Angiography, hepatic

The hepatic vessels may be visualised by conventional angiography or venography. These are invasive techniques requiring the injection of contrast media into the artery or vein via catheters during radiographic screening. Stenoses or occlusions are identified, e.g. occlusion of the hepatic veins in Budd-Chiari syndrome. 

Impressive images of portal arteries and hepatic veins can be produced by MR angiography. (131, 152) Nowadays, CM-supported MRA is the method of choice in monitoring the portal artery system (primarily before and after TIPS insertion). (152)... 

Furuse, J., Maru, Y., Yoshino, M., Mera, K., Suml, H., Seklgnchl, R., Sataka, M., Hasebe, T., Ochlal, A. Assessment of arterial tumor vascularity in small hepatocellular carcinoma. Comparison between color Doppler ultrasonography and radiographic imagings with contrast medium dynamic CT, angiography, and CT hepatic arteriography. Eur. J. Radiol. 2000 36 20-27... 

Goldberg, MA., Yucel, E.K., Saini, S., Hahn, P.F., Kanfmann, J.A., Cohen, M.S. MR angiography of the portal and hepatic venous system preliminary experience with echoplanar imaging. Amer. J. Roentgenol. 1993 160 35-40... 

Komori, K., Sonoda, T., Ikeda, Y., Kanematu, T., Sugimachi, K. Demonstration of hepatic artery aneurysma by subtraction angiography. Amer. J. Gastroenterol. 1991 86 1650-1653... 

The most frequent cause of posthepatic portal hypertension is right ventricular insufficiency. The central venous pressure is transferred to the hepatic veins and the sinusoids. Constrictive pericarditis leads to a state of pronounced posthepatic portal hypertension with the early development of ascites. Severe tricuspid valve incompetence also culminates in this condition. A membranous obstruction of the inferior vena cava was likewise described in 1968 as a genetically determined cause of posthepatic portal hypertension (S. Yamamoto et al.). Three variants can be distinguished by angiography, depending on the different ways in which the hepatic veins are involved or whether they are affected at all. Thrombosis of the inferior vena cava can develop either from thrombosis of the pelvic veins or independently in the presence of predisposing factors. 

Angiography Visualization of hepatic veins or arteries is rarely required. Angiography is indicated for diagnosing metastases of active endocrine tumours. This technique may also be necessary in the planning phase of liver surgery. A further possible indication is its use in carrying out therapeutic measures. 

Computer tomography, especially when coupled with a contrast medium and in the form of CTAP, is an excellent tool for analyzing the venous blood flow and detecting any disturbances in inflow or outflow. Thrombosed hepatic veins are not visible the parenchyma is characterized by an inhomogeneous, patch-like enhancement. (s. fig. 39.6) MRI provides reliable evaluation by means of multiphase, contrast-enhanced, three-dimensional MR angiography. 

Angiographic scanning of the hepatic artery confirms the diagnosis as well as giving an indication of the most appropriate therapeutic measures. Due to the development of modern MRI techniques, invasive angiography is no longer necessary in most cases. 

Erdem, C.Z., Erdem, L.O., Comert, M., Ustnndag, Y., Gundogu, S. Multiple intra-hepatic portal vein aneurysms — findings on magnetic resonance angiography. Clin. Radiol. 2003 58 899—901... 

A 23-year-old man who had taken comfrey leaves presented with hepatic veno-occlusive disease and severe portal hypertension and subsequently died from liver failure (4). Light microscopy and hepatic angiography showed occlusion of sublobular veins and small venous radicles of the liver, associated with widespread hemorrhagic necrosis of hepatocytes. 

Angiographic evaluation can be performed if embolization is a consideration. On angiography the hepatic arteries will show an increased diameter with early fill of hepatic veins (Mortele 2002). 

The first published description of aberrant hepatic arteries is attributed to Haller in 1756. The data necessary for the study of such variations may be obtained from direct observation of large autopsies, surgical series or from radiological studies, initially by conventional angiography including DSA or more recently from CT or MR angiography. 

Fig. 4. 7a,b. Patient with a stenosis of the celiac trunk, a Superior mesenteric angiography demonstrates reversed flow through the pancreatoduodenal arcade (arrow) with opacification of the hepatic artery (arrowhead), b Tumour was treated after selective catheterization of the right hepatic artery through the collateral network... 

Unlike other loco-regional therapies, pre-procedure planning and meticulous mesenteric angiography are of paramount importance in order to determine the safest and most effective treatment strategy. Identifying anatomic variants, isolating the hepatic circulation and prophylactic embolization requires... 

Covey AM, Brody LA, Maluccio MA, Getrajdman GI, Brown KT (2002) Variant hepatic arterial anatomy revisited digital subtraction angiography performed in 600 patients. Radiology 224 542-547... 

Fig. 7.1. High iodinated contrast uptake in liver tumours can be seen during angiography in those lesions with hypervascularization (a). In the same patient, hepatic nodules can be identified in the planar scintigraphy after MAA infusion as areas of focal uptake ( hot nodules ) spread in both lobes. The rest of the liver (non-tumoral) presents faint uptake of the...

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