Angiography in radiation “hepatitis”

Five cases of surgically and biopsy proven radiation hepatitis were studied by angiography. One case was studied in both the acute and late phases while the remainder were studied only during the late or chronic phase. The angiographic and pathologic findings correlate well. During the acute phase, when hepatic venule obstruction and lobular congestion are present, the angiogram shows enlargement of the affected region with stretching of the hepatic arteries and retrograde (hepatofugal) flow in intrahepatic portal vein branches. In the chronic, recovery phase, there is compensatory hypertrophy of non-irradiated areas with stretching of hepatic arteries and atrophy and fibrosis of the irradiated region which shows crowding and “corkscrewing” of the hepatic arteries with normal hepatopetal portal venous flow. By combining scanning and angiography it would appear that the correct diagnosis can often be suggested. The low probability of metastases can be predicted and re-exploration can thus be avoided with this combined technique especially during the chronic phase of radiation injury.