Comparison of sonography, computed tomography, angiography, and percutaneous transhepatic portography in detection of portal tumor thrombus in hepatoma

Evaluation of Intrahepatic Tumour Extent and Prediction of Resection Size in Liver Tumours by Computed Tomography, Ultrasonography and Angiography

Preoperative radiologic examinations were reviewed in 110 patients planned for liver resection. Forty-five patients had a CT examination within a month before the operation; 22 of these also had ultrasonography (US) and 38 had angiography. In a numeric analysis of lesions, true positive findings were observed at CT and US in 69 per cent and 61 per cent, respectively. Angiography, mainly performed to show the vascular anatomy and patency of the portal vein and not to optimize tumour detection, showed 55 per cent of the lesions. Attempts were made to predict resection size with CT by estimating intrahepatic tumour extent. CT showed correct tumour extent in 73 per cent but was inaccurate in 12 of 45 examinations. In 5 of these, tumour growth across the main and sagittal fissures was misinterpreted, with both under- and overestimations. Improvements of current imaging methods are needed to make the radiologic assessment prior to liver surgery more reliable.

Sonographic diagnosis of portal vein invasion in patients with hepatocellular carcinoma: comparison with arterial portography

The results of sonographic assessment of the main portal vein were compared with arterial portography in 65 patients with documented hepatocellular carcinoma. When compared with fully-diagnostic angiograms, obtained in 54 patients, sensitivity of ultrasound was 64% with a specificity of 98%. We conclude that ultrasound is a valuable first-line method of detecting portal vein invasion in the preoperative assessment of patients with hepatocellular carcinoma.