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Value of Intraarterial Prostaglandin E₁ Injection During CT Hepatic Arteriography

¹ Department of Radiology, Kyoto Prefectural University of Medicine, 465 Kajii, Kawaramachi-Hirokoji, Kamigyo, Kyoto, 602-8566, Japan.
² Department of Radiology, Akashi Municipal Hospital, 1-33, Takashyo, Akashi, Hyogo, 673-8501, Japan.
³ Department of Radiology, Kyoto First Red Cross Hospital, 5-749, Motomachi, Higashiyama, Kyoto, 605-0981, Japan.

OBJECTIVE. The purpose of our investigation was to determine if injection of prostaglandin E₁ during CT hepatic arteriography could help physicians to distinguish tumors from nonportal venous flow-related pseudolesions in the region of the gallbladder fossa.

SUBJECTS AND METHODS. In 34 patients who underwent CT during arterial portography to detect liver tumors, CT hepatic arteriography was performed before and after prostaglandin E₁ injection via the superior mesenteric artery. Between each study, an interval of 10 minutes was set. On CT hepatic arteriogram obtained 15 to 20 sec after prostaglandin E₁ injection, we distinguished changes in the size and shape of pseudolesions in the liver around the gallbladder as well as those of 42 tumorous lesions. In addition, we measured the change in CT attenuation of pseudolesions.

RESULTS. The size of the enhanced area of pseudolesions visible on CT hepatic arteriography decreased in 69% (25/36) of the pseudolesions after intraarterial prostaglandin E₁ injection, with the mean diameter diminishing from 14.1 mm to 8.8 mm. Notably, in 11 pseudolesions, the enhanced area disappeared. In 86% (31/36), the CT attenuation decreased with the mean attenuation, diminishing from 211.3 H to 163.8 H. However, the size and shape of the enhanced area of tumorous lesions did not change.

CONCLUSION. The hemodynamic features of pseudolesions on angiographically assisted helical CT scans caused by cholecystic venous inflow are easily influenced by increased portal venous flow. Consequently, pseudolesions around the gallbladder usually can be distinguished from tumorous lesions by adding prostaglandin E₁ injection via the superior mesenteric artery during CT hepatic arteriography.

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