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PubMed1986

Comparison of splenoportography and transhepatic portography in the diagnosis of portal vein thrombosis.

Accurate diagnosis and localization of thrombosis in the portal venous system is essential for proper surgical treatment. We compared the results of percutaneous transhepatic portography and splenoportography in 66 patients with cirrhosis of the liver. The two methods agreed on absence of thrombosis in 48, and in presence of thrombosis (verified later by surgery/autopsy) in four patients. In 12 patients an apparent thrombosis diagnosed by splenoportography was disproved by transhepatic portography, and vice versa in two patients. Free portal pressure and splenic pulp pressure did not differ significantly irrespective of the 'diagnosis' of thrombosis. We conclude, that transhepatic portography is better than splenoportography in making the diagnosis of thrombosis in the portal venous system although failure to visualize the splenic vein may indicate splenoportography.

Female↗
PubMedDate not supplied

Portal venous system: evaluation with contrast-enhanced 3D MR portography.

The purpose of this study is to compare contrast-enhanced three-dimensional (3D) magnetic resonance (MR) portograms to Doppler sonography in detection of portal venous abnormalities. Thirty-five consecutive patients, who were suspected of having portal venous system abnormalities, were examined with MR portography and Doppler sonography. Vascular abnormalities were identified in 27 of 35 patients. There was statistically significant agreement between the results of MR portography and Doppler sonography. The major limitation of contrast-enhanced 3D MR portography was its inability to provide objective hemodynamic data regarding flow direction and flow pattern.

Adolescent↗
PubMed2003

Portal cavernoma-associated cholangiopathy: a clinical and MR cholangiography coupled with MR portography imaging study.

Although biliary symptoms appear to be uncommon in patients with portal cavernoma, almost all of them have endoscopic retrograde cholangiographic abnormalities. The mechanisms underlying the biliary changes are explained poorly. This study in patients with portal cavernoma had 3 aims: (1) to assess the manifestations related to biliary involvement; (2) to evaluate with magnetic resonance (MR) imaging the aspect and frequency of cholangiographic changes; and (3) to clarify the mechanisms underlying biliary involvement. From December 1999 to July 2001, 25 consecutive adults with portal cavernoma without cancer or cirrhosis were studied with MR cholangiography coupled with MR portography. Seven patients presented with clinical manifestations of biliary disease. MR cholangiography findings were stenosis in 21 patients, with upstream dilatation in 16 and displacement in 13. MR cholangiography coupled with MR portography showed in all cases that the biliary abnormalities were secondary to a mass effect directly related to pressure by the cavernoma. In conclusion, in patients with portal cavernoma, clinical manifestations of biliary disease are most frequent; the cholangiographic abnormalities are very common and usually are caused by a mass effect by pressure from the veins composing the cavernoma. MR cholangiography coupled with MR portography is an effective noninvasive examination for simultaneous visualization of bile ducts and their relationship to the cavernoma.

Bile Duct Diseases↗
PubMed1976

[Trans-jugular retrograde portography. Preliminary communication].

Retrograde portography is carried out through a trans-jugular route. Contrary to previously available techniques of trans-juglar portography, the method does not inflict any trauma on the parenchyma or vessels. Demonstration of the portal system is achied by reserved flow through the liver sinusoids. Together with arterial hepatography and indirect splenic and mesenteric portography, the method provides additional information in various forms of pre-, intra- and post-hepatic block without submitting the patient to any additional risk.

Aged↗
PubMed1993

Hepatic tumors: role of computed tomographic arterial portography in surgical planning.

Various imaging modalities currently used to evaluate liver tumors include magnetic resonance imaging, ultrasonography, contrast-enhanced computed tomography, and computed tomographic arterial portography. In our review of 28 cases, we found CT arterial portography to be very sensitive, and in 5 of these 28 cases CT arterial portography was a key factor in altering the course of therapy.

Adult↗
PubMed1993

Hepatic metastases: detection with multisection FLASH MR imaging during gadolinium chelate-enhanced arterial portography.

PURPOSE: To determine the feasibility and sensitivity of multisection fast low-angle shot (FLASH) magnetic resonance (MR) imaging in the depiction of hepatic metastases. MATERIALS AND METHODS: The cases of 10 patients with 39 surgically proved hepatic metastases were prospectively evaluated. After unenhanced T1- and T2-weighted spin-echo (SE) and FLASH imaging, 4 mL of a 0.5 mol/L solution of a gadolinium chelate (tetraazacyclododecanetetraacetic acid) was injected into the superior mesenteric artery during FLASH imaging in a single breath-holding period. RESULTS: No side effects were noted. With multisection FLASH MR arterial portography, tumor-to-liver contrast-to-noise ratio (34.5 +/- 4.4) was significantly increased compared with unenhanced MR imaging. Sensitivity was 74% (29 of 39) for combined SE and multisection FLASH imaging and 95% (37 of 39) for multisection FLASH MR arterial portography (McNemar test, P < .02). CONCLUSION: Multisection FLASH MR arterial portography is a safe, feasible, and sensitive technique with which to detect hepatic metastases.

Adult↗
PubMed1986

Digital indirect portography.

Thirty-eight patients underwent digital indirect portography with arterial injections of dilute contrast medium. The portal system was seen in 37 patients. Compared with conventional portography, the technique offers many advantages, including increased sensitivity and earlier visualization of the portal venous system, lower contrast loads, and lack of need for vasodilators. Digital indirect portography is an excellent method for evaluating the portal venous system.

Adolescent↗
PubMed2002

Transvenous retrograde portography for identification and characterization of portosystemic shunts in dogs.

Transvenous retrograde portography for identification and characterization of portosystemic shunts in dogs A method for transvenous retrograde portography (TRP) in dogs suspected to have a portosystemic shunt (PSS) and results in 20 dogs are described. For TRP, dogs were anesthetized and positioned in left lateral recumbency A dual-lumen balloon-tipped catheter was inserted into the right jugular vein and advanced into the azygos vein. The balloon was inflated to occlude the azygos vein, and contrast material was injected during fluoroscopic evaluation. The catheter was then positioned in the caudal vena cava just cranial to the diaphragm. The balloon was again inflated to occlude the vena cava, and contrast material was again injected. Once a shunt was identified, selective catheterization was attempted with a guide wire and angled catheter. A PSS was identified in 18 of the 20 dogs. In 10 of the 18, the shunt vessel could be selectively catheterized, allowing measurement of portal pressures while the shunt was occluded with the balloon. In 1 dog, results of TRP were normal, but subsequent exploratory celiotomy revealed a single extrahepatic PSS, which was surgically attenuated. The other dog in which results of TRP were normal did not have a macroscopic PSS. In dogs suspected to have a PSS, TRP may be a useful adjunctive diagnostic test that is less invasive than operative mesenteric vein portography and allows measurement of portal pressures before and after temporary shunt occlusion.

Animals↗
PubMed1999

[Detection of malignant focal hepatic lesions. Comparison of ultrasonography, computerized tomography during arterial portography, delayed computerized tomography and magnetic resonance imaging].

AIMS: This study was performed to compare the sensitivity of ultrasonography, computerized tomography during arterial portography, delayed computerized tomography, and magnetic resonance imaging to detect focal liver lesions. Forty three patients with primary or secondary malignant liver lesions were studied prior to surgical intervention. METHODS: The results of the imaging studies were compared with intraoperative examination of the liver, intraoperative ultrasonography and pathology results (29 patients). In the non-operated (14 patients) group, we compared the number of lesions detected by each technique. RESULTS: One hundred and forty six lesions were detected. There was 84% sensitivity with computerized tomography during arterial portography, 61.3% with delayed scan, 63.3% with magnetic resonance imaging and 51% with ultrasonography in operated patients. In patients who did not undergo surgery, magnetic resonance imaging was more sensitive in detecting lesions. CONCLUSIONS: In operated and non-operated patients series, CT during arterial portography had the highest sensitivity, but magnetic resonance imaging had the most consistent overall results.

Adult↗
PubMed1992

Preoperative radiological evaluation of the liver by computerized tomographic portography in patients with hepatic tumors.

The main objective of preoperative imaging studies is to define as accurately as possible the number, size, location, and relationship of tumor masses in the liver to pertinent portal and hepatic venous vasculature. Computerized tomographic portography images hepatic veins and segmental portal vein branches and identifies the anatomical location of tumor nodules with excellent sensitivity and a low false-positive rate. The intraoperative correlation of computerized tomographic portography on 30 patients in the last 20 months at this institution shows a sensitivity of 88 per cent with a low rate of false-positivity. The ability to detect metastatic lesions in the liver by computerized tomographic portography diminishes when the lesions are noted to be less than 1 cm. The authors conclude that the preoperative interpretation of the computerized tomographic portogram provides valuable information not previously available to the surgeon operating on the liver.

Adult↗
PubMed2005

[Use of direct portal vein puncture portography with modified TIPS treatment in patients with portal hypertension and gastro-esophageal varices bleeding].

OBJECTIVE: To explore a better procedure for transjugular intrahepatic portosystemic shunt (TIPS) in order to improve its safety and to extend its indications. METHODS: To puncture the right portal branch under sonographic guidance in 20 patients with portal hypertension and gastro-esophageal bleeding. The Teflon sheath with gold marker was put into the portal vein; anterior and lateral portography was made, portal pressure was measured and the gastric coronal vein was embolized. The gold marker was put into the portal vein puncture site and the Rups-100 was guided under the gold marker during the TIPS puncture procedure. Anterior and lateral portography was again made to make sure the puncture site was 2 cm away from the portal vein bifurcation. In some cases a 10F sheath was used to suck the thrombosis in the portal vein, and a balloon was used to dilate the parenchyma channel and then a stent was released smoothly. RESULTS: 20 reformed TIPS were successfully performed on all patients and their gastric-esophageal bleedings were controlled immediately. 37 punctures were made in 20 of those cases; the average puncture per patient was 1.85+/-0.67, lower than that of the traditional method. The pressure of the portal vein declined from (30.5+/-1.1) mmHg to (16.9+/-0.9) mmHg, P < 0.05, showing that the difference of portal vein pressure before and after the reformed TIPS was significant. 25 stents were placed, and no complications occurred during the procedure in any of the cases. CONCLUSION: Direct portal vein puncture portography and gold marker guided TIPS procedure is feasible and safe; the indications of TIPS could be further extended.

Adult↗
PubMed1989

[An experimental comparative study of several vasodilators for enhancing arterial portography].

In order to improve visualization of the portal vein, an experimental comparative study of enhancing arterial portography with four vasodilators was conducted in 8 dogs and the hemodynamic changes observed after administration of these agents. This study confirms that prostaglandin E1. Vasoactive intestinal peptide and anisodamine can improve the image quality of portal vein in arterial portography, but priscoline is less effective. The mechanism, and technical factors involved and the clinical application of pharmaceutical-arterial portography were discussed. This study also provided the experimental data for a wide choice of vasodilators in enhancing visceral angiography.

Animals↗
PubMed1980

Percutaneous transhepatic portography in the assessment of portal hypertension. Clinical correlations and comparison of radiographic techniques.

Sixty-four transhepatic portograms performed before transhepatic obliteration of varices in patients with variceal hemorrhage have been reviewed. Sixty-two patients had coronary gastroesophageal vessels feeding gastric and esophageal varices and other major collateral circulation was seen in 25 patients. There was no relationship between the presence of major collateral circulation and the height of portal pressure or the severity of hemorrhage from gastroesophageal varices. Failure to opacify the intrahepatic portal venous system was seen in 11 patients and was strongly associated with portal-systemic encephalopathy. In addition to transhepatic portography, 35 patients had a splenic portogram, and 27 patients had coeliac axis angiography. There was poor agreement between the findings of these three techniques. Transhepatic portography was markedly superior in demonstrating the portal-systemic collateral circulation. Because of the excellent anatomical definition obtained, transhepatic portography is a superior technique for visualizing the portal system. However, even this technique may occasionally fail to demonstrate gastroesophageal collateral circulation in patients with endoscopically documented variceal hemorrhage.

Adult↗
PubMed1995

Portography in decision-making about indications for liver resection in hepatolithiasis.

We studied the findings of portograms of patients with hepatolithiasis and the role of portography in decision-making about indications for hepatic resection. The subjects were 20 patients in whom hepatic arteriography including the portal phase or percutaneous transhepatic portography was done. We studied the relationships between the findings of the portograms and cholangiograms and hepatic atrophy or associated cholangiocarcinoma. The portal vein in the involved segment of the liver was obstructed in nine patients, and these patients had hepatic atrophy with or without cholangiocarcinoma. There were 16 patients with hepatic atrophy. Four of five other patients in whom protal shrinking was seen had hepatic atrophy. Bile ducts in the involved segment were obstructed in six patients with hepatic atrophy. In all five patients with cholangiocarcinoma, there was portal obstruction at the branching point in the hepatic hilum, with obstruction of the bile ducts at the same point in two of these patients. Hepatic atrophy and cholangiocarcinoma was more closely associated to changes of the portal vein than obstruction of the bile ducts. Portography is useful to diagnose hepatic atrophy and cholangiocarcinoma and for decision-making about indications for hepatic resection in hepatolithiasis.

Adult↗
PubMed1994

[Ct-portography in diffuse liver steatosis. Potential for a false-negative assessment].

CT portography is the most sensitive technique currently available for the preoperative diagnosis of liver metastases. We report on a patient with liver steatosis in whom ultrasound examination revealed two liver metastases in the follow up after resection of a papillary carcinoma. The liver metastases could be clearly identified both on plain CT and on enhanced CT with dynamic bolus contrast medium injection. Because of the small difference in attenuation values between liver parenchyma and metastases the two liver metastases had not been recognized on CT portography. When severe and diffuse liver steatosis is present CT portography may fail to detect metastases or small hepatocellular carcinoma.

Adult↗
PubMed1996

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.

Adult↗
PubMed1991

Staging of hepatocellular carcinoma by ultrasonography, computed tomography, and angiography: the role of CT combined with arterial portography.

A series of 60 patients with hepatocellular carcinoma (HCC) were evaluated over a 2-year period of ultrasonography (US), computed tomography (CT), and angiography. The angiographic studies carried out with intraarterial digital technology were compared to both US and CT of the liver. In 16 of 60 patients, we observed discordance of the findings obtained with angiography, CT, and US. We therefore compared these three methodologies in those cases where diagnostic discordance was noted. In our experience, US had a sensitivity of 73.4%, 76.7% for CT, and 95% for angiography. In 13 of 60 patients, we performed CT with arterial portography (CTAP) which demonstrated a better resolution than conventional CT. In view of the sensitivity of US - comparable to that of CT - and for the even greater sensitivity of intraarterial digital angiography, we performed an US study of patients at risk of HCC. CT was found to play a diagnostic/staging role after angiographic study has been performed, especially when enhanced by arterial portography.

Adult↗
PubMed1998

[After-care of TIPSS patients. Comparison between color Doppler ultrasound and portography].

PURPOSE: Comparison of color Doppler sonography and venous portography in patients with a transjugular intrahepatic portosystemic stent shunt (TIPSS). MATERIALS AND METHODS: In a prospective study 40 consecutive patients with TIPSS underwent venous portography and color Doppler sonography on the same day as follow-up. Shunt velocities were recorded within the TIPSS at the proximal (hepatic vein segment) and distal part (portal vein segment). RESULTS: In 28 patients with functioning TIPSS the mean shunt velocity ranged between 30 and 120 cm/s (median 60 cm/s) at the portal vein segment and between 60 and 155 cm/s (median 82 cm/s) at the hepatic vein segment. There was a significant increase of the mean shunt velocity in the hepatic vein segment (P < 0.001). In 12 patients with compromised TIPSS the mean shunt velocity was reduced to 26 +/- 7 cm/s at the portal venous end (P < 0.0001). CONCLUSION: Because of an accelerated shunt velocity in the hepatic vein segment a site-specific evaluation of both TIPSS endings is necessary with color Doppler sonography. In compromised TIPSS the shunt velocity is reduced at the portal venous end. Color Doppler sonography is a valid non-invasive means for follow-up of patients with TIPSS.

Adult↗