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The radiologic diagnosis and management of hepatic metastases
Insights
Computed tomography (CT) best detects hepatic metastases. Transcatheter hepatic artery infusion and embolization offer effective treatment options, improving survival for patients with metastatic colorectal carcinoma.
Area of Science:
- Radiology
- Interventional Radiology
- Oncology
Background:
- Diagnostic radiologists are responsible for diagnosing hepatic metastases.
- Computed tomography (CT) is superior to scintigraphy and sonography for detecting hepatic masses.
- Hepatic angiography is primarily used for problem-solving and pre-therapeutic planning.
Purpose of the Study:
- To evaluate the efficacy of transcatheter management for hepatic metastases.
- To assess the role of hepatic artery infusion and embolization in treating metastatic disease.
- To analyze survival outcomes associated with these interventional procedures.
Main Methods:
- Comparison of diagnostic imaging techniques: scintigraphy, sonography, and CT.
- Superselective catheterization of hepatic arteries (95% success rate).
- Transcatheter hepatic artery infusion and embolization, utilizing the exclusive arterial supply of metastases.
Main Results:
- CT is the optimal imaging modality for hepatic mass detection and staging.
- Transcatheter management is feasible due to the arterial blood supply of metastases (90-95%).
- Median survival: 8 months for infusion alone, 15 months with infusion and occlusion, 11.5 months for embolization.
Conclusions:
- CT is the preferred imaging modality for hepatic metastases.
- Transcatheter hepatic artery infusion and embolization are effective treatments for hepatic metastases.
- These interventional techniques can significantly improve survival in patients with metastatic colorectal carcinoma.
Abstract:
The diagnosis of hepatic metastases is the responsibility of the diagnostic radiologist. In a comparison of the screening techniques, scintigraphy, sonography, and computed tomography, CT is the best single examination to determine the presence and extent of a hepatic mass. Hepatic angiography is now reserved for problem solving and in preparation for therapeutic management. Superselective catheterization is imperative and can be accomplished in 95%. Transcatheter management by hepatic artery infusion and embolization is feasible because the blood supply to hepatic metastases originates almost exclusively from the hepatic artery (90-95%), while the normal liver parenchyma has a dual supply--hepatic artery (25%) and portal vein (75%). This treatment delivered to the hepatic artery selectively effects the neoplasm. In the event of multiple hepatic (45%) arteries, occlusion of the aberrant artery with a steel coil redistributes flow through a single artery to facilitate infusion. The median survival from the time of the initiation of hepatic artery infusion for the treatment of metastatic colorectal carcinoma is 8 months and 15 months when the infusion is associated with occlusion. The median survival of 11.5 months is observed from the time of hepatic artery embolization which usually is done after failure of all other therapeutic modalities.