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Background: The management of blunt liver trauma in cirrhotic patients is challenging, because while bleeding is most often of arterial origin, the increased pressure in the portal system associated with cirrhosis can increase the risk of portal bleeding, which is sometimes difficult to confirm on contrast-enhanced abdominal computed tomography. Case presentation: We managed a 54-year-old cirrhotic patient who presented with blunt liver trauma. Computed Tomography showed active intraperitoneal bleeding presumed to be of hepatic origin. Given the patient's hemodynamic stability, the decision was made to manage the patient non-surgically. The patient underwent hepatic arteriography to rule out an arterial origin to the bleeding. A superior mesenteric arterial portography confirmed the portal venous origin of the bleeding. To stop the bleeding, a distal portal vein embolization using coils and glue was performed by approaching a large paraumbilical vein. Conclusions: Our case study shows the value of arterial portography in the management of these patients, when they are clinically stable enough to benefit from non-surgical management; This allows arterial bleeding to be excluded on hepatic arteriography, portal bleeding to be confirmed on portography following arteriography in the superior mesenteric artery, and guidance of portal vein embolization. [ABSTRACT FROM AUTHOR]

Background and aims: This study was part of an on-going randomized controlled trial to investigate the utility of computed tomography (CT) during hepatic arteriography and arterial portography (CTHA/CTAP) as a pre-treatment examination for patients with small hepatocellular carcinoma (HCC). Methods: A total of 137 patients with HCC who were diagnosed by dynamic CT showing hyperattenuation in the arterial phase and hypoattenuation in the equilibrium phase, were Child-Pugh class A, and had three or less tumors with diameters ≤ 3.0 cm were randomly assigned to undergo CTHA/CTAP. We compared the diagnostic utilities of CTHA/CTAP and dynamic CT. Univariate and multivariate logistic regression analyses with stepwise variable selection were performed to identify factors related to the detection of additional nodules. Results: The total number of HCCs at the time of diagnosis with contrast-enhanced dynamic CT was 197. 75 nodules with a mean diameter of 8.7 mm (range 2-20) in 45 patients (32.8%) were additionally diagnosed as definite HCC on CTHA/CTAP compared with dynamic CT. A retrospective review revealed that 54 nodules could have been identified on arterial or equilibrium phase of the previous dynamic CT, whereas 21 were indiscernible. Multivariate logistic regression analysis revealed that multinodularity on dynamic CT [odds ratio (OR) = 5.35, P = 0.002], recurrent case as opposed to initial case (OR = 2.16, P = 0.06), and seronegativity for hepatitis B surface antigen (OR = 10.0, P = 0.03) were associated with the detection of additional nodules. Conclusion: CTHA/CTAP may be useful for detecting additional nodules prior to percutaneous ablation in patients with multinodular HCC on dynamic CT, in recurrent cases, and in hepatitis B surface antigen-negative cases. [ABSTRACT FROM AUTHOR]

Background: Computed tomographic arterial portography (CTAP) has been an invaluable tool in detecting hepatic tumors for staging patients with hepatic malignancies. This technique is more sensitive than conventional computed tomography (CT) and allows for accurate surgical planning. One of the major drawbacks of CTAP has been the high false-positive rate. Delayed imaging after CTAP helps identify perfusion artifacts, increasing specificity. Using pathologic analysis of the resected specimen as the gold standard, the current study compares the sensitivity and specificity of standard CTAP to those that include a delayed-phase (210 to 240 minutes) imaging. Results: In 60 patients subjected to both phases of imaging and surgical resection of their hepatic colorectal metastases, 139 tumors were found at pathology. One hundred seventy lesions were identified on standard CTAP, with 55 being false-positive. Using delayed imaging, 155 lesions were noted, with 40 being false-positive. Thus, the sensitivity of CTAP remained high with the delayed imaging (83% vs 82% in standard CTAP), whereas the accuracy increased to 74% from 68% (p 5 .01). The positive predictive values were similarly increased (74% vs 68%). Conclusion: Delayed imaging can be easily performed during the observation period after CTAP. Although there is increased radiation exposure, the delayed images increase the specificity of CTAP significantly. We therefore feel that such delayed imaging should be included in the standard evaluation of the patient with hepatic tumors undergoing CTAP. [ABSTRACT FROM AUTHOR]

Abstract: Aims: The purpose of this study was to determine if Computed Tomography Arterial Portography (CTAP) has additional value to Contrast Enhanced helical CT (CE-CT) in selecting patients for hepatic surgery or Isolated Hepatic Perfusion/systemic chemotherapy. Materials and methods: Forty-one patients were included. All CT''s were performed in the normal pre-operative work-up of patients with liver metastases in our regular clinical setting and reviewed blinded by a radiologist. For CE-CT and CTAP the number, size (largest diameter) and location of all suspected malignant liver lesions were recorded. The favourable treatment option was determined based on the results of CE-CT and CTAP independently. The therapeutic decision based on CE-CT and CTAP was compared with the definite treatment. For all patients with recorded findings during surgery, consisting of intra-operative ultrasound, liver palpation and histology a standard of reference for lesion detection was available. For these patients detection rates and the fraction of false positive lesions were calculated. Results: Twenty-seven patients were treated with hepatic resection and/or RFA. Fourteen patients were treated with chemotherapy, 4 with Isolated Hepatic Perfusion (IHP) and 10 with systemic therapy. Based on the findings on CE-CT 31 patients were classified as surgical candidates and 10 as non-surgical patients. Based on the findings on CTAP, surgery should be the treatment of choice in 29 patients and 12 patients were classified non-surgical. CE-CT and CTAP disagreed in two cases (4.9%). Seventy-four metastases were identified at surgery and pathologically proved. CE-CT and CTAP showed 53 (.72) and 66 (.89) metastases, respectively. Conclusion: Despite a significantly higher detection rate for hepatic metastases, CTAP has no added value in the therapeutic stratification in candidates for resection of hepatic metastases of colorectal cancer. [Copyright &y& Elsevier]

An inflammatory pseudotumor of the liver was discovered during a metastatic examination of a patient with rectal adenocarcinoma. Magnetic resonance imaging showed a three-component lesion that infiltrated a large portal vein, and CT arteriography and CT during arterial portography showed a portal obstruction. A histopathological examination proved that necrosis was present in the central zone; infiltration by proliferating connective tissue with chronic inflammatory cells was prominent in the middle zone; and fibrous changes, including pseudo-bile duct proliferation, were present in the peripheral zone. Magnetic resonance imaging revealed both portal infiltration and histopathological features including the above-noted three components. Magnetic resonance imaging is perhaps the most useful diagnostic modality. [ABSTRACT FROM AUTHOR]

Purpose: To compare nicardipine (NCR) and prostaglandin E1 (PGE1) for portal venous contrast enhancement on indirect portography in a retrospective study.Methods: One milligram of NCR, a calcium antagonist, was injected into the superior mesenteric artery just prior to portography in 18 patients who had undergone otherwise identical portography using 20 micrograms PGE1 36-279 (mean 133) days before. All 18 patients had liver tumors and showed no changes in portal vein status in the interim.Results: Using conventional film/screen angiography, NCR provided equally good portograms as PGE1 with respect to image density and image contrast. Systemic effects on blood pressure and heart rate were minimal and no other side effects were observed with NCR.Conclusion: NCR is an inexpensive drug and is expected to provide well-contrasted, indirect portograms on conventional film/screen angiography. [ABSTRACT FROM AUTHOR]

For improved visualization of the intrahepatic portal vein, balloon-occluded superior mesenteric arteriography was performed using a torque-controlled balloon catheter after injection of 20 micrograms prostaglandin E1. In patients who underwent arterial portography twice, i.e., by the method using prostaglandin E1 alone and the prostaglandin E1 plus the balloon method, the latter method provided better visualization, particularly in cases in which an aberrant right hepatic artery arose from the superior mesenteric artery. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the necessity of arterial portography (AP) if a patent portal vein is seen on imaging before transarterial chemoembolization., Materials and Methods: All patients who underwent transarterial chemoembolization between January 2004 and July 2011 were retrospectively recruited. The study included 131 patients (100 men, 31 women) undergoing 243 transarterial chemoembolization procedures. AP was performed during 93 procedures. The mean time interval between imaging performed before transarterial chemoembolization and the transarterial chemoembolization procedure was 46.5 days (range, 0-161 d)., Results: AP did not detect any new cases of portal vein thrombosis (PVT) when imaging performed transarterial chemoembolization showed a patent portal vein. Imaging performed after transarterial chemoembolization revealed one main PVT, one left PVT extending into the main portal vein, two left PVT, and one right PVT. When imaging performed before transarterial chemoembolization showed a patent portal vein and AP was omitted, imaging performed after transarterial chemoembolization showed one case of main PVT, two right PVT, and two left PVT. In both groups, there was no significant difference in mortality (P = .673) or morbidity (P = .581) related to transarterial chemoembolization., Conclusions: AP is unnecessary if transarterial chemoembolization is performed within a reasonable time frame following computed tomography or magnetic resonance imaging that showed a patent portal vein. Omitting AP potentially reduces contrast material and radiation burden to both the patient and the operator., (© 2013 The Society of Interventional Radiology Published by SIR All rights reserved.)