Percutaneous transhepatic portal catheterization-modification of Chiba method and portal vein pressure in liver diseases.

Percutaneous transhepatic portal catheterization was performed in 68 cases of liver diseases in the 2 year period from 1978 to 1980. The Chiba University method was modified. Portal vein catheterization was successful in 61 cases (90%). Selective splenic vein catheterization was successful in 55 of the 61 cases (90%) and selective superior mesenteric vein catheterization in 59 cases (97%). The liver was punctured an average of 4.6 times in order to successfully insert the catheter into the main portal vein, and the number of punctures was less than 10 in 57 of the 61 cases (93%). The portal vein pressure was 310+/-67 mm H2O in idiopathic portal hypertension (8 cases), 290+/-83 in liver cirrhosis (33 cases), 193+/-71 in chronic hepatitis (7 cases) and 166+/-50 in fatty liver (4 cases). Portal vein pressure rose from 205+/-75 to 380+/-55 mm H2O in 11 cases after forced Valsalva maneuver. No major complications were encountered.</p

Ultrasonographic characteristics of small hepatocellular carcinoma.

The ultrasonographic characteristics of hepatocellular carcinomas (HCC) were investigated. Four typical features of HCCs, "mosaic internal echo pattern", "halo", "lateral shadow" and "posterior echo enhancement", were not recognized in minute HCCs smaller than 2 cm in diameter. These characteristics developed as the tumors grew. Only hypoechoic space-occupying lesions can be considered as small HCCs. In differentiating small HCCs from hypoechoic non-malignant space-occupying lesions in the cirrhotic liver, the ratios of short to long dimensions of the lesions seemed to be important since the ratios of HCCs were significantly larger than those of non-malignant lesions. The fact that 3 hyperechoic small HCCs could not be diagnosed even by celiac arteriography has suggested to us that ultrasonically guided biopsies should be performed in order to differentiate from small hemangiomas. Serum alpha-fetoprotein (AFP) levels of 1/3 of the patients with HCCs were below 100 ng/ml, indicating that it is impossible to detect small HCCs only by measuring serum AFP.</p