CT arterial portography: causes of technical failure and variable liver enhancement.

Paulson, Erik K.; Baker, Mark E.; Hilleren, D J; Jones, W.P.; Knelson, M.; Nadel, S N; Leder, Richard A.; Meyers, William C.

doi:10.2214/ajr.159.4.1326885

Cited by 46 publications

(23 citation statements)

References 15 publications

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“…The fact that technical failures have been implicated in this false-positive rate does not alter the decreasing efficacy of this method to accurately predict unresectability before operation. 15 The use of HAPS in this study did not improve either the positive predictive value for predicting unresectability (60%) or the sensitivity (83%) compared with CTAP. Although CTAP accurately detects most lesions found at surgery, the HAPS study predicts tumor that is not found at surgery, that is only found at blind resection or blind biopsy, and may even not be detected until months after operation.…”

Section: Discussioncontrasting

confidence: 53%

“…Its limitations, however, are the imaging ofrelatively isodense and/or small (less than 1 to 2 cm) lesions, visualization of extrahepatic disease, and the inability to distinguish between benign from malignant tumors.6'7 The decreased sensitivity of CT to detect metastatic lesions has not been improved with magnetic resonance imaging, although the latter accurately diagnoses lesions such as hemangiomas and cysts.8 Many recent reviews have documented the efficacy ofCT angiography (superior mesenteric arterial portography) in detecting small hepatic lesions not seen by standard CT.6'7'9-'3 The increased sensitivity (80% to 90%) of CT arterial portography (CTAP) has been associated with increased false-positive diagnoses because of flow artifacts, cysts, small benign tumors, and in some cases no lesions detected. [14][15][16] A natural selection process exists because most patients referred for surgery and possible resection have been prescreened using the noninvasive techniques of CT and magnetic resonance imaging. Patients are often considered ineligible for surgery when the standard CT examination shows extensive, bilobar, or extrahepatic disease, which precludes resection for possible cure.…”

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confidence: 99%

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Prediction of Surgical Resectability in Patients with Hepatic Colorectal Metastases

Vogel

Drane²,

Ros³

et al. 1994

Annals of Surgery

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ObjectiveTo evaluate the efficacy of two distinct imaging techniques to predict, before operation, unresectability compared with standard computed tomographic scan (CT). Summary BackgroundAccurate preoperative identification of the number, size, and location of hepatic lesions is crucial in planning hepatic resection for colorectal hepatic metastases. Although infusion-enhanced CT is the standard, its limitations are the imaging of relatively isodense and/or small (<1 cm) lesions. The increased sensitivity of CT arterial portography (CTAP) may be offset by false-positive results caused by benign lesions and flow artifacts. MethodsFifty-eight selected patients considered to be eligible for resection by standard CT had laparotomy. Before operation and in addition to CT, all patients had CT arterial portography and hepatic artery perfusion scintigraphy (HAPS) using radiolabeled macroaggregated albumin. Early studies showed an increased sensitivity for detecting small lesions using the invasive CTAP. Similarly, the HAPS study has detected malignant lesions not observed by standard CT. ResultsOf 58 patients having laparotomy, 40 were resectable by either lobectomy (22) or trisegmentectomy (1) and the rest by single or multiple wedge resections. Eighteen patients could not be resected because of combined intra-and extrahepatic disease or the number and location of metastases. Standard CT detected 64% of all lesions (12% of lesions less than 1 cm). Unresectability was accurately predicted by CTAP and HAPS in 16 (88%) and 15 (83%), respectively, of the 18 patients considered ineligible for resection at laparotomy. Of the 40 patients who had resection for possible cure, CTAP and HAPS falsely predicted unresectability in 6 of 40 patients (15%) and in 10 of 40 patients (25%), respectively. The positive predictive value for unresectability of CTAP and HAPS was 73% and 60%, respectively. False-positive lesions after CTAP included hemangiomas, cysts, granulomas, and flow artifacts. False-positive HAPS lesions included patients in whom no tumor was found at surgery but with some identified by intraoperative ultrasound, blind biopsy, and blind resection. ConclusionsFalse-positive results by HAPS and CTAP may limit the ability of these tests to accurately predict unresectability before operation and may deny patients the chance for surgical resection. The 508

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Section: Discussioncontrasting

confidence: 53%

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confidence: 99%

Prediction of Surgical Resectability in Patients with Hepatic Colorectal Metastases

Vogel

Drane²,

Ros³

et al. 1994

Annals of Surgery

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“…Unfortunately, there is no published study evaluating CTHA or the combination of CTHA and CTAP techniques with explant correlation; therefore, their sensitivity for the detection of HCC and DN is unknown. In any event, these techniques are too invasive and costly to be used on a routine basis, may result in false-negative diagnoses of HCC when arterial anatomy is aberrant [35], and are subject to technical failure due to catheter position and operator error [36].…”

Section: Catheter Angiography Ct Hepatic Angiography and Ct During Amentioning

confidence: 99%

Imaging of Dysplastic Nodules and Small Hepatocellular Carcinomas: Experience with Explanted Livers

Krinsky¹

2004

Intervirology

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Differentiation of benign from malignant nodules in the end-stage cirrhotic liver can be challenging, due to the presence of fibrosis, necrosis and altered blood supply. Whole liver explant pathologic correlation provides a unique opportunity to evaluate the sensitivity and specificity of current imaging modalities for the diagnosis of HCC and dysplastic nodules in the cirrhotic liver. This chapter will explore and critique the imaging literature with an emphasis on studies performed with timely explanted liver correlation.

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“…Paulson et al [27] reported such technical failures in 26% of patients. Causes of failure included catheter dislodgement either during transportation of the patient or during injection with recoil into the aorta, dense hyperenhancement of portions of liver due to laminar flow, reflux of contrast into a replaced right hepatic artery, and portal hypertension.…”

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confidence: 98%

Detection of liver neoplasms: Techniques and outcomes

Baron

1994

Abdom Imaging

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CT arterial portography: causes of technical failure and variable liver enhancement.

Abstract: 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.

Cited by 46 publications

References 15 publications

Prediction of Surgical Resectability in Patients with Hepatic Colorectal Metastases

Prediction of Surgical Resectability in Patients with Hepatic Colorectal Metastases

Imaging of Dysplastic Nodules and Small Hepatocellular Carcinomas: Experience with Explanted Livers

Detection of liver neoplasms: Techniques and outcomes

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