[Indirect (arterial) spleno-portography and portography in the diagnosis of pre-hepatic blocks (author's transl)].
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Adolescent↗
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Preoperative assessment of resectability of hepatic metastases from colonic carcinoma: CT portography vs sonography and dynamic CT.
OBJECTIVE: A retrospective study was performed to determine the influence of CT portography vs sonography and dynamic CT on the preoperative assessment of the resectability of hepatic metastases from colorectal cancer. MATERIALS AND METHODS: Results of sonography, bolus dynamic CT, and CT portography in 28 patients who underwent surgical exploration (resection or intraarterial catheter placement) for hepatic metastases from colorectal cancer were retrospectively reviewed by two abdominal radiologists and one hepatic surgeon. For each patient, the resectability and surgical approach were decided on the basis of the results of combined sonography-bolus dynamic CT and compared with the decision made from the CT portographic results alone. The final approach suggested was compared retrospectively with the surgical procedure actually performed. RESULTS: Sixty-nine metastases were identified at surgery and pathologically proved. Combined sonography-bolus dynamic CT and CT portography showed 52 (75%) and 64 (93%) metastases, respectively. Twelve metastases in five patients were seen only with CT portography. In four patients, CT portography depicted additional metastases, which changed the surgical approach that had been chosen on the basis of results of sonography and bolus dynamic CT. In one patient, CT portography showed four additional metastases, precluding hepatic resection. CONCLUSION: Findings from CT portography provide vital data unattainable with sonography and bolus dynamic CT that improve the preoperative assessment of the resectability of liver metastases from colonic carcinoma.
Colorectal Neoplasms↗
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↗
[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↗
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↗
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↗
[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↗
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↗
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↗
[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↗
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↗
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↗
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↗
[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↗
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↗
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↗
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↗
[Percutaneous transhepatic portography in patients with hepatocellular carcinoma: percutaneous transhepatic portal venous embolization].
Percutaneous transhepatic portography was performed in 28 patients with HCC and PTPE was attempted in 9 of them. Displacement of the portal vein was found in 37% of 52 HCCs. Other portographic findings were: encasement (19%), avascular area (19%), occlusion (10%), narrowing (4%), neovascularization (4%), tumor staining (2%). Frequency of the tumor-related portography findings was found to be increased in relation to tumor size. TAE followed by PTPE with stainless steel coil (6 cases) or microcapsule form of MMC (3 cases) was performed on 9 cases. PTPE appears to be a promising adjuvant to conventional TAE.
Aged↗