In Reply to: Case 0298_02 -- CT arterial portography posted by Editor on February 03, 1998 at 12:00:32:
We continue to do CT arterial portography and I continue to believe, at least for now, that this is an appropriate study for patients who are potential candidates for partial hepatectomy in cases of primary or metastatic liver malignancy.
I think that other imaging modalities (standard CT, MRI, US) are complementary studies and MRI in particular probably adds both sensitivity and specificity; we do not, however, do MRI routinely in conjuction with CTAP. Instead, we will often use intraoperative US as a 2nd screen at the time of surgery in patients who are eligible by CTAP. I think the questions point out a need for a large scale study looking at these questions.
As far as sma and celiac arteriography goes, we handle this by the rather inconvenient method of placing the catheter, confirming with only minimal contrast, sending the patient to CTAP, then bringing the patient back for single, low contrast dose celiac and sma runs. The surgeons who refer these cases to us like to have the vascular roadmap, as long as we're already there for the CTAP. Thus, we don't give the additional load before the CT. This would be another good use for a combined CT/Fluoro room.