Multidetector CT Arteriography with Volumetric Three-Dimensional Rendering to Evaluate Patients with Metastatic Colorectal Disease for Placement of a Floxuridine Infusion Pump
Vibhu Kapoor1,
Giuseppe Brancatelli1,
Michael P. Federle1,
Sanjeev Katyal2,
J. Wallis Marsh3 and
David A. Geller3
1 Division of Abdominal Imaging, Department of Radiology, University of
Pittsburgh Medical Center, 200 Lothrop St., Pittsburgh, PA 15213.
2 Department of Radiology, Western Pennsylvania Hospital, 4800 Friendship Ave.,
Pittsburgh, PA 15224.
3 Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
15213.
View larger version (95K):
[in a new window]
|
Fig. 1. —67-year-old woman with colorectal carcinoma that metastasized to
liver. Volumetric three-dimensional MDCT arteriogram of hepatic vessels
depicts classic hepatic arterial anatomy (Michels' type I), with common
hepatic artery (single straight arrow) arising from celiac artery
(black arrows) and then dividing into proper hepatic artery and
gastroduodenal artery (arrowheads). Right (curved arrow) and
left (double white arrows) hepatic arteries arise from proper hepatic
artery.
|
|
View larger version (95K):
[in a new window]
|
Fig. 2. —75-year-old man with colorectal carcinoma that metastasized to
liver. Volumetric three-dimensional CT arteriogram of hepatic vessels shows
highly vascularized mass (single straight arrow) supplied
predominately by branches of right hepatic artery (arrowhead). Note
bifurcation of common hepatic artery (double arrows) into
gastroduodenal artery (curved arrow) and proper hepatic artery.
|
|
View larger version (80K):
[in a new window]
|
Fig. 3A. —76-year-old man who was being evaluated as potential candidate for
placement of hepatic arterial floxuridine infusion pump to treat colorectal
carcinoma that metastasized to liver. Volumetric three-dimensional CT
arteriogram shows early right hepatic arterial branch (arrowhead),
with gastroduodenal artery (short arrow) originating from left
hepatic artery (double arrows). Splenic artery (long arrow)
arises from celiac artery, which is normal origination site.
|
|
View larger version (146K):
[in a new window]
|
Fig. 3B. —76-year-old man who was being evaluated as potential candidate for
placement of hepatic arterial floxuridine infusion pump to treat colorectal
carcinoma that metastasized to liver. Digital subtraction angiogram confirms
anatomy depicted on A—early right hepatic arterial branch
(arrowhead), gastroduodenal artery (short arrow) originating
from left hepatic artery (double arrows), and splenic artery
(long arrow) arises from normal site, celiac artery. Patient was not
considered suitable candidate for hepatic arterial pump placement.
|
|
View larger version (92K):
[in a new window]
|
Fig. 4A. —64-year-old woman who was being evaluated as potential candidate for
placement of hepatic arterial floxuridine infusion pump to treat colorectal
carcinoma that metastasized to liver. Volumetric three-dimensional CT
arteriogram shows replaced right hepatic artery (arrowheads) arising
from superior mesenteric artery (arrow).
|
|
View larger version (119K):
[in a new window]
|
Fig. 4B. —64-year-old woman who was being evaluated as potential candidate for
placement of hepatic arterial floxuridine infusion pump to treat colorectal
carcinoma that metastasized to liver. Digital subtraction angiogram confirms
CT arteriographic finding of anomalous origin of right hepatic artery
(arrowheads) from superior mesenteric artery (arrow).
|
|
View larger version (90K):
[in a new window]
|
Fig. 4C. —64-year-old woman who was being evaluated as potential candidate for
placement of hepatic arterial floxuridine infusion pump to treat colorectal
carcinoma that metastasized to liver. Volumetric three-dimensional CT
arteriogram depicts replaced left hepatic artery (curved arrow)
arising from left gastric artery (arrowhead). Middle hepatic artery
supplying segment IV (open arrows) arises from common hepatic artery
(double straight arrows). Long arrow points to celiac trunk and
double wavy arrows, to splenic artery.
|
|
View larger version (117K):
[in a new window]
|
Fig. 4D. —64-year-old woman who was being evaluated as potential candidate for
placement of hepatic arterial floxuridine infusion pump to treat colorectal
carcinoma that metastasized to liver. Digital subtraction angiogram confirms
that replaced left hepatic artery (curved arrow) arises from left
gastric artery (arrowhead). Middle hepatic artery supplying segment
IV (open arrows) arises from common hepatic artery (double
straight arrows). Long arrow points to celiac trunk, and double wavy
arrows point to splenic artery. Patient was not considered suitable candidate
for hepatic arterial pump placement.
|
|
View larger version (113K):
[in a new window]
|
Fig. 5A. —57-year-old woman with colorectal carcinoma that metastasized to
liver. Volumetric three-dimensional CT arteriogram shows replaced right
hepatic artery (single short straight arrows) arising from superior
mesenteric artery (single long straight arrow). Common hepatic
artery, which is branch of celiac artery (curved arrow), continues as
left hepatic artery (arrowheads) after giving rise to gastroduodenal
artery (double arrows).
|
|
View larger version (143K):
[in a new window]
|
Fig. 5B. —57-year-old woman with colorectal carcinoma that metastasized to
liver. Contrast-enhanced axial CT scan of liver obtained during portal venous
phase shows multiple bilobar hepatic metastases (arrowheads).
Numerous other bilobar metastases were present. Single infusion catheter would
not be adequate to treat metastases in this patient.
|
|
View larger version (114K):
[in a new window]
|
Fig. 6. —66-year-old man with colorectal hepatic metastasis who developed
deep venous thrombosis shortly after implantation of arterial floxuridine
infusion pump and who required anticoagulation therapy. Axial
contrast-enhanced CT scan of upper abdomen shows large intraperitoneal
hemorrhage (single arrows) adjacent to infusion catheter (double
arrows).
|
|
View larger version (83K):
[in a new window]
|
Fig. 7A. —68-year-old man with hepatic metastasis from colorectal carcinoma
who presented with abdominal pain 14 weeks after placement of hepatic arterial
floxuridine infusion pump. Volumetric three-dimensional CT arteriogram shows
tip of infusion catheter (thin arrow) in gastroduodenal artery at its
junction with hepatic artery (thick arrow).
|
|
View larger version (108K):
[in a new window]
|
Fig. 7B. —68-year-old man with hepatic metastasis from colorectal carcinoma
who presented with abdominal pain 14 weeks after placement of hepatic arterial
floxuridine infusion pump. Digital subtraction angiogram confirms tip of
infusion catheter (thin arrow) is in gastroduodenal artery at its
junction with hepatic artery (thick arrow). However, small branch
(arrowhead) of gastroduodenal artery, which is seen only on catheter
angiograms, is patent and supplies duodenum.
|
|
View larger version (125K):
[in a new window]
|
Fig. 7C. —68-year-old man with hepatic metastasis from colorectal carcinoma
who presented with abdominal pain 14 weeks after placement of hepatic arterial
floxuridine infusion pump. Infusion pump scintigram obtained with
99mtechnetium-macroaggregated albumin shows increased perfusion in
region of liver hilum (arrows).
|
|
View larger version (138K):
[in a new window]
|
Fig. 7D. —68-year-old man with hepatic metastasis from colorectal carcinoma
who presented with abdominal pain 14 weeks after placement of hepatic arterial
floxuridine infusion pump. Infusion pumpogram shows increased duodenal
perfusion (double arrows) that corresponds to increased perfusion in
region of liver hilum seen on C. Curved arrow marks infusion catheter,
and single straight arrow marks feeder artery.
|
|
View larger version (121K):
[in a new window]
|
Fig. 7E. —68-year-old man with hepatic metastasis from colorectal carcinoma
who presented with abdominal pain 14 weeks after placement of hepatic arterial
floxuridine infusion pump. Angiogram obtained by selectively injecting
duodenal artery (single straight arrow) via catheter (double
solid arrows) shows brisk blush (curved arrow) of duodenal wall.
Open arrows mark infusion catheter.
|
|
View larger version (127K):
[in a new window]
|
Fig. 7F. —68-year-old man with hepatic metastasis from colorectal carcinoma
who presented with abdominal pain 14 weeks after placement of hepatic arterial
floxuridine infusion pump. Catheter angiogram shows that endovascular coil
(arrowhead) embolization of feeder vessel was successful, with
isolated hepatic artery (single arrow) filling. Double solid arrows
mark angiographic microcatheter, and open arrows mark infusion catheter.
|
|
View larger version (125K):
[in a new window]
|
Fig. 8A. —57-year-old woman with hepatic metastasis from colorectal carcinoma
1 week after placement of hepatic arterial floxuridine infusion pump and
cholecystectomy. Infusion pump scintigram obtained with
99mtechnetium-macroaggregated albumin shows patchy perfusion of
liver with focal uptake (arrows) in region of gallbladder fossa.
Arrowhead marks large metastatic lesion.
|
|
View larger version (134K):
[in a new window]
|
Fig. 8B. —57-year-old woman with hepatic metastasis from colorectal carcinoma
1 week after placement of hepatic arterial floxuridine infusion pump and
cholecystectomy. Infusion pumpogram shows tiny feeder artery (straight
arrows) responsible for abnormal extrahepatic perfusion on scintigraphy
(A). Arrowhead marks common hepatic artery, and curved arrow marks
infusion catheter.
|
|
View larger version (126K):
[in a new window]
|
Fig. 8C. —57-year-old woman with hepatic metastasis from colorectal carcinoma
1 week after placement of hepatic arterial floxuridine infusion pump and
cholecystectomy. Catheter (double arrows) angiogram obtained via
selective injection through feeder vessel (branch of superior
pancreaticoduodenal arcade) shows blush (curved arrow) in region of
duodenum. Long straight arrow marks hepatic artery, and open arrows mark
infusion catheter.
|
|
View larger version (160K):
[in a new window]
|
Fig. 8D. —57-year-old woman with hepatic metastasis from colorectal carcinoma
1 week after placement of hepatic arterial floxuridine infusion pump and
cholecystectomy. Catheter (double arrows) angiogram obtained after
embolization of feeder vessel—performed with single tornado microcoil
(arrowhead)—shows no perfusion around duodenum. Long straight
arrows mark hepatic artery, and open arrow marks infusion catheter.
|
|
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
Copyright © 2003 by the American Roentgen Ray Society.
