CT portography by direct intrasplenic contrast injection: a new technique.

BACKGROUND

The evaluation of percutaneous contrast injection into splenic parenchyma as an alternative technique for computed tomographic (CT) portography in the preoperative assessment of primary hepatobiliary tumors.

METHODS

Thirty-two patients underwent a nonenhanced CT scan of the liver, after which a 19-gauge, 10-cm-long needle was introduced into the splenic parenchyma under CT guidance. One hundred forty milliliters of contrast medium (200 mgI/mL; 28 g/I) were injected through this needle: first, a 20-mL bolus (in 5 s) and then 2 mL/s for 60 s. At the end of the bolus injection (5 s), 8-mm-thick contiguous axial scans of the liver were obtained.

RESULTS

The success rate of the procedure was 93.7% (30/32; two technical failures). The average time required for the entire study was 13 min and 50 s (range = 7 min 53 s to 25 min 17 s). Hepatic parenchymal enhancement was good in 24/30 (80%), moderate in 3/30 (10%), and unsatisfactory in caudal sections of the liver in 3/30 (10%). Artifactual perfusion defects were seen in 4/30 (13%) due to inadvertant injection of small quantities of air. Intrasplenic subcapsular contrast accumulation occurred in 56.2% (18/32; minimal 15, moderate 3), extrasplenic contrast leakage in 12. 5% (4/32), and left shoulder pain in 18.7% (6/32). No major complications were observed.

CONCLUSIONS

Direct intrasplenic contrast injection for CT portography is a simple, effective, and safe technique with a high success rate and requires significantly less time and lower doses of contrast medium; it also eliminates angiography, indwelling arterial catheters, and patient transfers from angiography to the CT area.