(1/69) 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. (+info)
(2/69) Portal venous system aneurysms: report of five cases.
Until recently aneurysms in the portal venous system were considered to be very rare lesions. This opinion has largely been changed by the increasing number of cases reported in recent years. In this paper we report the cases of five patients with portal venous system aneurysms, including one with splenic vein aneurysm. One patient had associated portal hypertension. The reexamination of two patients 2 years later showed no change in the aneurysms. The sonographic features and related literature are reviewed. In the light of this series and the information in the literature, we recommend that portal venous system aneurysms should no longer be considered exceptionally rare entities. (+info)
(3/69) Differential diagnosis between tumor-forming pancreatitis and pancreatic cancer by percutaneous transhepatic portography and selective direct pancreatic venography.
In 32 patients with tumor-forming pancreatitis and 109 patients with pancreatic cancer, the usefulness of percutaneous transhepatic portography (PTP) and selective pancreatic venography (SPV) for differential diagnosis of the two diseases was evaluated. The PTP images were type I in 53.1%, type II in 21.9%, type III in 12.5%, and type IV in 12.5% of the patients with tumor-forming pancreatitis and type I in 20.2%, type II in 23.9%, type III in 37.6%, and type IV in 18.3% of the patients with pancreatic cancer. Advanced images (type III or type IV) were observed in more than half the patients with pancreatic cancer. Mild images classified as type II were observed slightly more frequently in the patients with pancreatic cancer, but the differential diagnosis of the two diseases was difficult in patients showing type II PTP images. SPV findings were primarily hypervascularization (78.1%) and vasodilation (68.8%) in the patients with tumor-forming pancreatitis. Although encasement (smooth encasement) was noted in 31.3%, obstruction was found in only 3.1%. In the patients with pancreatic cancer, obstruction was observed in 85.3%, and encasement (irregular encasement) was noted in 78.9%. However, hypervascularization or vasodilatation was infrequent, and the tumor was characteristically imaged as a hypovascular area. PTP and SPV were considered to be useful for the differential diagnosis of tumor-forming pancreatitis and pancreatic cancer. (+info)
(4/69) Clinical usefulness of computed tomography arteriography and computed tomography during arterial portography for the diagnosis of early and early advanced hepatocellular carcinoma.
OBJECTIVE: We examined the clinical usefulness of two techniques of Angio Computed tomography (CT), namely, CT arteriography (CTA) and CT during arterial portography (CTAP), for the diagnosis of early hepatocellular carcinoma (HCC) and early advanced HCC. MATERIALS AND METHODS: The subjects were six patients with a total of seven lesions: three had one early HCC lesion each, and three had four early advanced HCC lesions between them. There were five men and one woman, aged 61 approximately 73 years (mean: 65 years). A catheter was inserted into each inguinal artery according to Seldinger's method, and the results of CTA and CTAP were compared with those of conventional CT. RESULTS: Visualization of tumor borders, arterial blood feeding areas, and portal blood flow areas gave results equal to or better than those of conventional CT. CONCLUSIONS: A combination of CTA and CTAP is useful for the diagnosis of early HCC and early advanced HCC. (+info)
(5/69) Focal lesions in cirrhotic liver: comparing MR imaging during arterial portography with Gd-enhanced dynamic MR imaging.
The purpose of this study was to document the additional value of MR imaging during arterial portography (MRAP) in patients examined with intravenous contrast-enhanced dynamic MR imaging for the assessment of focal lesions in patients with cirrhosis or chronic viral hepatitis. The MR images of 24 patients with 39 hepatocellular carcinomas and 18 benign hepatocellular nodules examined with dynamic MR imaging and MRAP within a 14-day interval were retrospectively reviewed. For 39 hepatocellular carcinomas, MRAP revealed 37 perfusion defects (95%), while dynamic MR imaging demonstrated 35 occurrences of nodular contrast-enhancement (90%) on arterial dominant phases. Among the 11 benign nodules misinterpreted as hepatocellular carcinoma due to their high signal intensities on arterial-dominant phases of dynamic MR imaging, eight (73%) showed intratumoral portal venous perfusion on MRAP and were regarded as benign nodules. As a result of its high sensitivity and its potential ability to enable differentiation of benign and malignant hepatocellular nodules, MRAP can be added to dynamic MR imaging for planning future management in patients with equivocal hepatocellular nodules in the cirrhotic liver. (+info)
(6/69) Highly enhanced hepatic masses seen on CT during arterial portography: early hepatocellular carcinoma and adenomatous hyperplasia.
BACKGROUND: To describe computed tomographic (CT) features of highly enhanced hepatic masses as seen on CT during arterial portography (CTAP) and to survey the varieties of hepatic lesions associated with such findings. METHODS: CTAP files for 400 patients were reviewed, on the basis of which six patients with highly enhanced hepatic masses were selected. These six patients also subsequently underwent CT during hepatic arteriography (CTHA) on the same day. All the patients had chronic liver damage, which was cirrhotic in five cases. Five had a current diagnosis and one had a history of hepatocellular carcinoma (HCC). RESULTS: Solitary highly enhanced masses were observed on CTAP in three patients, three masses were seen in one patient and multiple (10-12) masses in the other two patients. All the CTAP-enhanced masses except one were round in shape and homogeneous in attenuation. The size of the mass ranged from 6 to 25 mm in diameter. In all except two nodules in one patient, the masses were hypoattenuated on CTHA. On histopathological examination of five nodules in three patients, the nodular lesions were consistent with so-called early HCC (well-differentiated HCC of Edmondson I) in four nodules and adenomatous hyperplasia in the other nodule. CONCLUSIONS: Highly enhanced hepatic masses relative to the surrounding liver parenchyma have been sporadically noted on CTAP, especially in patients with liver cirrhosis. When present, such nodules are typically hypoattenuated on CTHA and histological features are consistent with early HCC and adenomatous hyperplasia. (+info)
(7/69) CT via percutaneous splenoportography: experiment and application.
OBJECTIVE: To introduce computed tomography via percutaneous splenoportography (CTSP), a new method for determining hepatic diseases. METHODS: Ten hybrid dogs and 31 patients with primary hepatic cancer (PHC) were included in the study. Each dog was examined by CT, computed tomography via arterial portography (CTAP), and CTSP to compare the enhanced density of the liver. The 31 patients were examined by CTSP and the appearance of PHC was compared with their pathological results to evaluate the diagnostic significance of CTSP. RESULTS: The animal experiment showed that both CTAP and CTSP could obviously enhance the density of the liver (P < 0.01), but no significant difference was observed in the enhanced densities between the two methods (P > 0.05). On the CTSP images of the 31 patients, the density of the livers was increased to 168-192 Hu, whereas the density of the cancers was as low as that on the images of CT scans (< 58 Hu). The CTSP findings were consistent with the surgical ones from space occupying lesions. The diagnostic value of CTSP was obviously superior to that of general enhanced CT. However, it was difficult for CTSP to show nodules less than 1 cm in size located on the surface of the liver or the hepatic portal zone. CONCLUSIONS: Like CTAP, CTSP is also a sensitive method for showing occupant in the liver. But the equipments and the procedures are simpler for CTSP than for CTAP. CTSP is an alternative procedure in clinical practice. (+info)
(8/69) Effect of prostaglandin E1 on contrast enhanced CT of the liver: statistical analysis during arterial portography.
PURPOSE: To determine the diagnostic effect of prostaglandin E(1) on contrast enhancement quality of CT during arterial portography (CTAP). MATERIALS AND METHODS: Our patients population included 30 patients (11 women, 19 men; age range, 41 approximately 81 years) with liver tumors (23 hepatocellular carcinoma and 7 metastatic liver tumor) who had undergone angiography. We divided the 30 patients, who had undertaken CTAP twice, into two groups at random (group A; n=15, group B; n=15). In group A, first CTAP was performed without prostaglandin E(1). Approximately 5 minutes later, a second CTAP was again initiated 30 seconds after injection of prostaglandin E(1) under the same conditions. In group B, prostaglandin E(1) was injected before the first CTAP only. We measured the mean CT numbers and standard deviation (SD) numbers of anterior, posterior, medial and lateral segments in the liver at the same section of the CTAP using the same size and location of the regions of interest, and these values with and without prostaglandin E(1) were compared. RESULTS: 1) CT numbers: The CT numbers were significantly increased in the medial segment after the injection of prostaglandin E(1) (p<0.05) in all cases of both groups. On the other hand, they were clearly decreased in the posterior segment after the injection of prostaglandin E(1) (p<0.05) in both groups. There were no statistical differences in the CT numbers in the anterior and lateral segments in all patients. In addition, the CT numbers of anterior and posterior segments showed high attenuation compared with the medial and lateral segments in group A without prostaglandin E(1). 2) SD numbers: The SD numbers, which are an index of the homogeneous enhancement, were significantly decreased in the posterior, medial and lateral segments after the injection of prostaglandin E(1) (p<0.01, p<0.05, p<0.01, respectively) in both groups. There were no significant differences in the SD numbers in the anterior segment regardless of the injection of prostaglandin E(1) in all cases. CONCLUSION: CTAP with injection of prostaglandin E(1) makes contrast enhancement of liver parenchyma more homogeneously than the conventional procedure, and it may be a useful technique for the detection of liver tumors. (+info)