Angiography in soft tissue sarcomas.

Angiography was performed in 41 patients with histologically proven soft tissue sarcomas that included tumors derived from a variety of cell types and locations. The leiomyosarcomas and sarcomas of uncertain or mixed origin showed extensive neovascularity. Liposarcomas, synovial cell sarcomas, and fibrous histiocytic sarcomas were moderately vascularized. Sarcomas originating from vascular, fibrous, neural, and osseous tissues had variable degrees of vascularity. In nearly all of the cases studied, angiography revealed tumor size, extent, source, and degree of vascularity and helped to determine the degree of malignancy. While angiography does not provide a histologic diagnosis, it plays an important role in patient management when a conservative therapy plan that uses several modalities is followed.

Percutaneous transhepatic drainage. Risks and benefits.

We evaluated the risks and benefits of percutaneous transhepatic biliary drainage (PTD) in 44 patients. Patients were divided into two groups, palliative and preoperative, each of which had 22 patients. Major complications included bacteremia, hemobilia, and liver abscess and occurred in ten patients (23%). A liver abscess along the catheter tract may have contributed to the death of one patient with an advanced malignant neoplasm. Major complications were more likely to develop in palliative-group patients (36% v 9%) and those patients were more likely to die within 30 days of the procedure (27% v 0%). Four (57%) of seven palliative-group patients and none of six preoperative-group patients with pre-PTD bilirubin levels higher than 20 mg/dL died within 30 days after PTD. Liver function test results improved within seven days in approximately 85% of the patients. Twenty-one patients (95%) in the preoperative group survived surgery. We concluded that the risk of PTD may outweigh the benefit in the subset of patients with advanced malignant neoplasms and a bilirubin level higher than 20 mg/dL. Even then, however, PTD may be justified if pruritus is incapacitating. Pending results of further randomized trials, we have continued performing PTD preoperatively in patients whose bilirubin levels exceed 10 mg/dL.

Intra-arterial digital subtraction angiography: comparison with conventional hepatic arteriography.

To evaluate the efficacy of arterial digital subtraction angiography (DSA), 28 patients with a variety of hepatic lesions underwent intra-arterial DSA immediately following conventional celiac or hepatic arteriography. Thirty-one studies were obtained and the results of DSA were compared with the conventional arteriograms. DSA showed good visualization of the arteries in the early arterial phase of the examination. The late arterial phase was better evaluated on conventional arteriograms due to the decreased spatial resolution of DSA. Arterial DSA was most useful in the evaluation of the parenchyma of the liver; the use of remasking techniques allowed improved visualization of hepatic lesions, particularly in the left lobe of the liver. It is concluded that arterial DSA is useful in hepatic imaging and may supplant conventional hepatic arteriography as the technology improves.