Optimizing CT portography: a prospective comparison of injection into the splenic versus superior mesenteric artery.

Purpose: To evaluate whether computed tomographic arterial portography (CTAP) is best performed with injections in the superior mesenteric artery (SMA) or the splenic artery.
Materials and Methods: Seventy-one studies were performed with injection into the SMA (n = 37) or splenic artery (n = 34) of 150 mL of contrast material at 1.5 mL/sec and 20-second delay for both groups. Images were reviewed for location and type of nontumoral perfusion abnormalities. The degree of liver parenchymal enhancement with each technique was compared.
Results: Fewer nontumoral perfusion defects were seen with splenic artery (65%) versus SMA (78%) injection. Visual differences in contrast enhancement with greater attenuation in dependent portions of the liver were seen with greater frequency with SMA (41%) than with splenic artery (24%) injection. Contrast enhancement that obscured detail in the right lobe was seen only with SMA injections (16%). Greater parenchymal enhancement (up to 18 HU) at all time intervals was seen with splenic artery injection.
Conclusion: Because of greater parenchymal enhancement and fewer nontumoral perfusion abnormalities, splenic artery catheterization is the preferred technique for CTAP.