Spiral CT during arterial portography: technique and applications

Spiral computed tomography during arterial portography (CTAP) combines rapid scanning with selective imaging during the portal phase of enhancement of the liver, resulting in an effective method for evaluation of liver neoplasms prior to partial hepatic resection. Compared with dynamic incremental CTAP, spiral CTAP results in improved quality of three-dimensional and multiplanar reconstructions, facilitating presurgical planning. Accurate volumetric analysis of the tumor can be performed, and subsegmental tumor localization is facilitated by the high levels of hepatic and portal venous enhancement. Additional advantages of spiral CTAP include small reconstruction intervals for improved lesion detection. However, the specificity of spiral CTAP is low because both benign and malignant tumors appear as hypoattenuating perfusion defects. In addition, both focal and geographic nontumorous perfusion defects may be seen more frequently with spiral CTAP than with dynamic CTAP. Knowledge of common diagnostic pitfalls is necessary for accurate interpretation of spiral CTAP images.