Evaluation of intra-arterial digital subtraction angiography using carbon dioxide for liver tumor

Intraarterial Digital Subtraction Angiography using Carbon Dioxide (CO2-IADSA) was performed on 18 patients with several liver tumors and studied its diagnostic usefullness as well as intrahepatic hemodynamic observed by the technique. Intraarterial carbon dioxide injections were made in celiac artery (3 patients), common hepatic artery (6 patients) and proper hepatic artery (9 patients including right and left hepatic artery) using standard 5 French angiographic catheter or 6 French balloon catheter. In all patients, hand injections were made with 30 ∼ 50 ml plastic syringes that were filled from a small medical grade carbon dioxide tank using a standard oxygen regulator. The carbon dioxide injected into the hepatic artery flowed more rapidly than iodine contrast material, showing a very rapid retreat from the blood stream, but the carbon dioxide flowing into the tumor vessel remained longer than within normal hepatic artery. Relative good demonstration of hepatic artery was obtained by CO2-IADSA; in 13 of 18 patients, tumor vessels were distinctly visualized. In 9 of 11 patients with hepatoma, arterioportal shunt that could not be observed by conventional angiography were demonstrated. All of these patients, intrahepatic metastasis were found and their lesions locarized in the portal segment flowed out by carbon dioxide. Side effects to this technique included mild heat sensation (3 patients) and mild abdominal discomfort (2 cases), but no serious complication was exhibited in any cases. We concluded that CO2-IADSA was a safe angiographic technique and would be a useful method for hemodynamic investigations of hepatic tumors. (author)