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Nontumorous arterioportal shunts in the liver: CT and MRI findings considering mechanisms and fate

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Abstract

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.

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References

  1. Okuda K, Musha H, Yamasaki T, Jinnouchi S, Nagasaki Y, Kubo Y, Shimokawa Y, Nakayama T, Kojiro M, Sakamoto K, Nakashima T (1977) Angiographic demonstration of intrahepatic arterio-portal anastomoses in hepatocellular carcinoma. Radiology 122:53–58

    CAS  PubMed  Google Scholar 

  2. Bookstein JJ, Cho KJ, Davis GB, Dail D (1982) Arterioportal communications: observations and hypotheses concerning transsinusoidal and transvasal types. Radiology 142:581–590

    CAS  PubMed  Google Scholar 

  3. Demachi H, Matsui O, Takashima T (1991) Scanning electron microscopy of intrahepatic microvasculature casts following experimental hepatic artery embolization. Cardiovasc Intervent Radiol 14:158–162

    Article  CAS  PubMed  Google Scholar 

  4. Yu JS, Rofsky NM (2002) Magnetic resonance imaging of arterioportal shunts in the liver. Top Magn Reson Imaging 13:165–176

    Article  PubMed  Google Scholar 

  5. Itai Y, Hachiya J, Makita K, Ohtomo K, Kokubo T, Yamauchi T (1987) Transient hepatic attenuation differences on dynamic computed tomography. J Comput Assist Tomogr 11:461–465

    Article  CAS  PubMed  Google Scholar 

  6. Haratake J, Hisaoka M, Yamamoto O, Horie A (1991) Morphological changes of hepatic microcirculation in experimental rat cirrhosis: a scanning electron microscopic study. Hepatology 13:952–956

    Article  CAS  PubMed  Google Scholar 

  7. Jeong MG, Yu JS, Kim KW (2000) Hepatic cavernous hemangioma: temporal peritumoral enhancement during multiphase dynamic MR imaging. Radiology 216:692–697

    CAS  PubMed  Google Scholar 

  8. Okuda K, Musha H, Nakajima Y, Takayasu K, Suzuki Y, Morita M, Yamasaki T (1978) Frequency of intrahepatic arteriovenous fistula as a sequela to percutaneous needle puncture of the liver. Gastroenterology 74:1204–1207

    CAS  PubMed  Google Scholar 

  9. Mathieu D, Lardé D, Vasile N (1983) CT features of iatrogenic hepatic arterioportal fistulae. J Comput Assist Tomogr 7:810–814

    Article  CAS  PubMed  Google Scholar 

  10. Ito K, Honjo K, Fujita T, Awaya H, Matsumoto T, Matsunaga N (1995) Enhanced MR imaging of the liver after ethanol treatment of hepatocellular carcinoma: evaluation of areas of hyperperfusion adjacent to the tumor. AJR Am J Roentgenol 164:1413–1417

    CAS  PubMed  Google Scholar 

  11. Jabbour N, Reyes J, Zajko A, Nour B, Tzakis AG, Starzl TE, Van Thiel DH (1995) Arterioportal fistula following liver biopsy. Three cases occurring in liver transplant recipients. Dig Dis Sci 40:1041–1044

    Article  CAS  PubMed  Google Scholar 

  12. Lee SJ, Lim JH, Lee WJ, Lim HK, Choo SW, Choo IW (1997) Transient subsegmental hepatic parenchymal enhancement on dynamic CT: a sign of postbiopsy arterioportal shunt. J Comput Assist Tomogr 21:355–360

    Article  CAS  PubMed  Google Scholar 

  13. Bolognesi M, Sacerdoti D, Bombonato G, Chiesura-Corona M, Merkel C, Gatta A (2000) Arterioportal fistulas in patient with liver cirrhosis: usefulness of color Doppler US for screening. Radiology 216:738–743

    CAS  PubMed  Google Scholar 

  14. Hwang SH, Yu JS, Chung J, Chung JJ, Kim JH, Kim KW (2008) Transient hepatic attenuation difference (THAD) following transcatheter arterial chemoembolization for hepatic malignancy: changes on serial CT examinations. Eur Radiol 18:1596–1603

    Article  PubMed  Google Scholar 

  15. Fredrick MG, McElaney BL, Singer A, Park KS, Paulson EK, McGee SG, Nelson RC (1996) Timing of parenchymal enhancement on dual-phase dynamic helical CT of the liver: how long does the hepatic arterial phase predominate? AJR Am J Roentgenol 166:1305–1310

    Google Scholar 

  16. Murata S, Itai Y, Asato M, Kobayashi H, Nakajima K, Equchi N, Saida Y, Kuramoto K, Tohno E (1995) Effect of temporary occlusion of the hepatic vein on dual blood supply in the liver: evaluation with spiral CT. Radiology 197:351–356

    CAS  PubMed  Google Scholar 

  17. Itai Y, Matsui O (1997) Blood flow and liver imaging. Radiology 202:306–314

    CAS  PubMed  Google Scholar 

  18. Bruix J, Sherman M (2005) Practice Guidelines Committee, American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma. Hepatology 42:1208–1236

    Article  PubMed  Google Scholar 

  19. Rousselot LN, Grossi GE, Slattery J, Rossi P, Conte AJ, Ruzicka FF Jr (1964) Temporary hepatic outflow block with hepatic artery perfusion by anticancer agents. Surg Gynecol Obstet 118:1295–1304

    CAS  PubMed  Google Scholar 

  20. Kanazawa S, Douke T, Yasui K, Mitani M, Sato S, Ajiki M, Kohno Y, Kimoto S, Hiraki Y (1992) Hepatic arteriography under temporary hepatic venous occlusion. Nippon Igaku Hoshasen Gakkai Zasshi 52:1408–1416

    CAS  PubMed  Google Scholar 

  21. Kanazawa S, Wright KC, Kasi LP, Charnsangavej C, Wallace S (1993) Preliminary experimental evaluation of temporary segmental hepatic venous occlusion: angiographic, pathologic, and scintigraphic findings. J Vasc Interv Radiol 6:759–766

    Article  Google Scholar 

  22. Yu JS, Kim KW, Jeong MG, Lee JT, Yoo HS (2002) Nontumorous hepatic arterial-portal venous shunts: MR imaging findings. Radiology 217:750–756

    Google Scholar 

  23. Matsuo M, Kanematsu M, Kondo H, Maeda S, Goshima S, Suenaqa I, Hoshi H (2002) Arterioportal shunts mimicking hepatic tumors with hyperintensity on T2-weighted MR images. J Magn Reson Imaging 15:330–333

    Article  PubMed  Google Scholar 

  24. Yu JS, Lee JH, Chung JJ, Kim JH, Kim KW (2008) Small hypervascular hepatocellular carcinoma: limited value of portal and delayed phases on dynamic magnetic resonance imaging. Acta Radiol 49:735–743

    Article  CAS  PubMed  Google Scholar 

  25. Mori K, Yoshioka H, Itai Y, Okamoto Y, Mori H, Takahashi N, Saida Y (2000) Arterioportal shunts in cirrhotic patients: evaluation of the difference between tumorous and nontumorous arterioportal shunts on MR imaging with superparamagnetic iron oxide. AJR Am J Roentgenol 175:1659–1664

    CAS  PubMed  Google Scholar 

  26. Yamashita Y, Torashima M, Oguni T, Yamamoto A, Harada M, Miyazaki T, Takahashi M (1993) Liver parenchymal changes after transcatheter arterial embolization therapy for hepatoma: CT evaluation. Abdom Imaging 18:352–356

    Article  CAS  PubMed  Google Scholar 

  27. Ward J, Guthrie JA, Sheridan MB, Boyes S, Smith JT, Wilson D, Wyatt JI, Treanor D, Robinson PJ (2008) Sinusoidal obstructive syndrome diagnosed with superparamagnetic iron oxide-enhanced magnetic resonance imaging in patients with chemotherapy-treated colorectal liver metastases. J Clin Oncol 26:4304–4310

    Article  PubMed  Google Scholar 

  28. Chung J, Yu JS, Chung JJ, Kim JH, Kim KW (2008) Hypervascular pseudolesions during dynamic MRI of cirrhotic liver: difference between non-tumorous and peritumoral arterioportal shunts on diffusion-weighted imaging compared to SPIO-enhanced MRI. In: 94th Annual meeting of RSNA, Chicago, USA, 2008. (LL-GI4298-L02)

  29. Hwang SH, Yu JS, Kim KW, Kim JH, Chung JJ (2008) Small hypervascular enhancing lesions on arterial phase images of multiphase dynamic computed tomography in cirrhotic liver: fate and implications. J Comput Assist Tomogr 32:39–45

    Article  PubMed  Google Scholar 

  30. Guzman EA, McCahill LE, Rogers FB (2006) Arterioportal fistulas: introduction of a novel classification with therapeutic implications. J Gastrointest Surg 10:543–550

    Article  PubMed  Google Scholar 

  31. Yu JS, Kim KW, Sung KB, Lee JT, Yoo HS (1997) Small arterial-portal venous shunts: a cause of pseudolesions at hepatic imaging. Radiology 203:737–742

    CAS  PubMed  Google Scholar 

  32. Kim TK, Choi BI, Han JK, Chung JW, Park JH, Han MC (1998) Nontumorous arterioportal shunt mimicking hypervascular tumor in cirrhotic liver: two-phase spiral CT findings. Radiology 208:597–603

    CAS  PubMed  Google Scholar 

  33. Jeong YY, Mitchell DG, Kamishima T (2002) Small (<20 mm) enhancing hepatic nodules seen on arterial phase MR imaging of the cirrhotic liver: clinical implications. AJR Am J Roentgenol 178:1327–1334

    PubMed  Google Scholar 

  34. Takayasu K, Muramatsu Y, Mizuguchi Y, Moriyama N, Okusaka T (2006) Multiple non-tumorous arterioportal shunts due to chronic liver disease mimicking hepatocellular carcinoma: outcomes and the associated elevation of alpha-fetoprotein. Hepatology 21:286–294

    Google Scholar 

  35. Hanafusa K, Ohashi I, Himeno Y, Suzuki S, Shibuya H (1995) Hepatic hemangioma: findings with two-phase CT. Radiology 196:465–469

    CAS  PubMed  Google Scholar 

  36. Itai Y, Ohtomo K, Kokubo T, Okade Y, Yamauchi T, Yoshida H (1988) Segmental intensity differences in the liver on MR images: a sign of intrahepatic portal flow stoppage. Radiology 167:17–19

    CAS  PubMed  Google Scholar 

  37. Gabata T, Matsui O, Terayama N, Kobayashi S, Sanada J (2008) Imaging diagnosis of hepatic metastases of pancreatic carcinomas: significance of transient wedge-shaped contrast enhancement mimicking arterioportal shunt. Abdom Imaging 33:437–443

    Article  PubMed  Google Scholar 

  38. Semelka RC, Hussain SM, Marcos HB, Woosley JT (2000) Perilesional enhancement of hepatic metastases: correlation between MR imaging and histopathologic findings-initial observations. Radiology 215:89–94

    CAS  PubMed  Google Scholar 

  39. Yu JS, Yoon SW, Park MS, Lee JH, Kim KW (2005) Eosinophilic hepatic necrosis: magnetic resonance imaging and computed tomography comparison. J Comput Assist Tomogr 29:765–771

    Article  PubMed  Google Scholar 

  40. Gabata T, Kadoya M, Matsui O, Kobayashi T, Kawamori Y, Sanada J, Terayama N, Kobayashi S (2001) Dynamic CT of hepatic abscesses: significance of transient segmental enhancement. AJR Am J Roentgenol 176:675–679

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. 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

    Jhii-Hyun Ahn, Jeong-Sik Yu, Sung Ho Hwang, Jae-Joon Chung, Joo Hee Kim & Ki Whang Kim

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  1. Jhii-Hyun Ahn
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  2. Jeong-Sik Yu
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Correspondence to Jeong-Sik Yu.

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Ahn, JH., Yu, JS., Hwang, S.H. et al. Nontumorous arterioportal shunts in the liver: CT and MRI findings considering mechanisms and fate. Eur Radiol 20, 385–394 (2010). https://doi.org/10.1007/s00330-009-1542-z

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  • DOI: https://doi.org/10.1007/s00330-009-1542-z

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