Arteriographic Study on Diagnosis of Hepatic Lesion

• Published in: Japanese Journal of National Medical Services Vol. 22; no. 11; pp. 1282 - 1290
• Main Authors: MURAI, Tomoya, NEGAWA, Yasuo, MIYASHIRO, Akira, KURIMURA, Osamu, SEKI, Katsutada, KIRIMOTO, Koji, KOZUKA, Takahiro, NOSAKI, Tadaharu
• Format: Journal Article
• Language: Japanese
• Published: Japanese Society of National Medical Services 20.11.1968
• ISSN: 0021-1699; 1884-8729
• DOI: 10.11261/iryo1946.22.1282

The diagnostic procedure of the hepatic lesions with selective hepatic arteriography has recently been developed to a great extent. During a period from 1965 to 1967, we performed the hepatic arteriography in 28 cases with various kinds of hepatic lesions. Eleven cases hed benign hepatic lesions (5 cases of liver cirrhosis, 3 of chronic hepatitis, 2 of splenomegaly, and 1 of postinflammatory status). In 4 of them, Iaparoscopy was performed. The ages ranged from 18 to 59 years. Malignant tumors were found in remaiaing 17 cases (7 cases of gastric carcinoma, 5 of carcinoma of the hepatocholangeal system, 2 of rectal carcinoma, 1 of gastric sarcoma, 1 of pancreatic carcinoma and 1 of seminiferous carcinoma). The ages ranged from 25 to 68 years. In all these cases with malignant tumor, biopsy with iaparotomy or autopsy was performed. The hepatic arteriograms were made by peroutaneous transfemoial teohnique with Seldinger's method. Ödman-Ledin's green catheter with curved tip was used, and 15-30ml of 80% Iothalamate or 76% Diatrizoate was injected as a contrast medium. There was no remarkable complication. Major variations in the hepatic arterial system were noted in 4 of 28 case. In 2 of 4 cases, the common hepatic artery was divided from the superior mesenteric artery and the celiac axis bifurcated into the splenic and left gastric arteries. In the other 2 cases, the right hepatic artery arised from the superior mesenteric artery. In liver cirrhosis, irregularity in outline with tortuosity of the intrahepatic arteries and dilatation of the stem arteries accompanying abrupt narrowing of the peripheral branches were significant. In some cases with liver cirrhosis, diminished hepatic volume was disclosed. Of these findings, irregularity of outline of the intrahepatic arteries was important and a pathognomonic sign. In chronic hepatitis, the degree of such changes as shown in liver cirrhosis was mild, even if the arteries were narrow and curved. In the hepatic tumors, the findings were depended on the degree of their vascularity. In the primary hepatocellular carcinoma, hypervascular changes were noted with early accumulation of the contrast medium, whereas in cholangiocarcinoma, pathologic vessels are scarcely found. In the metastatic carcinoma of the liver of the hypervascular type, abundant tumor vessels with accumulation of the contrast medium could be revealed. However, there may be the tumors of the hypovascular type, and it characterized by vascular displacement by the tumor and defect in the parenchymatous phase. The tumor with rich vascularity could be detected easier than that with hypovascularity because of accumulation of the contrast medium. It may be difficult to determine whether the tumor is primary or not, especially in the case of hypovascular type. In short, selective hepatic arteriography is very useful for diagnosis of hepatic lesions and it would be possible to improve the clinical presumptive diagnosis up to definite diagnosis in respect to decision of nature, degree, extent and location of the lesions.