CT portography by direct intrasplenic contrast injection: a new technique

Background: The evaluation of percutaneous contrast injection into splenic parenchyma as an alternative technique for computed tomographic (CT) portog raphy in the preoperative assessment of primary hepatobiliary tumors. Methods: Thirty-two patients underwent a nonenhanced CT scan of the liver, after which a 19-gauge, 10-cm-long needle was introduced into the splenic p arenchyma under CT guidance. One hundred forty milliliters of contrast medi um (200 mgI/mL; 28 g/I) were injected through this needle: first, a 20-mL b olus (in 5 s) and then 2 mL/s for 60 s. At the end of the bolus injection ( 5 s), 8-mm-thick contiguous axial scans of the liver were obtained. Results: The success rate of the procedure was 93.7% (30/32; two technical failures). The average time required for the entire study was 13 min and 50 s (range = 7 min 53 s to 25 min 17 s). Hepatic parenchymal enhancement was good in 24/30 (80%), moderate in 3/30 (10%), and unsatisfactory in caudal sections of the liver in 3/30 (10%). Artifactual perfusion defects were see n in 4/30 (13%) due to inadvertant injection of small quantities of air. In trasplenic subcapsular contrast accumulation occurred in 56.2% (18/32; mini mal 15, moderate 3), extra-splenic contrast leakage in 12.5% (4/32), and le ft shoulder pain in 18.7% (6/32). No major complications were observed. Conclusions: Direct intrasplenic contrast injection for CT portography is a simple, effective, and safe technique with a high success rate and require s significantly less time and lower doses of contrast medium; it also elimi nates angiography, indwelling arterial catheters, and patient transfers fro m angiography to the CT area.