CT during arterial portography

CT during arterial portography (CTAP) is based on portal enhancement of the liver by infusion of contrast material through the superior mesenteric or splenic artery. This technique provides high degrees of enhancement of the portal vein and intrahepatic vessels, allowing reliable segmental localisation of tumours and accurate assessment of relationships between tumours and intrahepatic vessels. Because of its invasiveness, CTAP must be limited to patients for whom non-invasive preoperative imaging suggests resectable tumour. In the majority of cases, CTAP is performed in patients with hepatic metastases from colorectal cancer, but other types of hepatic tumour (either primary or secondary) and pancreatic tumour may be an indication for CTAP. Visualisation of non-tumorous perfusion defects is a limitation of this technique, but such defects have been well described and have characteristic locations and appearance. In difficult cases, correlation with sonographic, CT and MRI findings helps characterise portal perfusion defects. CTAP is the most sensitive technique for the detection of intrahepatic tumours, and the recent use of spiral technology shows promise in the performance of CTAP. CTAP data can be viewed as multiplanar and three-dimensional reconstructions that allow preoperative planning of the extent of resection and determination of the volume of the remaining liver after resection.