Percutaneous transhepatic portography with intravascular ultrasonography for evaluation of venous involvement of hepatobiliary and pancreatic tumors.
OBJECTIVE
To determine the safety and utility of percutaneous transhepatic portography (PTP) with intravascular ultrasonography (IVUS) for preoperative evaluation of major spleno-mesenteric-portal venous invasion by tumors of the pancreas, porta hepatis, or liver.


METHODS
This is a 2-year prospective observational study including 15 consecutive patients (five men, 10 women; mean age, 63.3 y +/- 10.2) with tumors of the pancreas (n = 8), liver (n = 3), or porta hepatis (n = 4) who underwent PTP/IVUS after computed tomography indicated possible tumor invasion into a major portal radical. Transhepatic portal access was created under fluoroscopic guidance with an 8-F vascular sheath and IVUS was performed with an 8-F, 10-MHz system. When appropriate, operative exploration was performed (nine of 15) and findings were correlated with imaging data from PTP/IVUS.


RESULTS
PTP/IVUS was performed successfully in all patients and good visualization of the major portal radicals was achieved. There were no complications from PTP/IVUS, which was performed as an outpatient procedure in most (n = 14) patients. PTP/IVUS provided precise anatomic data regarding the longitudinal and circumferential extent of major portal venous invasion by these tumors. There was excellent correlation between PTP/IVUS and operative findings.


CONCLUSIONS
PTP/IVUS can be performed safely in a preoperative outpatient setting and accurately defines the extent of major portal venous invasion by tumors of the pancreas, porta hepatis, and liver.
Stein
Moni
M
Department of Radiology, University of California Davis Medical Center, Sacramento, California, USA. monistein@earthlink.net
Schneider
Philip D
PD
Ho
Hung S
HS
Eckert
Robin
R
Urayama
Shiro
S
Bold
Richard J
RJ
D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D008638:Mesenteric Arteries; D008642:Mesenteric Veins; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000473:pathology; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000473:pathology; D011172:Portography; D011446:Prospective Studies; D018084:Ultrasonography, Interventional