Angiography of liver transplantation patients

Over 45 months, 119 angiographic examinations were performed in 95 patients prior to liver transplantation, and 53 examinations in 44 patients after transplantation. Transplantation feasibility was influenced by patency of the portal vein and inferior vena cava. Selective arterial portography, wedged hepatic venography, and transhepatic portography were used to assess the portal vein if sonography or computed tomography was inconclusive. Major indications for angiography after transplantation included early liver failure, sepsis, unexplained elevation of liver enzyme levels, and delayed bile leakage, all of which may be due to hepatic artery thrombosis. Other indications included gastrointestinal tract bleeding, hemobilia, and evaluation of portal vein patency in patients with chronic rejection who were being considered for retransplantation. Normal radiographic features of hepatic artery and portal vein reconstruction are demonstrated. Complications diagnosed using results of angiography included hepatic artery or portal vein stenoses and thromboses and pancreaticoduodenal aneurysms. Intrahepatic arterial narrowing, attenuation, slow flow, and poor filling were seen in five patients with rejection.     

Angiography in the diagnosis of liver disease in children.

75 angiographic examinations were done in 64 children aged 1 day to 16 years; 41 with various liver diseases and 23 with normal lives. The angiographic diagnosis was accurate in 95% of 44 patients where proof was established by surgery and/or biopsy. Properly used hepatic angiography is a reasonably safe procedure of great value in diagnosing and planning the surgical management of liver masses. It is also a useful tool in the diagnosis of diffuse hepatic processes of neoplastic, inflammatory or degenerative origin.     

Angiography of the liver (author's transl)]

Angiography is a decisive technique of diagnosis of space-occupying processes in the liver. In contrast to laboratory-techniques, scintigraphy and ultrasound which ought to precede it, angiography permits a diagnosis of the type of lesion and is a guide to the chances of surgery on the basis of vascular topography. Angiographic findings in primary and secondary benign and malignant tumors of the liver, of cysts, abscesses and trauma are described and demonstrated on cases. The various forms of portal hypertension are a further field for angiographic diagnosis, explained on examples. The techniques of showing the hepatic arteries, the portal circulation and hepatic veins including direct portography are described and their usefulness for the various diseases discussed. The still little tested therapeutic use of liver angiography in hemorrhage and tumors is mentioned.     

CT of primary lymphoma of the liver

Primary lymphoma of the liver is a rare disease. In each of six cases, a large, often poorly defined mass of low attenuation was present within the liver. Four lesions originated in the right lobe and two originated in the left lobe. Satellite nodules were seen at presentation in one case and developed after presentation in two others. Other features, such as enhancement after contrast administration, necrosis, and calcification, were variable. Three of six lesions had areas of very low density, suggestive of necrosis. One mass had calcifications. After IV contrast administration, no enhancement occurred in three tumors, patchy enhancement occurred in two, and an enhancing ring was seen in the remaining tumor. The radiologic presentation of primary lymphoma of the liver differs from that of secondary involvement of the liver in systemic lymphoma. Whereas secondary lymphoma is often diffusely infiltrative and difficult to detect on CT, the lesions of primary lymphoma of the liver are easily identified on CT scans even before the administration of IV contrast material. Although rare, primary lymphoma of the liver should be included in the differential diagnosis of a large, hypodense liver mass on CT.     

Angiography and intervention in tumors of the pancreas, liver and bile ducts

The importance of angiography and of interventional radiology in tumours of the pancreas, liver and bile ducts is discussed. Angiography is performed prior to surgical intervention to assess tumour resectability, for a preoperative visualisation of vascular anatomy, as well as in non-diagnostic findings in ultrasound and computerised tomography. Diagnostic and therapeutic interventional techniques in the liver (fine needle puncture, perfusion, embolisation) and the bile ducts (PTC, ERCP, PTCD, endoprosthesis, stents) are performed selectively in tumour patients in close co-operation with surgeons, radiologists and gastroenterologists.     

Angiography and scintigraphy in patients with possible liver malignancy.

Angiography and 99Tcm-scintigraphy were performed in 100 adult patients with suggested primary or secondary liver malignancy. The results were compared to the final diagnosis obtained by biopsy, surgery, autopsy or long term clinical follow up. The reasons for false positive and negative diagnoses are discussed in detail.     

CT of nodular hyperplasia of the liver in non-Hodgkin lymphoma

During follow-up of non-Hodgkin lymphoma in a 60-year-old man, multiple hepatic small lesions were incidentally found by sonography. Dynamic CT disclosed enhancing masses in both the right and left lobes and faint arterioportal shunting in the left lobe of the liver. These findings were confirmed by angiography. Portal hypertension was, however, not present. Exploratory laparotomy revealed nodular regenerative hyperplasia of the liver. The nontumorous liver was normal.     

Imaging of primary non-Hodgkin's lymphoma of the liver

AIM: To describe the radiological findings in primary liver lymphoma, which is a rare entity, presenting usually as a localized liver mass. MATERIALS AND METHODS: We reviewed retrospectively the imaging findings at presentation, of patients in whom a diagnosis of primary liver lymphoma was finally made histologically. The study period covered a 10-year period between January 1990 and December 1999. There were seven patients, all men, with a mean age of 49.6 years. Each patient presented with hepatobiliary disease without peripheral adenopathy. Imaging prior to diagnosis included ultrasonography (seven patients), computed tomography (seven patients) and magnetic resonance imaging (MRI) (two patients). Appearances during and after aggressive chemotherapy were reviewed. RESULTS: Imaging appearances were of either single or multiple liver lesions simulating liver metastases. On ultrasound all foci of primary hepatic lymphoma (PHL) were hypoechoic relative to normal liver. Computed tomography (CT) showed hypoattenuating lesions in all cases, and two cases showed rim enhancement following contrast administration. The MRI appearances were variable, and no pathognomonic feature of PHL was identified, so that histology was required in all patients to establish the diagnosis. CONCLUSIONS: This paper demonstrates the spectrum of findings encountered on various imaging modalities in PHL. We conclude that although PHL is a rare condition, it should always be considered in the differential diagnosis of liver metastases when no primary tumour is apparent.     

Primary lymphoma of the liver - A complex diagnosis

A 59-year-old woman presented with the clinical symptoms and radiologic investigations of a liver lesion suspect of metastasis. However, postoperative histopathology revealed a primary hepatic lymphoma (PHL). The case of a patient with a solitary PHL, which was treated by resection and subsequent chemotherapy, will be discussed with a short overview of the literature.