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In 17 patients with suspected bleeding in the lower intestinal tract 23 scintigraphic studies were performed with Tc-colloid, followed in each case by visceral-artery angiography. Comparison of the two methods with the final clinical diagnosis indicated that angiography was correct in 6 of 23 examinations (26%), scintigraphy in 12 of 23 (52%). All scintigraphically negative results were negative also angiographically. Noninvasive, relatively unstressful scintigraphy should be performed for immediate diagnosis in any case of acute bleeding. Emergency-type angiography is reasonably performed only if scintigraphy is positive.

Aneurysms of the pancreatic arteries are a rare complication of pancreatitis. Most usually they are observed with pancreatic pseudocysts or pancreatic abscesses. In view of the danger of haemorrhage, the diagnosis and treatment of these aneurysms is of considerable clinical significance. Angiography plays a dominant role, since it can demonstrate the source of bleeding and, at the same time, provides effective treatment by means of vascular embolisation. This is illustrated by three examples.

In 16 patients with carcinoma of the extrahepatic bile ducts, percutaneous transhepatic portography (PTP) and cholangiography (PTC) were performed. Fourteen of these patients also had angiography, which failed to show the tumor in 7 cases. Findings indicating non-extirpability of the tumor were demonstrated by angiography in 3 patients. At PTP non-extirpability was confirmed in these cases. PTP further indicated non-extirpability in one patient and gave hints of infiltration of the liver by the tumor in 5 patients because of intra or extrahepatic invasion of the portal vein.

A double-curve catheter with side-holes was used for intraarterial digital subtraction angiography of the aortic arch and selective angiography of the supraaortic arteries. Applying this technique the same catheter can be used in the majority of cases (approximately 75%) if aortic arch angiography is followed by selective catheterisation of the supraaortic arteries.

Fifty patients were examined to determine whether intraarterial DSA can replace conventional angiography to assess the resectability of pancreatic and periampullary carcinomas. Intraarterial DSA yielded equivalent diagnostic information in 60% of the cases. As a result of contrast-enhanced visualisation of the splanchnic veins intraarterial DSA was superior to conventional angiography in 26% of the cases, whereas in 14% intraarterial DSA provided less information due to motion artifacts.

Contrast medium was injected in the portal vein at a low flow rate via a transumbilical catheter in twelve patients. The distribution of the contrast medium in the liver was investigated by computed tomography. The results of this study demonstrate an incomplete mixture of splenic and mesenteric venous blood in the portal vein. In addition, there is layering of the contrast medium and blood in the portal vein, causing inhomogeneous contrast medium perfusion of the liver.

The angiographic findings in 34 patients with adrenal lesions were reviewed, including 11 adrenal metastases, 9 adrenal pheochromocytomas, 4 adrenal cortical carcinomas, 4 adrenal cortical adenomas, 3 cases of adrenal hyperplasia and 3 cases of adrenal invasion from carcinoma of the upper pole of the kidney. The results indicate differential diagnostic difficulties in distinguishing among these various entities by angiography.

Inguinal intravenous digital subtraction angiography (DSA) was performed in 14 patients referred for preoperative evaluation of a renal tumor previously diagnosed by CT and ultrasound. Conventional cavography and aortography were used as reference methods for comparison. Both DSA and conventional angiography were carried out following selective arterial injection to the abnormal kidney. The diagnostic value of DSA in examination of the inferior vena cava was generally comparable to that of conventional cavography. Intravenous aortography was unsuccessful in 2 patients due to motion artifacts. In all other patients, the information provided by DSA regarding the aorta, renal arteries and renal veins was similar to that of conventional aortography. Intrarenal vascular detail, however, was far superior on conventional films and was only useful with DSA when intra-arterial injection was implemented. In one of the 12 diagnostic examinations, localization of the renal mass could not be established by intravenous DSA, but was possible in all others. The inguinal approach advocated permits simultaneous inferior vena cavography and intravenous aortography with one single injection of contrast medium; the method is less traumatic than aortography , and does not require hospitalization of the patient. DSA may also be of value in those cases still requiring selective catheterization of the renal arteries, i.e. for angiotherapy . Intra-arterial DSA then allows reduction of the amount of contrast medium and a rapid processing of the images without detriment to the quality of the examination.

The arteriographic findings in adrenal metastases are described on the basis of 13 cases. The problems of differentiating primary from metastatic adrenal tumors by means of angiographic criteria are discussed.

The diagnostic effectiveness of percutaneous transhepatic portography (PTP) was evaluated in 21 patients with primary and metastatic liver carcinoma, who also had infusion hepatic angiography. The findings at PTP were compared with unequivocal tumor changes demonstrated at infusion hepatic angiography in all cases. PTP revealed tumors in 14 of 21 cases. The location, size and number of the tumor(s) were decisive for their detectability at PTP. Solitary lesions smaller than 2 cm in the central parts of the liver escaped detection, whereas lesions larger than 7 cm in the left lobe and 6 cm in the right lobe were demonstrated in all cases. Multiple metastases of 1--2 cm were detected in most cases. Lesions smaller than 4 cm were better shown by the sinusoidal phase at PTP, where lesions larger than 5 cm were better delineated by the portal venous phase.

The technique, indications, contraindications and complications of percutaneous transhepatic portography based on the experience of 300 cases are described. The advantage of this method is discussed and compared with transjugular and transumbilical portography.

The extrahepatic course of both portal vein and bile ducts and their interrelation are analysed by simultaneous portography and cholangiography in 25 adult cadavers. The findings are correlated with the topographic anatomy in the porta hepatis, the hepatoduodenal ligament, and the duodeno-pancreatic region. Minor variations of the interspace between the bile ducts and the portal vein and superior mesenteric vein are demonstrated. The results of this investigation are discussed with respect to the clinical experience that carcinomas of the proximal part of the extrahepatic bile ducts often engage the bifurcation and the main stem of the portal vein, whereas the confluence of the portal vein and the superior mesenteric vein is more often affected by cancer of the head of the pancreas.