title: Percutaneous transhepatic portography with intravascular ultrasonography for evaluation of venous involvement of hepatobiliary and pancreatic tumors.
abstract: 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.
authors.affiliation: Department of Radiology, University of California Davis Medical Center, Sacramento, California, USA. monistein@earthlink.net
authors.forename: Moni
authors.initials: M
authors.lastname: Stein
authors.forename: Philip D
authors.initials: PD
authors.lastname: Schneider
authors.forename: Hung S
authors.initials: HS
authors.lastname: Ho
authors.forename: Robin
authors.initials: R
authors.lastname: Eckert
authors.forename: Shiro
authors.initials: S
authors.lastname: Urayama
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Bold
mesh_terms: 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