Value of an early arteriographic acquisition for evaluating the splanchnic vessels as an adjunct to biphasic CT using a multislice scanner

Abstract

Our objective was to assess the clinical value of an early arterial scan for assessing the hepatic and mesenteric vasculature in patients with suspected primary or metastatic hypervascular liver disease undergoing multislice computed tomography. In 42 patients a very early arteriographic scan was performed before standard arterial and portal venous scans. Technical parameters of the very early acquisition were: 2.5-mm image thickness; table speed 15 mm/s; pitch 6; 120 kVp; 300 mA; 8.9-s scan time; cranio-caudal acquisition direction; 1.25-mm image interval reconstruction;16-s delay after injection of 110 ml of iodinated contrast agent at 5 ml/s; scan volume focused to image hepatic, splenic, and superior mesenteric arteries (SMA). Standard arterial and portal venous phases were performed with 5-mm image thickness, 15mm/s table speed, pitch 6, 8-to 10-s scan time, 30-and 70-s delay. The three phases were performed during three different breath-holds. Axial, multiplanar reformatted, maximum intensity projection, and volume-rendering images were evaluated. Image quality was scored, and vascular abnormalities were recorded. Digital subtraction angiography (DSA) was performed in 17 patients. In 36 of 42 patients good-quality CT angiograms were obtained. In 9 patients 12 vascular abnormalities were found, all confirmed at DSA: 3 right hepatic arteries originating from the SMA, 2 left hepatic arteries from the gastric artery, 2 stenoses of the SMA, 1 independent origin of the hepatic and splenic arteries, 2 arteriovenous fistulas, and 2 aneurysms of the common hepatic artery and the SMA. This technique could add important information about vascular splanchnic anatomy which would be particularly useful for surgeons and interventional radiologists.

Noonan syndrome

“…73,75-77 The most common features include cardiac defects (74%), low set ears (80%), low posterior hairline (68%), down-slanting palpebral fissures (68%), cryptorchidism (94% of boys), and short stature (93%). 75,76,78 …”

Case report: Noonan syndrome with protein-losing enteropathy

“…It is unclear whether the mutation in the PTPN11 gene is more likely to cause PLE. The most common features of patients with NS due to PTPN11 mutations include heart defects (74%), low ear position (80%), low posterior hairline (68%), lower strabismus blepharoplasty (68%), cryptorchidism (94% of boys) and short stature (93%) ( Zandrino et al, 2003 ; Yoshida et al, 2004 ; Sznajer et al, 2007 ). An infant with pulmonary lymphangiectasia (PL) was diagnosed with NS by genomic DNA sequence analysis after death because he had a G503R heterozygous mutation in the PTPN11 gene ( Mathur et al, 2014 ).…”

Application of ultrasonography in the diagnosis and treatment tracing of hepatocellular carcinoma‐associated arteriovenous fistulas

“…Angiography is considered to be sensitive but not as specific for HAVF because it does not allow differentiation from malignant liver lesions. Many studies have indicated that CT and MRI (8–10) had a good clinical application prospect in displaying the shape and anatomical variation of the liver supply artery, tumour supply artery, combined portal vein tumour emboli and arterial–portal shunts of the intermediate or advanced‐stage HCC. It can be regarded as a new image examination method of synthetical evaluation of HAVF and the result of treatment during TACE.…”