The Epinephrine Effect in Angiography of Gastrointestinal Tract Tumors

Epinephrine was first shown to be useful in angiography of renal tumors (1). Since normal vessels undergo more vasoconstriction than those supplying tumor, the angiography performed during the epinephrine effect permits a better delineation of the latter. We have applied a similar technic in the examination of the celiac and mesenteric arteries in an attempt to improve the diagnosis of neoplasms of the gastrointestinal tract. Materials and Methods This report reviews 100 consecutive selective arteriographic studies of the celiac or mesenteric arteries or their branches performed after intra-arterial injection of epinephrine (Table I). Most of these examinations were undertaken for the evaluation of known or suspected tumors of the gastrointestinal tract. Control arteriograms without epinephrine were made in all cases. A surgically or pathologically proved diagnosis was available in 70 patients. Abdominal aortography, utilizing a percutaneous retrograde femoral catheter approach, was the initial step in each study. Selective catheterization of pertinent vessels was then carried out, and serial arteriograms obtained. After selection of the vessel of special interest, an intra-arterial epinephrine infusion was performed immediately, before repeat angiography. The dose of epinephrine varied from 5 to 30µg, depending on the size of the vessel, and a dilution of 1 /µg/cc of normal saline was employed. The infusion was administered in exactly two minutes, and the contrast injection was begun as soon as possible thereafter, usually within three seconds. Methylglucamine diatrizoate 60 per cent in doses of 10 to 35 cc was injected over a ten-second period, while serial films were obtained two to three seconds apart for fifteen to twenty seconds. The patient's reaction and blood pressure were observed closely. Results After the administration of epinephrine, a constriction of the major visceral arteries, as well as a contraction at the arteriolar level, is manifested by a decrease in blood flow (Fig. 1). Both the splenic and hepatic trunks show an average reduction in diameter of slightly over 25 per cent. The splenic blood flow, estimated by measuring the progress of contrast medium over several serial films, is about 1 cc/sec, and the hepatic blood flow about 2 cc/sec. This correlates well with the observation that aortic reflux is noted in the postepinephrine celiac arteriogram whenever the injection rate exceeds about 3 cc/sec. (8). There is also a decrease in spleen length of about 6 per cent. The response of the gastric and pancreatic arteries to epinephrine is usually fairly brisk, but somewhat variable. The arteries to the colon show more vasoconstriction than those to the small bowel. Frequently the gallbladder and adrenal glands (4) display a peculiar unresponsiveness to epinephrine. After the two-minute infusion of epinephrine, the vasoconstriction remains intense for about fifteen seconds and then diminishes over the next minute.