Multislice CT angiography of the celiac and superior mesenteric arteries: comparison with arteriographic findings.

PURPOSE: The aim of the present study is to evaluate the feasibility of multislice computed tomography (MSCT) angiography of the celiac and superior mesenteric arteries with a non tailored protocol. Sixteen patients underwent both MSCT of the upper abdomen and digital subtraction celiac and superior mesenteric angiography. CT examinations included unenhanced scanning and dual-phase (arterial and portal) scanning of the upper abdomen. Retrospective 2.5 mm thick slices with 50% overlap were used for CT angiography reformations with volume rendering (VR), high density maximum intensity projection (HD-MIP) and subvolume MIP technique; normal arterial anatomy, variants, stenoses and aneurysms were assessed and compared with findings of digital subtraction angiography. RESULTS: All VR and HD-MIP reconstructions were considered satisfactory, except in two cases because of inappropriate setting of scan parameters; subvolume MIP reformations were considered satisfactory in all cases, and superior in the depiction of small arteries. Aneurysms and stenoses were always detected, whereas a case of replaced right hepatic artery in a patient with complex vascular anatomy was misdiagnosed by MSCT angiography. The overall accuracy of VR, HD-MIP and MIP CT angiographic reconstructions was 71.9%, 81.8% and 94.6%, respectively. CONCLUSIONS: In our preliminary report, CT angiography with multidetector CT has proved effective in depicting splanchnic arterial anatomy, and can replace diagnostic invasive angiography in most cases. Good quality of axial images is necessary for reformations with VR and MIP techniques.

Transcatheter arterial chemoembolization for hepatocellular carcinoma in patients with Child's grade A or B cirrhosis: a multivariate analysis of prognostic factors.

We evaluated factors affecting long-term survival after transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) complicating cirrhosis. One hundred eighty-two patients with Child's class A or B cirrhosis and an HCC, not amenable to surgery or percutaneous ethanol injection, underwent 346 TACEs (mean 1.9) with epirubicin, iodized oil, and gelatin sponge. Many prognostic factors were subjected to univariate analysis and thereafter, when significant, to the Cox's hazard proportional model. Finally, the significant indices in the Cox's model were used to estimate the accuracy of the probability of death with computation of the area under the receiving operative characteristic (ROC) curve. The cumulative survival rates at 1, 2, 3, and 5 years were 0.83, 0.52, 0.40, and 0.16, respectively. According to Cox's model, the factors associated with significantly worse survival were the presence of ascites (p = 0.0027), elevated bilirubin levels (p = 0.0163), elevated alpha-fetoprotein (alphaFP) values (p = 0.0067), a tumor greater than 5 cm in diameter (p = 0.0001), and the absence of a tumor capsule-like rim (p = 0.0278). According to these parameters, the accuracy of the probability of death estimated with ROC analysis was 0.63. Minor and major complications occurred in 82 patients (45%) and caused death in 2 patients. Long-term prognosis after TACE for HCCs in patients with Child's class A or B cirrhosis depends on the presence of ascites, the bilirubin level, the alphaFP value, the diameter of the tumor, and the presence of a tumor capsule-like rim. However, when considered altogether, these variables are poor predictors to evaluate survival, and other factors should be investigated to identify subjects more responsive to TACE. Complications occur in a high percentage of patients, but they do not affect long-term prognosis.