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At least 163 records · Page 9Linked to original sources
PubMedDate not supplied

CT angiography and CT arterial portography in evaluation of hepatic adenomas.

OBJECTIVE: Our goal was to evaluate the contribution of CT arterial portography (CTAP) and CT angiography to accurate determination of disease extent in patients with known hepatic adenomas. MATERIALS AND METHODS: Imaging results were reviewed in three women with known hepatic adenomas, all of whom had percutaneous biopsy to confirm the diagnosis. Results of CTAP studies in all patients as well as results of CT arteriography in one patient were compared with routine dynamic CT studies in all three and with MRI studies in two. RESULTS: The CTAP and CT arteriography demonstrated multiple additional lesions in all patients as compared with routine dynamic CT and MRI studies. In one of the patients who was found to have hepatic adenomatosis, the degree of tumor involvement changed the operative procedure from partial hepatectomy to liver transplantation. CONCLUSION: In patients with known hepatic adenomas who require surgery, CTAP provides more accurate preoperative staging of extent of liver replacement with tumor.

Adenoma↗
PubMedDate not supplied

Detection of focal hepatic masses: STIR MR vs. CT during arterial portography.

OBJECTIVE: Our goal was to compare short tau inversion recovery MRI (STIR) to CT during arterial portography (CTAP) in the detection of hepatic lesions. MATERIALS AND METHODS: Over a 24 month period, 40 patients evaluated for possible hepatic resection underwent T1, T2, and STIR MRI and CTAP. These studies were randomly ordered and interpreted by two independent readers. The total number of lesions and number of lesions within each hepatic segment were analyzed using McNemar's test. RESULTS: Readers 1 and 2 detected 95 and 91 lesions by CTAP and 78 and 83 by STIR, respectively, which was not significantly different (p = 0.1, reader 1; p = 0.4, reader 2). For both readers CTAP and STIR MRI detected more lesions than either T2 or T1 MRI (p < 0.01). In the medial segment, readers 1 and 2 detected 18 and 17 lesions by CTAP and 7 and 9 by STIR, respectively (p = 0.01, reader 1; p = 0.035, reader 2). CONCLUSION: Short tau inversion recovery MRI and CTAP are similar in total lesion detection except in the medial segment where lesions were more frequently identified by CTAP than STIR MRI.

Adult↗
PubMedDate not supplied

CT arterial portography vs pancreatic arteriography in the assessment of vascular involvement in pancreatic and periampullary tumors.

OBJECTIVE: Preoperative staging of pancreatic tumors is frequently accomplished through a combined effort of CT and arteriography. For tumor detection and delineation of disease extent CT is utilized routinely, with CT arterial portography (CTAP) being the single most accurate study for the detection liver metastases. Arteriography has remained the "gold" standard for assessing vascular involvement. The purpose of this study was to determine whether CTAP could become the single study of choice for assessing resectability in patients with pancreatic and periampullary tumors with particular emphasis on its accuracy in determining vascular involvement. MATERIALS AND METHODS: Radiologic studies and medical records were reviewed in 20 patients who had received both CTAP and arteriographic examinations for preoperative assessment of pancreatic and periampullary tumors. These findings were correlated with results from either surgery (12 cases) or percutaneous biopsy and follow-up (8 cases) in 12 nonresectable and 8 resectable tumors. RESULTS: Arteriography and CTAP correctly concurred in 75% of cases (15 of 20); CTAP correctly demonstrated vascular involvement not appreciated on arteriography in 15% (3 of 20) with an overall sensitivity and specificity of 90 and 100%, respectively. Arteriography was superior to CTAP in one patient (5%) with an overall sensitivity and specificity of 70 and 90%, respectively, for predicting vascular involvement by tumor. CONCLUSION: Our experience suggests that CTAP is more accurate than arteriography for demonstrating tumor involvement of major peripancreatic vessels. Because CTAP, additionally, has a high sensitivity for detecting liver metastases, no further studies may be necessary to determine operability of these patients.

Adenocarcinoma↗
PubMedDate not supplied

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

PURPOSE: 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. METHOD: 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. RESULTS: 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. CONCLUSION: Liver cirrhosis decreases the frequency of pseudolesions around the falciform ligament, but not around the gallbladder or posterior edge of the medial segment.

Adult↗
PubMedDate not supplied

Overestimating the size of hepatic malignancy on helical CT during arterial portography: equilibrium phase CT and pathology.

PURPOSE: Overestimating the size of hepatic malignancy with helical CT during arterial portography (CTAP) can be a potential pitfall in determining liver resection area. We evaluated the prevalence and extent of overestimation of hepatic malignancy on CTAP in correlation with helical equilibrium phase CT (EPCT) and pathologic findings. METHOD: CTAP and EPCT in 47 histologically proven malignant hepatic tumors [33 hepatocellular carcinomas (HCCs) and 14 metastases] in 39 patients were retrospectively studied. Nineteen tumors were resected and pathologically evaluated. RESULTS: The size overestimation ratios (CTAP/EPCT) ranged from 1.02 to 1.56 (mean +/- SD 1.24 +/- 0.16) in HCC and from 1.00 to 2.48 (1.34 +/- 0.42) in metastasis. In 19 surgical specimens, the overestimation ratios (CTAP/specimen) ranged from 1.05 to 1.45 (1.20 +/- 0.13) in HCC and from 1.10 to 1.38 (1.22 +/- 0.10) in metastasis. Histopathologically, flattening of parenchymal structures (100%), atrophy of hepatic cords (95%), sinusoidal congestions (95%), fibrosis and ductular proliferation (58%), and no tumor were seen in peritumoral parenchyma corresponding to perilesional perfusion defects with CTAP. CONCLUSION: CTAP frequently and significantly overestimates the size of malignant hepatic tumors. This phenomenon is attributable to either benign histopathological changes in the perilesional liver parenchyma caused by parenchymal compression or portal venous obstruction by malignant liver tumors or to a siphoning effect by hypervascular neoplasms.

Adenocarcinoma↗
PubMedDate not supplied

Pseudolesion in segments II and III of the liver on CT during arterial portography caused by aberrant right gastric venous drainage.

We report three cases of pseudolesions caused by aberrant right gastric venous drainage (AGVD) in segment II/III of the liver as demonstrated on CT during arterial portography (CTAP). On CTAP, the lesions were seen as wedge-shaped perfusion defects, and on hepatic arteriography, AGVD directed to the area with the perfusion defect was visible in all three cases. When a perfusion defect is detected at the edge of segments II/III at CTAP, a pseudolesion caused by AGVD should be suspected.

Aged↗
PubMedDate not supplied

Intrahepatic portal venous variations: demonstration by helical CT during arterial portography.

PURPOSE: We assessed the prevalence and types of intrahepatic portal venous variations by helical computed tomography performed with arterial portography (CTAP). METHODS: In 192 patients without evidence of vascular invasion or distortion, CTAP images were reviewed retrospectively to identify portal venous variations. RESULTS: Of the 192 patients examined, 10 (5.2%) had trifurcation, 5 (2.6%) had a right posterior segmental branch arising from the main portal vein, 5 (2.6%) had an absence of the horizontal segment of the left portal vein, and 1 (0.5%) had an absence of the left lateral segmental portal branch. Of the patients without a horizontal segment, two had a right-sided ligamentum teres associated with malposition of the gallbladder, while another had complete ramification of intrahepatic portal branches from an umbilical vein-like segment. In the patient missing the left lateral segmental branches, the right portal vein segments were subcapsularly located. CONCLUSION: Variations of the intrahepatic portal veins can be recognized on CTAP imaging. tomography-Portal vein, computed tomography.

Congenital Abnormalities↗
PubMedDate not supplied

CT during arterial portography: effects of precontrast injection of prostaglandin E1 into the superior mesenteric artery.

Prostaglandin E1 (PGE1) is a vasodilator that increases portal venous flow. Hepatic CT during arterial portography (CTAP) was performed in 42 patients with and without PGE1 to compare peak hepatic enhancement and nontumorous abnormalities. Although no significant differences in peak hepatic enhancement were observed (71 +/- 12 HU for CTAP with PGE1; 74 +/- 34 HU for CTAP without PGE1), the number of nontumorous abnormalities for CTAP with PGE1 (n = 11) was significantly lower than that for CTAP without PGE1 (n = 24) (p < 0.01, Wilcoxon signed rank test). CTAP combined with PGE1 therefore represents a useful method to study lesions of the liver, as the number of nontumorous abnormalities observed is significantly reduced and liver parenchyma can be scanned more evenly.

Aged↗
PubMed2001

Is CT during arterial portography useful for the preoperative evaluation of liver metastases from pancreatic carcinoma?

We evaluated computed tomography during arterial portography (CTAP) for the preoperative evaluation of liver metastases from pancreatic carcinoma. Thirty-one patients with invasive ductal carcinoma of the pancreas underwent CTAP for evaluation of liver metastasis. Diagnostic accuracy of CTAP was compared with that of intravenous contrast-enhanced CT (IVCT). In this series, both CTAP and IVCT showed the same diagnostic accuracy for the patients. The sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of both CT examinations for detecting liver metastases were 60% (three of five), 100% (26 of 26), 100% (three of three), 93% (26 of 28), and 94% (29 of 31), respectively. CTAP did not confer any advantage over IVCT for the preoperative evaluation of liver metastases from pancreatic carcinoma.

Humans↗
PubMed2004

Preoperative detection of liver metastases secondary to pancreatic cancer: utility of combined helical computed tomography during arterial portography with biphasic computed tomography-assisted hepatic arteriography.

OBJECTIVE: This study was designed to define the diagnostic advantage of computed tomography during arterial portography combined with computed tomography-assisted hepatic arteriography ( CTAP + CTHA) for preoperative detection of liver metastases secondary to pancreatic cancer compared with that of multidetector computed tomography (MDCT). METHODS: From January 2002 to February 2003, we retrospectively studied 19 consecutive patients with pancreatic cancer. MDCT was performed on all patients prior to preoperative visceral angiography. Fourteen patients underwent CTAP + CTHA at the time of preoperative angiography. RESULTS: Liver metastases were identified in 3 patients by means of MDCT. Of 14 patients who underwent CTAP + CTHA, 8 patients (57.1%) were diagnosed as having liver metastases, which could not be detected by MDCT. These tumors missed by MDCT ranged from 5 to 15 mm in size. On CTAP + CTHA, a single nodule in the liver was detected in 2 patients, 2 nodules in 2 patients, 3 lesions in 1 patient, and > or =4 lesions in 3 patients. The sensitivity and specificity of CTAP + CTHA versus MDCT were 75.0% versus 23.1% and 66.7% versus 100%, respectively. CONCLUSIONS: In conclusion, the combination of CTAP and CTHA is useful to confirm liver metastases before operation for resectable pancreatic cancer because it has higher sensitivity to detect of liver metastases compared with MDCT.

Adenocarcinoma↗
PubMedDate not supplied

Usefulness of a saline flush for intravenous 3-dimensional computed tomography portography using multidetector-row helical computed tomography.

PURPOSE: To evaluate the clinical usefulness of a saline flush technique in improving the imaging quality of 3-dimensional computed tomography portography (3D-CTP). METHODS: To evaluate liver metastases, 58 patients were divided into 2 groups undergoing 3D-CTP with or without a saline flush. The computed tomography (CT) values of the right portal vein (RPV), left portal vein (LPV), main portal vein (MPV), and right hepatic parenchyma (RHP) were assessed. Maximum intensity projection (MIP) 3D-CTP images were evaluated by vessel visualization. RESULTS: Higher mean CT attenuation values in the RPV, LPV, MPV, and RPV-RHP were observed in the saline flush group and were statistically significant (P = 0.04, P = 0.03, P = 0.01, and P = 0.04, respectively). The difference in imaging quality between 2 groups was statistically significant (P = 0.04). In segment VIII, the ability to depict the segmental branches was significantly higher when the saline flush technique was used (P = 0.03). CONCLUSIONS: The saline flush technique increases the CT attenuation values of the portal vein and the difference in values between the portal vein and the tissue around it and improves the MIP imaging quality of 3D-CTP.

Contrast Media↗
PubMed2006

The use of carbon dioxide wedged hepatic venography to identify the portal vein: comparison with direct catheter portography with iodinated contrast medium and analysis of predictive factors influencing level of opacification.

PURPOSE: This study was conducted to assess the value of wedged hepatic venography (WHV) with CO(2) as a contrast agent for identification of the portal venous system in patients with cirrhosis. Additionally, the predictive value of several parameters that potentially influence the level of portal vein opacification by CO(2) WHV was analyzed. MATERIALS AND METHODS: In 163 patients, CO(2) WHV was performed before transjugular intrahepatic portosystemic shunt creation to opacify and map the portal vein for subsequent targeting by intrahepatic puncture technique. Concordance between CO(2) WHV and direct catheter portography with iodinated contrast medium was assessed by analysis of sensitivity parameters. Additionally, analysis of factors potentially influencing the opacification of the portal vein with use of CO(2) WHV was assessed. RESULTS: CO(2) WHV was successfully performed in all 163 patients. In three patients (1.8%), CO(2) extravasation was noted, but without any clinical consequence. Sensitivity rates of CO(2) WHV for opacification of the right and left portal veins and the portal main trunk were 93.83% and 68.52%, respectively. Positive predictive factors (P < .05, Wilcoxon two-sample test) were high portosystemic gradient, spontaneous splenorenal shunt, esophageal varices, and reversed portal flow. One negative predictive factor was a patent umbilical vein. CONCLUSIONS: CO(2) WHV is safe, highly efficient, and reliable in the identification of the right and left portal veins. CO(2) WHV is clearly less effective in opacifying the entire portal main trunk. With use of CO(2) WHV, the portal venous system is most distinctly opacified in patients presenting with a high portosystemic gradient, a spontaneous splenorenal shunt, esophageal varices, and reversed portal flow.

Adult↗
PubMed2000

Computed tomography during arteriography and arterial portography in small hepatocellular carcinoma and dysplastic nodule: a prospective study.

We studied the relationship between the findings of computed tomography during arteriography (CTA) and computed tomography during arterial portography (CTAP), and pathologic findings of 81 small nodular lesions (3 cm or less in diameter) in resected liver specimens. The 81 lesions consisted of 8 dysplastic nodule (DN) lesions, 23 well-differentiated hepatocellular carcinomas (early HCCs) and 50 moderately or poorly differentiated HCCs (advanced HCCs). We also performed standard computed tomography (CT), digital subtraction angiography (DSA), magnetic resonance imaging (MRI), and ultrasonography, and compared sensitivities with CTA, CTAP, or combination of CTA and CTAP with other imaging methods. Forty-four of the 50 advanced HCCs, 12 of the 23 early HCCs, and none of 8 DNs hyperattenuated with CTA and hypoattenuated with CTAP. The sensitivity for the early HCCs was significantly higher for CTA and CTAP in combination as compared with DSA or standard CT. The sensitivity for the advanced HCCs was significantly higher for CTA and CTAP in combination than with DSA. The sequential changes of the blood supply from the portal vein to the hepatic artery during the development of the HCCs were observed. Although CTA and CTAP in combination were useful for the distinction of advanced HCC from early HCC or DN, CTA and CTAP used in combination were not superior to CTA alone in the detection of such lesions.

Adult↗
PubMed1997

Use of spiral and non-spiral computed tomography arterial portography in the detection of potentially malignant liver masses.

The present study assesses the usefulness of computed tomography (CT) arterial portography (CTAP) in detecting and defining the number and anatomy of potentially malignant liver lesions. One hundred and one adults studied in 1993 and 1994 were retrospectively reviewed, including patients with primary or secondary tumours for possible resection and patients with non-hepatic malignancies in whom the detection of liver metastases would preclude surgery. Twenty-three patients underwent non-spiral CT studies and 78 had studies on a spiral unit, with 22 of these having single phase and 56 having dual phase studies to overcome artefact problems. The relationship between lesion size and detection sensitivity is critical. On non-spiral studies, the overall lesion detection sensitivity and positive predictive value was 69 and 90%, respectively. Detection sensitivity was 100 and 20% for lesions > 1 cm and < 1 cm, respectively. On single phase spiral CTAP the overall detection sensitivity and positive predictive value was 80 and 66%, respectively. Detection sensitivity for lesions > 1 cm and < 1 cm was 100 and 0%, respectively. On dual phase spiral CTAP the overall detection sensitivity and positive predictive value was 76 and 71%, respectively. For lesions > 1 cm and < 1 cm the sensitivity was 81 and 55%, respectively. Eighteen patients with non-hepatic malignancies with unsuspected metastatic spread did not proceed to major surgery because of liver metastases detected on CTAP. Perfusion artefacts occurred in 30 and 64% of non-spiral and of initial portal venous spiral CTAP studies, respectively. By using the double-phase technique, these artefacts were substantially diminished. In conclusion, CTAP is a valuable tool for assessing the presence, site and size of possible liver tumours and confers a benefit even when previous ultrasound and conventional CT have already been used. In addition, CTAP has a lower limit of useful resolution of approximately 1 cm. Perfusion artefacts can be reduced by a dual phase protocol.

Adult↗
PubMed1992

CT during arterial portography: diagnostic pitfalls.

Computed tomography (CT) during arterial portography (CTAP) is an important technique for evaluating the liver before hepatic tumor resection. With this technique, most tumors are of low attenuation compared with that of enhancing parenchyma. At times, low-attenuation lesions are encountered that represent perfusion abnormalities rather than tumor deposits. These perfusion abnormalities can be categorized as (a) those resulting from improper technique; (b) those extending from hilum to capsule (straight-line sign), with or without an obstructing mass; (c) perihilar and periligamentous abnormalities; (d) subcapsular defects (linear or wedge shaped); and (e) those seen with cirrhosis or regenerating nodules. Adjuvant use of delayed CT, magnetic resonance imaging, and intraoperative ultrasound aids in characterization of these nontumorous defects, thereby improving specificity. The authors conclude that when potential candidates are evaluated for hepatic tumor resection, knowledge of the existence of the various diagnostic pitfalls of CTAP and their imaging characteristics is imperative to avoid inadvertent false results.

Angiography, Digital Subtraction↗
PubMed1995

Spiral CT during arterial portography: technique and applications.

Spiral computed tomography during arterial portography (CTAP) combines rapid scanning with selective imaging during the portal phase of enhancement of the liver, resulting in an effective method for evaluation of liver neoplasms prior to partial hepatic resection. Compared with dynamic incremental CTAP, spiral CTAP results in improved quality of three-dimensional and multiplanar reconstructions, facilitating presurgical planning. Accurate volumetric analysis of the tumor can be performed, and subsegmental tumor localization is facilitated by the high levels of hepatic and portal venous enhancement. Additional advantages of spiral CTAP include small reconstruction intervals for improved lesion detection. However, the specificity of spiral CTAP is low because both benign and malignant tumors appear as hypoattenuating perfusion defects. In addition, both focal and geographic nontumorous perfusion defects may be seen more frequently with spiral CTAP than with dynamic CTAP. Knowledge of common diagnostic pitfalls is necessary for accurate interpretation of spiral CTAP images.

Adult↗
PubMedDate not supplied

CT during hepatic arteriography and portography: an illustrative review.

The combination of computed tomography (CT) during arterial portography (CTAP) and CT during hepatic arteriography (CTHA) has been used for evaluation of hepatic neoplasms before partial hepatic resection. Focal hepatic lesions that can be demonstrated with CTAP and CTHA include regenerative nodules, dysplastic nodules, dysplastic nodules with malignant foci, hepatocellular carcinoma, cholangiocarcinoma, hemangioma, and metastases. CTAP is considered the most sensitive modality for detection of small hepatic lesions, particularly small hepatic tumors such as hepatocellular carcinoma and metastatic tumors. CTHA can demonstrate not only hypervascular tumors but also hypovascular tumors and can help differentiate malignant from benign lesions. However, various types of nontumorous hemodynamic changes are frequently encountered at CTAP or CTHA and appear as focal lesions that mimic true hepatic lesions. Such hemodynamic changes include several types of arterioportal shunts, liver cirrhosis, Budd-Chiari syndrome, inflammatory changes, pseudolesions due to an aberrant blood supply, and laminar flow in the portal vein. Familiarity with the CTAP and CTHA appearances of various hepatic lesions and nontumorous hemodynamic changes allows the radiologist to improve the diagnostic accuracy.

Angiography↗
PubMed1983

Work in progress: dynamic sequential computed tomography during arterial portography in the detection of hepatic neoplasms.

Dynamic sequential computed tomography with table incrementation during arterial portography (DSCTI-AP) of the entire liver was performed in an attempt to improve the detection of hepatic neoplasms. In 13 of 17 patients, DSCTI-AP detected more hepatic lesions than were detected by other imaging methods, including radionuclide liver scans, ultrasound, computed tomography, and hepatic angiography. In only one case, an extremely hypervascular hepatocellular carcinoma, hepatic angiography was superior to DSCTI-AP. DSCTI-AP is a simple technique that may be carried out as a part of hepatic angiography. We believe that DSCTI-AP is a sensitive and useful method for the accurate detection of hepatic neoplasms.

Angiography↗