Femoral Arterial Puncture: Comparison of Using the Inguinal Crease and Bony Landmarks

PURPOSE: We tried to compare the accuracy of using bony landmarks and inguinal crease landmarks for performing femoral artery puncture and to determine an ideal puncture site. MATERIALS AND METHODS: We studied ninety consecutive patients who underwent femoral arterial puncture for performing angiogram. For the evaluation of bony landmarks, the pelvis and inguinal areas were divided into 8 zones according to 7 lines that were drawn parallel to the line drawn between the anterior superior iliac spine and the pubic tubercle. For evaluation of the inguinal crease as a landmark, the 8 zones above and 4 zones below the inguinal crease were determined. The zones were divided by 11 lines drawn parallel to the inguinal crease, and the interval between each line was 1cm. Locations of the inguinal ligament and femoral bifurcation were recorded for every patient according to the above zones, and an ideal zone for the femoral arterial puncture was decided upon. The ideal zone was considered if the locations of all of inguinal ligaments were above the zone and the least possibility to puncture was below the femoral bifurcation. RESULTS: On the bony landmark, the femoral bifurcations were located at zone 3 in 1 patient (1.1%), at zone 4 in 2 patients (2.2%), at zone 5 in 3 patients (3.3%), at zone 6 in 24 patients (26.7%), and at zone7 in 44 patients (48.9%). Inguinal ligaments were at zone 1 in 2 patients (3.0%), at zone 2 in 34 patients (50.7%), at zone 3 in 25 patients (37.3%), and at zone 4 in 6 patients (8.9%). When the inguinal creases were used as a landmark, the femoral bifurcations were located at zone 4 in 4 patients (4.4%), at zone 3 in 19 patients (21.1%), at zone 2 in 30 patients (33.3%), at zone 1 in 19 patients (21.1%), at zone -1 in 13 patients (14.4%), at zone -2 in 3 patients (3.3%) and at zone-4 in 2 patients (2.2%). Inguinal ligaments were at zone 8 in 7 patients (10.4%), at zone 7 in 11 patients (16.4%), at zone 6 in 19 patients (28.4%), at zone 5 in 20 patients (29.9%), at zone 4 in 7 patients (10.4%), and at zone 3 in 3 patients (4.5%). Therefore, the best zone for femoral arterial puncture was zone 5 with using bony landmarks and zone 2 with using inguinal crease landmarks. In terms of zone 5 on the bony landmark, every locations of inguinal ligaments was above it and 84 patients (93.4%) had their femoral bifurcation below it, excluding the 6 patients who had their femoral bifurcations at zones 3, 4, and 5. Therefore, zone 5 with using the bony landmarks was a good indicator for femoral arterial puncture. In case of zone 2 on the inguinal crease landmark, although every location of the inguinal ligament was above it, 53 patients (58.8%) had their femoral bifurcation above it at zones 4, 3, and 2. So, it was not a good indicator for femoral arterial puncture. CONCLUSION: Bony landmarks are more accurate indicators for performing femoral arterial puncture than the inguinal crease landmark. Zone 5 on the bony landmark is an ideal location for femoral arterial puncture.

Hepatocellular Carcinoma: Comparison Study on Detecting Tumor Vascularity among Various Imaging Techniques

PURPOSE: To compare the detectability of tumor vascularity using triphasic spiral CT, angiography, CT during hepatic arteriography(CTHA) and single-level dynamic CTHA(SLD-CTHA). MATERIALS AND METHODS: Seventy-nine pathologically confirmed nodular hepatocellular carcinomas(HCCs) in 77 patients were included in this study. Sixty patients were male and 17 were female, and their ages ranged from 31 to 77 (average, 57.4) years. HCCs were classified into three groups according to the size: less than 2 cm (n=20), 2 -4 cm (n=32), and more than 4 cm (n=27) in diameter. If a portion of tumor demonstrated greater enhancement than surrounding liver parenchyma, vascularity was deemed to be present. Detectability by each imaging technique was compared according to size and overall. RESULTS: Hypervascularity was frequently detected by SLD-CTHA [90.9%(40/44)], followed by CTHA[88.0%(66/75)], angiography [80.3%(61/76)], triphasic spiral CT [72.4%(42/58)]. In the less than 2 cm group, detectability rates for triphasic spiral CT, angiography, CTHA and SLD-CTHA were 53.3%(8/15), 55.6%(10/18), 76.5%(13/17) and 87.5%(6/7), respectively. while the 2 -4 cm group demonstrated corresponding figures of 71.4%(15/21), 78.1%(25/32), 84.4%(27/32) and 86.4%(19/22). In the more than 4 cm group, the rate for triphasic spiral CT was 86.4%(19/22), while for angiography, CTHA and dynamic CTHA, it was 100%. CONCLUSION: In the detection of hypervascularity of HCC, SLD-CTHA showed the highest rate, followed by CTHA, angiography, and triphasic spiral CT. In HCCs less than 4 cm in diameter, the corresponding ordering was SLD-CTHA, CTHA, angiography and triphasic spiral CT, but in HCCs of more than 4 cm, angiography, CTHA and SLD-CTHA detected hypervascularity equally well. Lesion size most affected the findings of angiography.