title: CT portography by direct intrasplenic contrast injection: a new technique.
abstract: 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.
authors.affiliation: Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
authors.forename: R
authors.initials: R
authors.lastname: Jain
authors.forename: S
authors.initials: S
authors.lastname: Sawhney
authors.forename: P
authors.initials: P
authors.lastname: Sahni
authors.forename: K
authors.initials: K
authors.lastname: Taneja
authors.forename: M
authors.initials: M
authors.lastname: Berry
mesh_terms: D001661:Biliary Tract Neoplasms / Q000000981:diagnostic imaging*; D003287:Contrast Media / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007267:Injections / Q000379:methods; D008099:Liver / Q000000981:diagnostic imaging; D008113:Liver Neoplasms / Q000000981:diagnostic imaging*; D008297:Male; D011169:Portal Vein / Q000000981:diagnostic imaging*; D011172:Portography / Q000379:methods*; D013154:Spleen; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media