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PubMed1989

Ultrasonography in non-cirrhotic portal hypertension: correlation with splenoportography.

Real time sonography followed by splenoportography was performed in 38 cases with non-cirrhotic portal hypertension. Eleven of these cases, in whom porto-systemic shunt surgery was done, were also evaluated by real time sonography post-operatively. The ultrasound findings correlated well in 37 cases (98%) with splenoportography. All the post-operative cases also revealed a patent portosystemic shunt on sonography. Ultrasonography, a valuable, non-invasive, initial investigation of portal hypertension, may thus be used as the only investigation to distinguish intra- from extra-hepatic obstruction and to evaluate patency of surgically created porto-systemic shunts. Invasive portography may be performed only if surgical treatment is anticipated.

Adolescent↗
PubMed1984

Splenoportography--a reappraisal.

Seventy-five percutaneous splenoportographies and splenic pulp pressure measurements were performed in 70 patients. This procedure was done routinely during the preoperative investigation of patients with bleeding esophageal varices. Splenoportagraphy was also performed for evaluation of patients with portal hypertension of an obscure etiology, and for follow-up study after portosystemic shunt procedures, where the spleen had been preserved. There were no complications related to the procedure. Splenoportography is a simple and safe diagnostic tool. The information obtained is important for planning an operation to relieve portal hypertension. It may also help in the postoperative evaluation of the patency of certain types of shunt procedures.

Child↗
PubMed1989

Radioisotopic splenoportography in patients with portal hypertension.

Radio-isotopic splenoportography was performed by injecting 99mTcO4- into the spleens of 46 patients with portal hypertension and 14 patients with various disorders not having portal hypertension. No collateral circulation was demonstrated in the 14 patients without portal hypertension whereas some RI-images of portosystemic collaterals were found in 40 (87.0 per cent) of the 46 patients with portal hypertension. Collaterals were divided into an ascending group and a descending group, the appearance rate of ascending collaterals being 80.4 per cent and that of descending collaterals, 41.3 per cent. There were 3 image patterns in the ascending group, namely, an AZ-pattern in which the azygos vein was demonstrated; a SC-pattern in which the RI-bolus ascended along the esophagus to the neck and the subclavian vein; and an EG-pattern which showed stagnation of the RI-bolus in the esophagogastric region. There were 4 patterns in the descending group, namely; a pattern of gastro-renal caval shunt (GR-pattern); reverse flow patterns into the umbilical or paraumbilical veins (UV-pattern); into the superior mesenteric vein (SMV-pattern); and into the inferior mesenteric vein (IMV-pattern). The appearance of the EG-pattern was seen most frequently (74.4 per cent). The usefulness of this method for surveying the collateral circulation in portal hypertension, estimating the risk of esophageal variceal bleeding and evaluating its treatments, was suggested by the results of this study.

Collateral Circulation↗
PubMed2006

Ultrafine needle CO2 splenoportography: a comparative investigation with transarterial portography and MR portography.

PURPOSE: To evaluate the safety and quality of CO2 splenoportography (CO2-SP) by comparison to 3-dimensional dynamic contrast-enhanced magnetic resonance portography (3D-DCE-MRP) and transarterial portography (TAP). MATERIALS AND METHODS: CO2-SP, 3D-DCE-MRP and TAP were performed within 3 days in 35 patients. CO2-SP was conducted with a 26G needle by puncture of spleen under fluoroscopy and/or ultrasound guidance. A fifty mm3 of CO2 was manually injected within 3s. The safety and the side effects of CO2-SP were assessed with a scoring system based on both the subjective feeling of patients questioned and the objective appearances of vital signs, electrocardiogram (ECG) and saturation of percutaneous blood oxygen (SpO2). The quality of the imaging was compared among the three groups using different methods by a scoring criterion based on visualization of the portal branches. RESULTS: Transient mild discomfortable reaction was present in 18 patients (51.4%). The scores measured for quality of portal vein branch visualization in the groups with CO2-SP, 3D-DCE-MRP and TAP were 226, 196 and 167, respectively (P<0.001, the higher of the scores, the better of the quality). The visibility of collateral veins was not significantly different amongst the three imaging techniques. CONCLUSION: Ultrafine needle CO2-SP is safe and minimally invasive. The quality of CO2-SP is better than that with 3D-DCE-MRP and TAP in terms of the visualizing portal vein branches.

Adult↗
PubMed1975

Celiac arteriography following percutaneous splenoportography.

Splenic arteriography was performed in 14 patients immediately following antecedent splenoportography. Arteriographic evidence of splenic hematoma was demonstrated in 3 patients while in the remaining 11, no arteriographic abnormalities were detected.

Angiography↗
PubMed1991

A digital splenoportography: more sensitive method of detecting spontaneous splenorenal shunt.

Splenoportography was performed upon 195 pediatric patients, including 137 by conventional technique and 58 by digital subtraction technique. The results obtained were compared, and it was found that the percentage of diagnosis of spontaneous splenorenal shunt was higher with digital than with conventional technique. In conclusion digital technique is a more sensitive and safer method than the conventional method.

Angiography, Digital Subtraction↗
PubMed1979

Percutaneous transhepatic portography. II. Comparison with splenoportography in portal hypertension.

Percutaneous transhepatic portography and splenoportography were compared in 67 patients with portal hypertension. Portograms were evaluated without knowledge of the identity of patients. Factors evaluated included technical success of the examination; visualization of the portal vein, splenic vein, and other tributaries; contrast medium density, portal blood flow direction; presence and type of collaterals and varices; and liver size and configuration. Percutaneous transhepatic portography proved superior with regard to delineation of the portal venous system and esophageal varices. A definite diagnosis of portal vein thrombosis was possible only with the transhepatic approach.

Adolescent↗
PubMed1998

Animal experiments and clinical application of CT during percutaneous splenoportography.

AIM:To introduce computed tomography during percutaneous splenoportography (CTSP), a new method for determining hepatic diseases.METHODS:Ten hybrid dogs and 20 patients with primary hepatic cancer (PHC) were included in the study. Each dog was examined by CT, CTAP (computed tomography during arterial portography) and CTSP to compare the enhanced degrees of the liver. The 20 PHC patients were examined by CTSP and the appearance of PHC was compared with their pathological results to evaluate the diagnostic significance of CTSP.RESULTS:The animal experiments showed that both CTAP and CTSP could obviously enhance the liver (P < 0.01), but there was no significant difference in the enhanced results between the two methods (P >0.05). On the CTSP images in the 20 patients, the density of the livers was increased to 168-192Hu, whereas the density of the cancers remained as low as that on the images of CT scans (< 58Hu). The CTSP findings were consistent with the surgical ones from spaceoccupying lesions. Its diagnostic value was obviously superior to that of general enhanced CT and ultrasonic examination. However, it was difficult for CTSP to show nodules less than 1cm in size located on the surface of the liver or the hepatic portal zone.CONCLUSION:Like CTAP, CTSP is also a sensitive method for showing occupants in the liver. But the equipments and the procedures for CTSP are simpler than for CTAP. Therefore, it is an alternative procedure in clinical practice.

Journal Article↗
PubMed1975

Determination of portacaval shunt patency in rats by splenoportography.

Open splenoportography was performed on a series of control, "sham-operated" and portacaval-shunt rats. Relevant vascular anatomy was well demonstrated. The criteria for diagnosis of patency, partial and total occlusion of portacaval shunts are mentioned and findings are correlated with postoperative weight variations. The possible significance of collaterals in the region of the shunt is briefly discussed.

Animals↗
PubMed2000

CT via percutaneous splenoportography: experiment and application.

OBJECTIVE: To introduce computed tomography via percutaneous splenoportography (CTSP), a new method for determining hepatic diseases. METHODS: Ten hybrid dogs and 31 patients with primary hepatic cancer (PHC) were included in the study. Each dog was examined by CT, computed tomography via arterial portography (CTAP), and CTSP to compare the enhanced density of the liver. The 31 patients were examined by CTSP and the appearance of PHC was compared with their pathological results to evaluate the diagnostic significance of CTSP. RESULTS: The animal experiment showed that both CTAP and CTSP could obviously enhance the density of the liver (P < 0.01), but no significant difference was observed in the enhanced densities between the two methods (P > 0.05). On the CTSP images of the 31 patients, the density of the livers was increased to 168-192 Hu, whereas the density of the cancers was as low as that on the images of CT scans (< 58 Hu). The CTSP findings were consistent with the surgical ones from space occupying lesions. The diagnostic value of CTSP was obviously superior to that of general enhanced CT. However, it was difficult for CTSP to show nodules less than 1 cm in size located on the surface of the liver or the hepatic portal zone. CONCLUSIONS: Like CTAP, CTSP is also a sensitive method for showing occupant in the liver. But the equipments and the procedures are simpler for CTSP than for CTAP. CTSP is an alternative procedure in clinical practice.

Animals↗
PubMed2004

Perfusion homogeneity of hepatic parenchyma in magnetic resonance imaging during splenoportography.

OBJECTIVE: To evaluate the homogeneity of hepatic parenchyma enhancement in magnetic resonance imaging during splenoportography (MRSP) in the portal phase. METHODS: MRSP was performed in 16 patients suspected of space-occupying lesions in the livers. The signal intensity of non-lesion abnormal perfusion areas and that of peripheral parenchyma were measured in all the scanning phases including unenhanced phase, portographic phase, equilibrium phase, and delayed phase. RESULTS: Perfusion abnormalities were observed in 8 non-lesion foci in the portal phase in 4 cases of hepatic cirrhosis, most frequently appearing in triangle or fan-like shapes (7/8) with unpredictable locations. Hepatic cirrhosis patients had more non-lesion perfusion abnormalities than non-cirrhosis patients. CONCLUSIONS: The presence of non-lesion perfusion abnormalities in MRSP does not affect the diagnosis of the disease, and more homogeneous enhancement of the hepatic parenchyma in the portal phase can be achieved in MRSP than in CT during arterial portography and magnetic resonance imaging during arterial portography.

Adult↗
PubMed1979

[Splenoportography: still important technic. New prospects (author's transl)].

Splenoportography still plays today an important role among angiographic examinations used in the study of portal hypertension. The authors arrived at these conclusions after studying the results obtained in more than 500 examinations carried out. In the text, they give a few details of the technic used to improve the photographic result and to reduce the risk of the examination.

Child, Preschool↗
PubMed1976

Scintillation splenoportography: hemodynamic and morphological study of the portal circulation.

The intrasplenic injection of 99mTc-labeled albumin microspheres, followed 30 sec later by an injection of 99mTc-labeled red blood cells with recording of the progression of the two tracers, were performed in 110 patients. This also enabled the plotting of activity versus time curves on splenic, hepatic, cardiac, and pulmonary areas of interest, there by giving access to several hemodynamic variables. Scintillation image demonstrated splenoportal obstruction in 8 cases. Intrahepatic obstruction with reflux via collaterals were observed in 53 cases, 14 with umbilical reflux. In 13 cases, the patency of surgical portacaval anastomoses were verified. The splenoportal blood flow velocity was not significantly different in patients with cirrhosis (V = 10.1 cm per sec +/- 3.0 SD) and in normal subjects (V = 13.2 cm per sec +/- 5.8 SD). The fraction of shunted splenic flow in the case of cirrhosis varied from 0 to 100%; there was no relationship between this percentage and the seriousness of the clinical status. In 3 cases, the presence of intrahepatic shunts was detected. There was a very significant difference between mean transit time (MTT) of red blood cells in patients with cirrhosis (t = 12.2 sec +/- 4.4 SD) and those without cirrhosis (t = 19.9 sec +/- 3.7 SD). Among patients with cirrhosis, those with a history of jaundice had a shorter MTT than those without such a history. On the other hand, the MTT was not significantly different whether the patients with cirrhosis had or did not have hemorrhage, ascites or encephalopathy. There was a positive correlation (P less than 0.01) between MTT and plasma albumin concentration,and between MTT and prothrombin (P less than 0.01). Finally, there was a high negative correlation (P less than 0.001) between MTT and total serum bilirubin. Scintillation splenoportography is a useful technique for assessing hepatic hemodynamics and for demonstrating abnormalities of the intrahepatic circulation.

Blood Flow Velocity↗