Small arterial-portal venous shunts: a cause of pseudolesions at hepatic imaging.
OBJECTIVE
To compare hepatic angiographic findings of small arterial-portal venous shunts with those of other imaging modalities, and to determine whether these shunts are related to hepatocellular carcinoma.


METHODS
At hepatic angiography in 223 patients, small arterial-portal venous shunts not directly related to hepatocellular carcinoma and focal areas of parenchymal contrast material enhancement more than 1 cm in diameter were found in 28 patients. These 28 patients were prospectively evaluated with computed tomography (CT) during arterial portography (CTAP) (n = 12), CT after iodized oil administration (n = 23), intraoperative ultrasonography (n = 5), or follow-up hepatic angiography (n = 13). Magnetic resonance (MR) images (n = 10) and dynamic CT scans (n = 4) in these patients were retrospectively reviewed.


RESULTS
Arterial-portal venous shunts noted at angiography manifested as perfusion defects at CTAP in 10 patients and as an area of arterial contrast enhancement at dynamic CT in three patients. No lesion was seen at MR imaging, and no persistent iodized oil uptake was seen at CT. There was no evidence of hepatocellular carcinoma tumor growth around the shunts at follow-up angiography, and no tumor was present at surgery.


CONCLUSIONS
Understanding of the hemodynamic changes caused by these small shunts can aid in the interpretation of vascular imaging findings.
Yu
J S
JS
Department of Diagnostic Radiology, Yonsei University College of Medicine, Seoul, South Korea.
Kim
K W
KW
Sung
K B
KB
Lee
J T
JT
Yoo
H S
HS
D000792:Angiography; D001158:Arteries; D001164:Arteriovenous Fistula / Q000000981:diagnostic imaging* / Q000601:surgery; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000601:surgery; D003287:Contrast Media; D005500:Follow-Up Studies; D006439:Hemodynamics; D006499:Hepatic Artery / Q000000981:diagnostic imaging; D006801:Humans; D007430:Intraoperative Care; D007459:Iodized Oil; D008099:Liver / Q000098:blood supply*; D008107:Liver Diseases / Q000000981:diagnostic imaging* / Q000601:surgery; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011169:Portal Vein; D011172:Portography; D011446:Prospective Studies; D011856:Radiographic Image Enhancement; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D018084:Ultrasonography, Interventional
D003287:Contrast Media; D007459:Iodized Oil