Impact of new imaging methods on the evaluation of focal hepatic lesions

I discus the experience at Kanazawa University Hospital with the newer imaging methods (RI, US, CT) and how they have influenced the angiographic workup of patients with hepatic mass. Hepatic angiography is no longer performed a diagnosis of hepatic cyst and the US has been valuable for it. The combination of CT or US, and AFP has been associated with the decrease in the number of hepatic angiography for the advanced hepatoma. In contrast to the advanced, angiography has to be performed actively to demonstrate the small foci for the patient with a strong clinical suspicion. The conventional celiac angiography and hepatic angiography were not always able to detect small foci measuring less than 2 cm in diameter, due to vascular proliferation which cannot be distinctly identified by conventional angiography. In these cases infusion hepatic angiography enhanced the detection of the foci. We routinely rely on CT as a valuable supplement prior to surgical management, for obtaining more exact information as to the extent of hepatoma. The dynamic CT with bolus injection enables us to make exact diagnosis of cavernous hemangioma of the liver without performing of hepatic angiography. Also CT arteriography and dynamic CT have the advantage over the conventional CT in the correct diagnosis of small hepatoma. (author)