Angiographic Diagnosis of Benign Diseases of the Liver

Abstract

In the course of obtaining selective celiac, hepatic, splenic, and superior mesenteric angiograms in various combinations in 200 consecutive cases, 32 patients with benign diseases of the liver that were subsequently proved by autopsy, biopsy, or surgery have been studied. Of this number, 24 had cirrhosis, 3 had obstructive jaundice secondary to common-duct obstruction, and 3 had hemangiomas; there was one case each of polycystic disease and Budd-Chiari syndrome. It is upon this series that this paper is based. Technic The technic employed in selective celiac and superior mesenteric angiography is essentially that of Ödman (1) and has been described in a recent communication (2). If selective catheterization of the hepatic or splenic artery is desired, the catheter is advanced from the celiac axis into either of these vessels. Following the time sequence of a bolus of contrast medium injected selectively into the celiac axis, the angiographic findings have been divided into the arterial phase, the arterial hepatogram phase, and the portal hepatogram phase. The arterial hepatogram phase is the homogeneous blush often obtained throughout the entire normal liver as the contrast agent leaves the arteries; this probably corresponds to the period when the medium is in the sinusoids and perhaps the central veins. An injection into the celiac axis will produce, about ten to twenty seconds later, a portal hepatogram of varying intensity, depending upon the concentration of the contrast material returning from the spleen via the splenic and portal veins (this, too, is a homogeneous blush and also probably represents contrast medium within the sinusoids and perhaps the central veins). Separate selective catheterization and injection of the hepatic artery are now preferred to obtain the arterial and the arterial hepatogram phases, with selective catheterization of the splenic artery for the portal hepatogram phase. This approach enables one to choose the amount of contrast medium (or vasodilating or vasoconstricting drug) to be injected into either vessel rather than depending upon chance flow distribution. Thus not only are both sharper arterial and arterial hepatogram phases achieved, but the portograms are now always of diagnostic quality, as compared with a 76 per cent yield of diagnostic splenoportograms from a celiac axis injection (3). An hepatic venous phase is not described as in none of the entire series of 200 patients in whom the authors have performed selective celiac, superior mesenteric, hepatic, and/or splenic angiograms has it been possible to see the hepatic veins draining into. the inferior vena cava. Results Cirrhosis: The great majority of patients in this series of proved benign diseases of the liver have had cirrhosis.