SMA is the optimal dose for achieving sufficient contrast enhancement on indirect portography while reducing the transit time of contrast medium and minimizing effects on the systemic circulation.

Aged↗
PubMed2006

Extrahepatic portal vein morphology in children with extrahepatic portal hypertension assessed by 3-dimensional computed tomographic portography: a new etiology of extrahepatic portal hypertension.

BACKGROUND/PURPOSE: The cause of extrahepatic portal hypertension in children has not been clarified. Our aim was to determine the morphological features of the extrahepatic portal vein in children with extrahepatic portal hypertension by 3-dimensional computed tomographic portography and to clarify the etiology of this disorder. MATERIALS AND METHODS: Six patients ranging in age from 10 to 18 years (median age, 12.8 years) who had portal hypertension presented with hematemesis. They underwent intravenous computed tomographic portography using a helical computed tomography scanner and 3-dimensional image reconstruction. RESULTS: The extrahepatic portal vein was visualized in all patients by 3-dimensional computed tomographic portography. None of the patients showed extrahepatic portal vein obstruction or cavernous transformation. All patients had a tortuous eta-shaped extrahepatic portal vein, and a line could be drawn through the flexures of the portal vein to the hepatic hilum. CONCLUSION: In children, extrahepatic portal hypertension is not caused by extrahepatic portal vein obstruction and may be of embryological origin.

Adolescent↗
PubMed1988

Assessment of portal vein patency: comparison of arterial portography and ultrasound scanning.

The accuracy of ultrasound assessment of portal vein patency has been defined by comparing it with the results of arterial portography in 115 cases. The accuracy of arterial portography was confirmed in 21 cases where orthotopic liver transplantation was performed and used as a 'bench-mark' against which to assess the ultrasound findings. Ultrasound correctly assessed portal vein patency in 87.5% of patients. It was more accurate in assessing patency (90%) than occlusion (68%). Ultrasound correctly assessed portal vein patency in 90% of cases of cirrhosis and hepatic malignancy. Difficulties occurred in children with biliary atresia particularly following the Kasai operation (37.5% accuracy). In the absence of previous surgery to the portal vein or biliary system, ultrasound is comparable to arterial portography and can be used as the sole means of assessment.

Adolescent↗