Nondiseased portal perfusion defects adjacent to the right ribs shown on helical CT during arterial portography.
OBJECTIVE
The purpose of our study was to assess the frequency and imaging characteristics of nonpathologic portal perfusion defects in subcapsular liver parenchyma adjacent to the right ribs as seen on CT hepatic arteriography combined with helical CT during arterial portography (CTAP).


METHODS
From January 1994 to June 1997, helical CTAP and CT hepatic arteriography were performed in 94 patients with suspected malignant hepatic tumors. The patient group comprised 66 men and 28 women ranging from 37 to 83 years old (mean, 64 years old). Three radiologists retrospectively reviewed the images obtained by CTAP to evaluate portal perfusion defects adjacent to the right ribs for location, shape, size, and correlation with findings seen on CT hepatic arteriography.


RESULTS
We identified 16 nonpathologic portal perfusion defects adjacent to the right eighth (n = 1), ninth (n = 12), and tenth (n = 3) ribs in 12 (13%) of 94 patients. The shapes of the 16 defects were circular (n = 1), oval (n = 7), wedge (n = 3), and irregular (n = 5). The defects were 10-30 mm in diameter (mean, 16.9 mm). In four (25%) of 16 locations, CT hepatic arteriography showed poorly identified, homogeneous, irregularly shaped areas of contrast enhancement corresponding to the defects seen on CTAP. The portal perfusion defects were proven to be nonpathologic on definitive surgery in four patients and on follow-up radiography in eight patients.


CONCLUSIONS
Helical CTAP may show nonpathologic portal perfusion defects adjacent to the right ribs. Most defects did not appear circular but rather were oval, irregular, or wedge-shaped. CT hepatic arteriography infrequently showed corresponding findings. Radiologists should recognize this potential pitfall when interpreting images obtained by helical CTAP.
Department of Radiology, Gifu University School of Medicine, Tsukasamachi, Japan.
M
M
Kanematsu
H
H
Kondo
M
M
Enya
R
R
Yokoyama
H
H
Hoshi
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D006528:Carcinoma, Hepatocellular / Q000098:blood supply / Q000000981:diagnostic imaging*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000556:secondary; D008297:Male; D008875:Middle Aged; D011172:Portography; D012189:Retrospective Studies; D012272:Ribs / Q000000981:diagnostic imaging*; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed