Nontumorous arterioportal shunts in the liver: CT and MRI findings considering mechanisms and fate.
The intrahepatic non-tumorous arterioportal shunt (APS) is one of the important causes of transient hepatic enhancement differences (THED) on dynamic CT or MRI. Most small APSs are located in the peripheral portion of the liver. Because of the parenchymal distortion in the advanced cirrhotic liver, many small APSs tend to show an amorphous or nodular appearance, making them difficult to distinguish from hypervascular tumors. In addition to the use of dynamic CT or MRI, iso-attenuation densities or iso-intensities on pre-contrast and equilibrium phases, MRI using a liver-specific contrast agent can be useful to characterize the hypervascular pseudolesions. Because there is no difference in water diffusion in the hepatic parenchyma in the region of the APS, diffusion-weighted MRI also has great potential to distinguish non-tumorous shunts from true focal lesions. Larger (>2 cm) APSs of direct arterio-portal venous fistulas from extrinsic insults show typical subcapsular wedge-like THEDs that are only temporarily depicted several months after the traumatic event; most of these THEDs gradually decrease in size or vanish completely. By understanding the nature of non-tumorous APSs, radiologists will be able to provide a more accurate assessment of many THEDs during daily interpretations of CT or MR images of the liver.
Ahn
Jhii-Hyun
JH
Department of Radiology and Research Institution of Radiological Science, Yonsei University College of Medicine, Gangnam Severance Hospital, 612 Eonjuro, Gangnam-gu, Seoul 135-720, Republic of Korea.
Yu
Jeong-Sik
JS
Hwang
Sung Ho
SH
Chung
Jae-Joon
JJ
Kim
Joo Hee
JH
Kim
Ki Whang
KW
D001164:Arteriovenous Fistula / Q000175:diagnosis*; D003937:Diagnosis, Differential; D006499:Hepatic Artery / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis; D008279:Magnetic Resonance Imaging / Q000379:methods*; D011169:Portal Vein / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000473:pathology; D014057:Tomography, X-Ray Computed / Q000379:methods*; D019043:Vascular Neoplasms / Q000175:diagnosis