[Radiologic diagnosis of secondaries in the liver (author's transl)]

A diagnosis of secondaries in the liver carries considerable weight in prognosis and treatment, particularly pre-operatively, so that a possibly unnecessary operation may be avoided. Among techniques available for screening for metastases of the liver scintigraphy plays an important part. Besides laboratory tests and clinical examination it is relatively efficient and does not burden the patient. But they often are incapable of providing a basis for therapeutic decisions. Radiologic techniques are unsuitable (13). Knowledge and proper interpretation of indirect signs will permit guidance at the right time. In essence they serve the radiologic proof of advanced metastatic growths. Space occupying processes in the liver are the main indication for angiography. This is certainly not a routine method but makes sense when trying to identify the nature of defects shown in scintigrams (10). Where a primary tumor is known, angiography will follow scintigraphy of the liver, the search technique of choice. While the two techniques are correctly positive in 75-90% for avascular secondaries, experience of numerous investigations confirms that vascular metastases can be recognized earlier in angiograms than in scintigrams. Only angiography provides specific information differentiating metastases from a heptoma. The additional proof of primary tumors of the pancreas is important. Angiography is essential for indication and planning of partial hepatectomy. The angiographic picture does not permit conclusions from the metastases as to site and identity of the primary tumor. Critical evaluation of the radiographic techniques for early recognition of secondaries in the liver suggests humility. Only by carefully combining the various techniques will it be possible to demonstrate secondaries in the liver earlier and more frequently.