title: Imaging diagnosis of hepatic metastases of pancreatic carcinomas: significance of transient wedge-shaped contrast enhancement mimicking arterioportal shunt.
abstract: We aimed to evaluate the imaging findings of hepatic metastases from pancreatic cancers, especially wedge-shaped enhancement and its etiology. Dynamic CT and MR images were performed in 87 patients with liver metastases from pancreatic carcinomas, and CT during arterial portography (CTAP) and CT during hepatic arteriography (CTHA) in 51 patients. Liver metastases were multiple in 84 patients (97%) and solitary in only three (3%). In 44 of 87 patients (51%), all liver metastases showed ring-like enhancement compatible with metastatic adenocarcinomas on dynamic CT and/or dynamic MR imaging. In 37 patients, more than one metastatic lesion showed wedge-shaped contrast enhancement on dynamic CT, dynamic MRI and CTHA, and wedge-shaped perfusion defect on CTAP adjacent to metastatic tumors. Six patients showed multiple wedge-shaped enhancements, which were initially diagnosed as multiple arterioportal shunts (AP shunts). However, metastatic tumors appeared within the area of wedge-shaped enhancement and increased in size on follow-up CT and/or MR images. After all, 43 of 87 patients (49%) had AP shunt like contrast enhancement adjacent to liver metastases. Liver metastases from pancreatic carcinomas frequently show transient wedge-shaped enhancement, and should not be misdiagnosed as nontumorous arterioportal shunts.
authors.affiliation: Department of Radiology, Kanazawa University, School of Medical Science, 13-1 Takara-machi, Kanazawa City, 920-8641, Japan. gabata@med.m.kanazawa-u.ac.jp
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Gabata
authors.forename: Osamu
authors.initials: O
authors.lastname: Matsui
authors.forename: Noboru
authors.initials: N
authors.lastname: Terayama
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kobayashi
authors.forename: Junichiro
authors.initials: J
authors.lastname: Sanada
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary*; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D011168:Portal System / Q000000981:diagnostic imaging / Q000473:pathology; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media