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Revealing Hepatic Metastases from Colorectal Cancer

Value of Combined Helical CT During Arterial Portography and CT Hepatic Arteriography with a Unified CT and Angiography System

Yoshitaka Inaba1, Yasuaki Arai1, Masayuki Kanematsu2, Yoshito Takeuchi3, Kiyoshi Matsueda1, Kenzo Yasui4, Hiroaki Hoshi2 and Yuji Itai5

1 Department of Diagnostic Radiology, Aichi Cancer Center, 1-1 Kanokoden Chikusa-ku, Nagoya 464-8681, Japan.
2 Department of Radiology, Gifu University School of Medicine, 40 Tsukasamachi, Gifu 500-8705, Japan.
3 Department of Radiology, Kyoto First Red Cross Hospital, Kyoto 605-0981, Japan.
4 Department of Gastroenterological Surgery, Aichi Cancer Center, Nagoya 464-8681, Japan.
5 Department of Radiology, Institute of Clinical Medicine, University of Tsukuba, Tsukuba 305-8575, Japan.



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  		Fig. 1A. —Unified CT and angiography system. We developed and started to clinically use this unified CT and angiography system in 1992. Angiographically assisted CT is performed using this system. System includes CT scanner and angiography unit arranged in linear configuration with common patient cradle.

 


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  		Fig. 1B. —Unified CT and angiography system. We developed and started to clinically use this unified CT and angiography system in 1992. Angiographically assisted CT is performed using this system. Drawing shows that sliding single-patient cradle between CT gantry and angiographic imager can be used for fluoroscopic monitoring, angiography, or helical CT imaging.

 


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  		Fig. 2A. —63-year-old woman with hepatic metastasis from cancer of transverse colon. CT during arterial portography image shows area of subtle portal perfusion decrease. Note metastasis (arrow).

 


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  		Fig. 3A. —68-year-old man with hepatic metastasis from rectal cancer. CT during arterial portography image shows several portal perfusion defects that mimic metastatic tumor deposits (arrowheads) and were confirmed at surgery with intraoperative sonography and follow-up imaging to be nontumorous portal perfusion abnormality. Note that subcapsular portal perfusion defect adjacent to right rib was presumably caused by impression of right rib and that portal perfusion defect in posterior aspect of segment IV was presumably caused by aberrant right gastric venous drainage. Also note hepatic metastasis (arrow).

 


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  		Fig. 4A. —56-year-old woman with hepatic metastases from cancer of ascending colon. CT during arterial portography image shows two areas of portal perfusion defect (arrows) that suggest metastatic tumor deposits.

 


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  		Fig. 4B. —56-year-old woman with hepatic metastases from cancer of ascending colon. Digital subtraction celiac arteriogram shows common hepatic artery (arrow) supplying left hepatic lobe, replaced right hepatic artery that arises from celiac trunk (arrowhead) supplying right hepatic lobe, and splenic artery.

 


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  		Fig. 2B. —63-year-old woman with hepatic metastasis from cancer of transverse colon. CT hepatic arteriogram shows corresponding area as discrete ring enhancement. Note small focal enhancement (arrowhead), presumably caused by small arterioportal shunt. Also note hepatic metastasis (arrow).

 


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  		Fig. 3B. —68-year-old man with hepatic metastasis from rectal cancer. CT hepatic arteriogram shows metastasis as area of discrete ring enhancement (arrow).

 


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  		Fig. 4C. —56-year-old woman with hepatic metastases from cancer of ascending colon. CT hepatic arteriograms separately obtained by selectively opacifying common hepatic artery (C) and replaced right hepatic artery (D) show metastasis as area of ring enhancement caused by metastatic tumor (arrow, C) and as areas of homogeneous enhancement caused by metastatic tumor (arrow, D).

 


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  		Fig. 4D. —56-year-old woman with hepatic metastases from cancer of ascending colon. CT hepatic arteriograms separately obtained by selectively opacifying common hepatic artery (C) and replaced right hepatic artery (D) show metastasis as area of ring enhancement caused by metastatic tumor (arrow, C) and as areas of homogeneous enhancement caused by metastatic tumor (arrow, D).

 

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