Coaxial Catheter: A New Technique For Sequential Spiral Ct During Arterial Portography And Hepatic Arteriography

Purpose: To evaluate a coaxial catheter method to sequentially acquire spiral-computed tomography (CT) during arterial portography (CTAP) and hepatic arteriography (CTA) at a single transfer.Patients and methods: Sixteen patients with malignant hepatic tumours (12 patients with hepatocellular carcinoma, four with metastases) were studied using spiral CT. Depending upon the vascular anatomy revealed by conventional coeliac and superior mesenteric arteriography, an outer and inner catheter were selectively placed to perform CTA and CTAP, respectively. CTAP images were obtained first, while injecting contrast material through an inner catheter followed by the acquisition of the CTA images during injection through an outer catheter. In three patients, the resected specimens were available for comparison with the imaging findings.Results: In 12 patients with standard hepatic arterial anatomy, high quality images of CTAP and CTA were obtained. More lesions were detected by the combination of CTAP and CTA than by CTAP or CTA alone in five patients. In one patient with breast carcinoma and a left hepatic artery arising from the left gastric artery, numerous hepatic metastases were delineated on both sets of images. In three patients with replaced or accessory right hepatic arteries, evaluation of the whole liver was difficult on CTA. These procedures were well tolerated by all 16 patients and no complication or technical failure was experienced.Conclusion: These preliminary data support this new technique as a promising method of performing CTA and CTAP in patients with standard hepatic arterial anatomy with a single catheter insertion.