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At least 73 records · Page 4Linked to original sources
PubMedDate not supplied

CT portography by direct intrasplenic contrast injection: a new technique.

BACKGROUND: The evaluation of percutaneous contrast injection into splenic parenchyma as an alternative technique for computed tomographic (CT) portography in the preoperative assessment of primary hepatobiliary tumors. METHODS: Thirty-two patients underwent a nonenhanced CT scan of the liver, after which a 19-gauge, 10-cm-long needle was introduced into the splenic parenchyma under CT guidance. One hundred forty milliliters of contrast medium (200 mgI/mL; 28 g/I) were injected through this needle: first, a 20-mL bolus (in 5 s) and then 2 mL/s for 60 s. At the end of the bolus injection (5 s), 8-mm-thick contiguous axial scans of the liver were obtained. RESULTS: The success rate of the procedure was 93.7% (30/32; two technical failures). The average time required for the entire study was 13 min and 50 s (range = 7 min 53 s to 25 min 17 s). Hepatic parenchymal enhancement was good in 24/30 (80%), moderate in 3/30 (10%), and unsatisfactory in caudal sections of the liver in 3/30 (10%). Artifactual perfusion defects were seen in 4/30 (13%) due to inadvertant injection of small quantities of air. Intrasplenic subcapsular contrast accumulation occurred in 56.2% (18/32; minimal 15, moderate 3), extrasplenic contrast leakage in 12. 5% (4/32), and left shoulder pain in 18.7% (6/32). No major complications were observed. CONCLUSIONS: Direct intrasplenic contrast injection for CT portography is a simple, effective, and safe technique with a high success rate and requires significantly less time and lower doses of contrast medium; it also eliminates angiography, indwelling arterial catheters, and patient transfers from angiography to the CT area.

Biliary Tract Neoplasms↗
PubMedDate not supplied

Bleeding duodenal varices successfully treated with balloon-occluded retrograde transvenous obliteration (B-RTO) assisted by CT during arterial portography.

A 60-year-old woman with massive hemorrhage from duodenal varices was transferred to our hospital for the purpose of transcatheter intervention. Although digital subtraction arterial portography could not depict the entire pathway of collateral circulation, the efferent route of the duodenal varices was clearly demonstrated on subsequent CT during arterial portography. Balloon-occluded retrograde transvenous obliteration (B-RTO) of the varices was performed via the efferent vein and achieved complete thrombosis of the varices.

Angiography, Digital Subtraction↗
PubMedDate not supplied

Computed tomography during arterial portography prior to transcatheter arterial therapy in hepatocellular carcinoma with marked portal extension: four case reports.

Computed tomography during arterial portography (CTAP) is acknowledge as a valuable preoperative method for the detection of small intrahepatic lesions in patients with liver neoplasm. Four patients with hepatocellular carcinoma (HCC) with marked portal extension are presented. Evaluation of intrahepatic portal blood flow was achieved more accurately by CTAP than by conventional arterial portography. CTAP also plays an important role in patients with inoperable HCC, since portal extension is the most important prognostic factor of transcatheter arterial therapy.

Adult↗
PubMed1977

[Transjugular puncture of the portal vein. Portography and selective phlebography of abdominal organs. An experimental study in dogs (author's transl)].

Transjugular transhepatic portography is a new method for catheterising the portal vein and its tributaries. In order to gather experience of the method before applying it clinically, the transvenous approach was studied in six dogs. Transjugular portography has the following advantages as compared with umbilical vein catheterization and percutaneous, transhepatic portal vein catherterisation: 1. Because of the relative positions of the jugular veins, vena cava and portal vein, manipulation of the catheter for selective phlebography is simpler. 2. There is no risk of a haemoperitoneum or bile peritonitis if a correct technique is used since the liver capsule remains intact. 3. In the presence of portal hypertension, it may be possible in future to create an intrahepatic portocaval shunt by the transjugular approach without a major operation. Sclerosis of oesophageal varices is possible, as it is with the other procedures.

Animals↗
PubMed2004

Computed tomography perfusion of the liver: assessment of pure portal blood flow studied with CT perfusion during superior mesenteric arterial portography.

PURPOSE: To quantitatively assess the portal component of hepatic blood flow using computed tomography (CT) perfusion studies during superior mesenteric arterial portography. MATERIAL AND METHODS: Thirty-four patients with hepatocellular carcinoma and liver cirrhosis (LC) and 13 patients with liver metastasis without chronic liver disease were enrolled in this study. Ten milliliters of a non-ionic contrast medium (150 mg I) was injected at a rate of 5 ml/s via a catheter placed in the superior mesenteric artery. Single-slice cine CT images at the level of the main trunk or the right/left main trunk of the portal vein were acquired over 40 s. The deconvolution method was then used on these CT images to measure blood flow (BF), blood volume (BV), and mean transit time (MTT) in (a) liver parenchyma in patients with HCC and liver cirrhosis; (b) liver parenchyma in patients with liver metastasis without cirrhosis; (c) directly in the HCC; and (d) directly in one of the metastases. RESULTS: In 34 LC patients (a), BF, BV, and MTT in the liver parenchyma were 44.7+/-24.5 ml/min/100 g, 3.9+/-2.4 ml/100 g, and 10.9+/-5.5 s, respectively. In 13 patients without cirrhosis (b), BF, BV, and MTT in the liver parenchyma were 89.6+/-52.0 ml/min/100 g, 6.3+/-3.2 ml/100 g, and 8.7+/-3.6 sec, respectively. A significant difference in BF and BV was seen in patients with liver cirrhosis compared to those without cirrhosis. BF, BV, and MTT measured directly in HCC (c) were 6.5+/-4.5 ml/min/100 g, 0.4+/-0.4 ml/100 g, and 3.0+/-3.1 sec respectively, and BF, BV, and MTT in liver metastases (d) were 19.3+/-21.7 ml/min/100 g, 0.6+/-0.8 ml/100 g, and 1.8+/-1.6 s, respectively. CONCLUSION: CT perfusion studies during superior mesenteric arterial portography allow quantitative assessment of pure portal blood flow in the liver.

Blood Flow Velocity↗
PubMed1985

Comparison of diatrizoate, iopamidol, and ioxaglate for arterial portography. An experimental study in normal dogs and dogs with portal hypertension.

Diatrizoate, iopamidol and ioxaglate were compared in five normal dogs and in five dogs with presinusoidal cirrhosis and portal hypertension for arterial portography. After selective injection of 40 ml of each contrast agent in iodine concentrations of 320 mg per ml into the superior mesenteric artery, portal vein blood samples were collected in 2-second intervals and the iodine concentrations determined using x-ray energy spectrometry. The highest iodine concentrations in the portal blood were found in both normal portal pressure and portal hypertension with ioxaglate, followed by iopamidol and diatrizoate in this order. Compared with diatrizoate, ioxaglate and iopamidol increased the peak portal blood iodine concentrations 45% and 22%, respectively. The use of ioxaglate in arterial portography should show the portal system at least as well as when a conventional contrast agent is used together with a vasodilator such as tolazoline.

Animals↗
PubMedDate not supplied

MRI of liver metastases from colorectal cancer vs. CT during arterial portography.

A prospective study was performed to compare, with a lesion-by-lesion analysis, the sensitivities of high field strength MRI and CT during arterial portography (CTAP) in detecting hepatic metastases from colorectal cancer. Twenty-one patients with liver metastases from colorectal cancer were prospectively investigated by high field strength MRI (1.5 or 2 T) and CTAP. High field strength MRI was performed with pre and post gadopentetate dimeglumine enhanced T1-weighted SE sequences and T2-weighted SE sequences. All patients underwent partial hepatectomy and 37 metastases were surgically and pathologically proved. The metastasis detection rate (sensitivity) was 94% (35 of 37) for CTAP and 78% (29 of 37) for high field strength MRI. The 16% (95% confidence interval: 1-31%) difference in sensitivity between CTAP and high field strength MRI was statistically significant (p < 0.05, McNemar test). The use of gadopentetate dimeglumine did not improve the sensitivity of T1-weighted SE sequences. Since our study demonstrated significant difference in sensitivities between high field strength MRI and CTAP in our group of patients, we can conclude that high field strength MRI cannot replace CTAP in the preoperative evaluation of patients with liver metastases from colorectal cancer. Computed tomography during arterial portography must be considered as the preoperative gold standard.

Colonic Neoplasms↗
PubMedDate not supplied

Nontumorous attenuation changes on CT arterial portography.

OBJECTIVE: We prospectively studied the frequency and the distribution of nontumorous attenuation changes during CT arterial portography. MATERIALS AND METHODS: Computed tomography arterial portograms were obtained in 67 consecutive patients. The frequency and distribution of nontumorous attenuation changes (pseudolesions, areas of hypo- or hyperperfusion) were analyzed and related to the size of the tumor, the vascular status assessed by Doppler examination, and the presence of chronic liver disease. RESULTS: Pseudolesions were detected in 19 patients (28%). They were typical in 13 cases and atypical (round shaped or located in the caudate or right lobe) in 6. Segmental, lobar, or diffuse perfusion defects were seen in 36 patients (54%). In 56% of the cases, they were adjacent to large tumors and related to compression or thrombosis of intrahepatic portal branches as demonstrated by sonographic and Doppler findings. Areas of hyperperfusion were detected in 14 patients (21%). Of these cases, eight (57%) were peritumoral hyperperfusion. In all cases, the mean diameter of the tumors was large and there was compression of adjacent hepatic vein as demonstrated by sonographic and Doppler findings. CONCLUSION: Nontumorous attenuation changes are common in CT arterial portography. Factors leading to these artifacts include size of the tumor and vascular consequences of the tumor. Sonographic and Doppler studies may play a role in predicting these factors.

Adolescent↗
PubMed1996

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.

Artifacts↗
PubMedDate not supplied

Contrast-enhanced three-dimensional MR portography.

Three-dimensional (3D) magnetic resonance (MR) portography with contrast material enhancement is a fast means of evaluating the portal venous system that has some advantages over currently used modalities, such as digital subtraction angiography, helical computed tomography, ultrasonography, and nonenhanced MR angiography with time-of-flight and phase-contrast techniques. With contrast-enhanced 3D MR portography, a first-pass study of the mesenteric vasculature is performed after rapid bolus injection of gadopentetate dimeglumine; a 3D fast field echo sequence is used, which can demonstrate the intrahepatic and extrahepatic portal venous system clearly. Repeated sequences after administration of gadopentetate dimeglumine allow separate demonstration of the splanchnic arteries and portomesenteric veins. The images are reconstructed by means of maximum-intensity projection postprocessing, and a subtraction technique can be used to eliminate arterial enhancement and demonstrate portosystemic shunts. The coronal source images simultaneously demonstrate parenchymal lesions of the liver, pancreas, biliary tract, and spleen. This technique is clinically indicated in portosystemic shunt, portal vein thrombosis, hepatocellular carcinoma, pancreatobiliary tumor, hepatic vein obstruction, differentiation of splanchnic arterial from portal venous disease, and gastrointestinal hemorrhage. Its limitations include allergic reactions to contrast media, inappropriate positioning of the 3D acquisition slab, respiratory motion artifacts, and pseudodissection.

Contrast Media↗
PubMed1999

Correlation of a defect of portal perfusion in the dorsal part of segment IV of the liver on CT arterial portography with inflow of the aberrant pancreaticoduodenal vein.

The correlation between an aberrant pancreaticoduodenal vein and a portal perfusion defect in the dorsal part of segment IV as demonstrated on CT arterial portography (CTAP) was investigated. 14 patients with non-tumorous defects of portal perfusion in the dorsal part of segment IV of the liver parenchyma, shown on CTAP underwent CT during pancreaticoduodenal arteriography. The defect on CTAP was shown as an enhanced area resulting from non-portal venous inflow in eight (57%) of 14 patients on CT during pancreaticoduodenal arteriography. In conclusion, the non-portal venous supply via an aberrant pancreaticoduodenal vein occasionally causes a defect of portal perfusion in the dorsal part of segment IV on CT arterial portography.

Aged↗
PubMed1981

Sonography of hypertensive portal venous system: correlation with arterial portography.

Sixteen patients with portal hypertension and bleeding from gastroesophageal varices were studied prospectively by sonography and arterial portography. Sonography was able to demonstrate anechoic venous structures in characteristic sites in the upper abdomen corresponding with portosystemic collateral veins seen with arterial portography. Of four patients with sonographic visualization of a dilated umbilical vein, three were seen with angiography. Two patients had periportal collateral veins seen with both methods. Of 10 patients with retrograde opacification of the left gastric vein, nine were seen with sonography. Although all 16 patients had endoscopic proof of gastroesophageal varices, only 12 were demonstrated by angiography. Of these 12 patients, 10 had sonographic visualization of varices alone the gastroesophageal junction and lesser curvature of the stomach. One patient with opacification of a gastrorenal communication also had left upper quadrant venous abnormalities at sonography. Sonography is useful in the noninvasive identification of portosystemic collateral vessels in patients with portal hypertension.

Adult↗
PubMed1992

CT arterial portography: causes of technical failure and variable liver enhancement.

OBJECTIVE: We studied the causes of technical failure and enhancement variability encountered during CT arterial portography. MATERIALS AND METHODS: CT arterial portograms and digital arteriograms were obtained via the superior mesenteric artery before partial liver resection in 43 patients with malignant tumors. These studies were reviewed for causes of technical failure and variable enhancement. RESULTS: Eleven (26%) of 43 procedures were technical failures. Causes of failure included aortic injection after catheter dislodgement (four), dense hyperenhancement associated with laminar flow in the portal vein produced by rapid venous return from a selective injection into a proximal branch vessel of the superior mesenteric artery (two), premature scanning beginning at the iliac crest (two), reflux into a replaced right hepatic artery (one), hepatic arterial enhancement via the pancreaticoduodenal arcade (one), and portal hypertension (one). Of the 32 remaining studies, 28 showed areas of parenchymal hypoenhancement or hyperenhancement. Causes of variable enhancement included impaired portal vein perfusion from mass effect of the tumor, laminar flow in the portal vein, and focal fatty infiltration. CONCLUSION: Technical failures and enhancement variability are common in CT arterial portography. Factors leading to technical failure include catheter choice and position, portal hypertension, and operator error.

Carcinoma, Hepatocellular↗
PubMed2001

Influence of patient positioning on sensitivity of mesenteric portography for detecting an anomalous portosystemic blood vessel in dogs: 34 cases (1997-2000).

OBJECTIVE: To determine whether sensitivity of detecting an anomalous portosystemic blood vessel during operative mesenteric portography varied with patient positioning. DESIGN: Retrospective study. ANIMALS: 34 dogs with a portosystemic shunt diagnosed via scintigraphy or surgery. PROCEDURE: Portograms were evaluated for a portosystemic blood vessel. Sensitivity was calculated from results obtained with dogs in left lateral, right lateral, and dorsal recumbency and from results obtained with dogs in 2 or 3 positions. Differences in sensitivity among positions and between 2 examiners were evaluated. RESULTS: Sensitivity was 85, 91, and 100% in dorsal, right lateral, and left lateral recumbency, respectively. Sensitivity was lower in dorsal recumbency than in left lateral recumbency, although differences were not significant. There was no significant difference between sensitivity of results obtained in dorsal and right lateral recumbency or right lateral and left lateral recumbency. Sensitivity for combined right lateral and dorsal positions was 97%, which was better than that in dorsal recumbency alone, although the difference was not significant. Because sensitivity in left lateral recumbency was 100%, there was no need to evaluate the improvement obtained by combining the result of this position with the results of other positions. CONCLUSION AND CLINICAL RELEVANCE: Results of mesenteric portography varied with patient positioning. The optimal position varied among patients but left lateral recumbency may be better and dorsal recumbency worse. Sensitivity may be improved by performing the test with the patient in orthogonal recumbent positions.

Animals↗
PubMed1999

Ultrasonographic arterial portography with second harmonic imaging: evaluation of hepatic parenchymal enhancement with portal venous flow.

Ultrasonographic arterial portography was evaluated with second harmonic and conventional gray scale imaging after the administration of 0.001 to 0.1 ml/kg of FS069 (Optison) in 10 dogs (four dogs with ligation of the portal vein branch) and two woodchucks with hepatocellular carcinomas. Harmonic imaging was required to obtain good liver parenchymal enhancement for ultrasonographic arterial portography to be useful. The tumors were visible as regions of greater enhancement after intravenous injection and as hypoechoic regions after superior mesenteric artery injection. The segments with portal vein ligation were not detected after intravenous injection but were clearly seen after superior mesenteric artery injection. Doppler signal measurement verified a significant difference between the portal vein and hepatic vein after superior mesenteric artery injection and in the femoral artery after intravenous versus superior mesenteric artery injection, demonstrating that minimal levels of FS069 pass through the liver.

Albumins↗
PubMedDate not supplied

Pseudotumorous hyperplasia of the caudate lobe in the non-cirrhotic liver: MR and CT arterial portography appearance.

We describe the magnetic resonance image and computed tomographic arterial portography appearance of pseudotumorous hyperplasia in the caudate process of the caudate lobe in a non-cirrhotic patient. A prominent portal vein branch directly arising from the right main portal branch was seen in the center of the lesion on magnetic resonance imaging and computed tomographic arterial portography. We think that portal flow change of the caudate lobe by an anomalous portal branch may be correlated to pseudotumorous hyperplasia.

Diagnosis, Differential↗
PubMed2005

Modified magnetic resonance angiography of the liver using sensitivity encoding in comparison with digital subtraction angiography and CT arterial portography.

BACKGROUND: Over 355 patients have received orthotopic liver transplantation (OLT) at this hospital since 1993. Preoperative imaging studies of both hepatic vessels and parenchyma in these recipients bettered surgical planning or even precluded the necessity of surgery. Here we report our preliminary results of modified magnetic resonance angiography (MRA) using sensitivity encoding (SENSE) through comparative study with conventional digital subtraction angiography (DSA) and CT arterial portography (CTAP). METHODS: Sixteen patients with suspected liver diseases were included in the study. All of them received both dynamic MRI of the liver using SENSE and digital DSA with CTAP within a two-week interval. The four-phase MRA was reconstructed from source images of the coronal dynamic study. The arterial phase of the modified MRA was compared with DSA in the evaluation of hepatic arteries and the portal phase compared with CT portography reconstructed from source images of CTAP. In dynamic study of the liver, a fixed dose (20 ml) of contrast medium and scan timing were used. RESULTS: The main branches and variations of the hepatic arterial system were well shown on the modified MRA, although the marginal branches of hepatic arteries were of poor quality. The figures of portal veins on MRA were as clear as or superior to those of CTAP. In addition, the suprarenal inferior vena cava (IVC) was well demonstrated on MRA and/or non contrast-enhanced coronal balanced fast-field echo (b-FFE) scan sequence in most cases. MRI detected most parenchymal lesions of the liver and hemodynamics of these lesions could be evaluated on source images of the modified MRA. MRI/MRA also serendipitously revealed several extrahepatic disease entities or variations that were not found on DSA/CTAP. CONCLUSIONS: The modified MRA using SENSE is a cost-effective modality of examination for the demonstration of the whole hepatic vascular system. Combined with MRI, it has the potential as a one-stop imaging modality in the preoperative evaluation in fields such as OLT.

Aged↗
PubMed2005

Preoperative evaluation of endoscopic ultrasonography and portography in selecting devascularization surgery for esophagogastric varices.

This study assesses the role of endoscopic ultrasonography (EUS) and portography in selection of mode of devascularization surgery for esophagogastric varices (EGV) in patients with portal hypertension and reports our experience in the treatment of EGV with modified devascularization surgery. Forty-two cirrhotic patients with EGV were treated with devascularization surgery for variceal hemorrhage. Preoperatively, percutaneous transhepatic portography (PTP) and EUS were used as the guiding mode for therapy of EGV. In addition to devascularization and splenectomy, esophageal transection (ET) was performed in 26 patients with upward-flow varices (UFV), whereas 16 patients with downward-flow varices (DFV) underwent proximal gastrectomy instead of ET. In both UFV and DFV groups, grade II of intramural varices and extramural collaterals were most commonly observed on EUS imaging. There was no significant difference of EUS grading between these two groups (P > 0.05). The incidence of postoperative complications, mortality, and recurrent varices were not significantly different between these two groups. The overall 5-year survival rate for UFV group was 69.2 per cent, whereas that for the DFV group was 68.7 per cent (P > 0.05). Our study shows that devascularization surgery is highly effective for the prevention of recurrent bleeding from EGV, and it provides an alternative treatment modality. Combined PTP and EUS are very helpful in determining adequate modalities of devascularization surgery.

Adult↗