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Hepatic arterioportal shunts: dynamic CT and MR features.

Choi BI, Lee KH, Han JK, Lee JM - Korean J Radiol (2002 Jan-Mar)

Bottom Line: With the increased temporal resolution available in dynamic computed tomography (CT) and magnetic resonance imaging (MRI), hepatic arterioportal shunts are now more frequently encountered than in the past.The condition occurs in various hepatic diseases in which portal or hepatic venous flow is compromised.Familiarity with the pathophysiology of arterioportal shunt also allows investigation of the hepatic hemodynamic changes occurring in various hepatic diseases.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, College of Medicine, Seoul National University Hospital, 28 Yongon-dong, Chongno-gu, Seoul 110-744, Korea. choibi@radcom.snu.ac.kr

ABSTRACT
With the increased temporal resolution available in dynamic computed tomography (CT) and magnetic resonance imaging (MRI), hepatic arterioportal shunts are now more frequently encountered than in the past. The condition occurs in various hepatic diseases in which portal or hepatic venous flow is compromised. The underlying mechanism and the degree of shunt affect its appearance at dynamic imaging. The dynamic CT and MRI findings have been summarized as early enhancement of peripheral portal veins, and wedge-shaped transient parenchymal enhancement during the hepatic arterial phase. Recognition of arterioportal shunt can suggest the presence of a previously unsuspected disorder and avoids false-positive diagnosis or overestimation of a hepatic disease. Familiarity with the pathophysiology of arterioportal shunt also allows investigation of the hepatic hemodynamic changes occurring in various hepatic diseases.

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Related in: MedlinePlus

Arterioportal fistula in a 42-year-old man with symptoms of portal hypertension such as recurrent gastrointestinal bleeding and ascites. He had undergone percutaneous liver biopsy seven years earlier.A. A maximum-intensity projection image of CT scans obtained during hepatic arterial phase shows hyperattenuation of the right lobe of the liver, with an enlarged hepatic artery (arrowheads).B. Celiac angiogram demonstrates that shunted arterial flow from the fistulous point (arrow) is instantaneously drained into portal branches in the entire right lobe of the liver. Subsequent embolization of the fistula relieved this patient's symptoms.
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Figure 3: Arterioportal fistula in a 42-year-old man with symptoms of portal hypertension such as recurrent gastrointestinal bleeding and ascites. He had undergone percutaneous liver biopsy seven years earlier.A. A maximum-intensity projection image of CT scans obtained during hepatic arterial phase shows hyperattenuation of the right lobe of the liver, with an enlarged hepatic artery (arrowheads).B. Celiac angiogram demonstrates that shunted arterial flow from the fistulous point (arrow) is instantaneously drained into portal branches in the entire right lobe of the liver. Subsequent embolization of the fistula relieved this patient's symptoms.

Mentions: Whereas high-flow APS shows a variable amount of retrograde flow through the portal vein (Fig. 3), sometimes with reflux to the contralateral side or collaterals at HAP imaging, low-flow APS involving smaller portal branches is often seen at dynamic CT only as a THAD (7, 18, 21). Whereas high-flow APS is usually associated with organic shunt through macroscopic arterioportal fistulas or along the transvasal route (i.e. HCC), low-flow APS is associated with functional shunt which follows the transplexal or transsinusoidal route, though there are exceptions and considerable overlap (1, 16).


Hepatic arterioportal shunts: dynamic CT and MR features.

Choi BI, Lee KH, Han JK, Lee JM - Korean J Radiol (2002 Jan-Mar)

Arterioportal fistula in a 42-year-old man with symptoms of portal hypertension such as recurrent gastrointestinal bleeding and ascites. He had undergone percutaneous liver biopsy seven years earlier.A. A maximum-intensity projection image of CT scans obtained during hepatic arterial phase shows hyperattenuation of the right lobe of the liver, with an enlarged hepatic artery (arrowheads).B. Celiac angiogram demonstrates that shunted arterial flow from the fistulous point (arrow) is instantaneously drained into portal branches in the entire right lobe of the liver. Subsequent embolization of the fistula relieved this patient's symptoms.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2713981&req=5

Figure 3: Arterioportal fistula in a 42-year-old man with symptoms of portal hypertension such as recurrent gastrointestinal bleeding and ascites. He had undergone percutaneous liver biopsy seven years earlier.A. A maximum-intensity projection image of CT scans obtained during hepatic arterial phase shows hyperattenuation of the right lobe of the liver, with an enlarged hepatic artery (arrowheads).B. Celiac angiogram demonstrates that shunted arterial flow from the fistulous point (arrow) is instantaneously drained into portal branches in the entire right lobe of the liver. Subsequent embolization of the fistula relieved this patient's symptoms.
Mentions: Whereas high-flow APS shows a variable amount of retrograde flow through the portal vein (Fig. 3), sometimes with reflux to the contralateral side or collaterals at HAP imaging, low-flow APS involving smaller portal branches is often seen at dynamic CT only as a THAD (7, 18, 21). Whereas high-flow APS is usually associated with organic shunt through macroscopic arterioportal fistulas or along the transvasal route (i.e. HCC), low-flow APS is associated with functional shunt which follows the transplexal or transsinusoidal route, though there are exceptions and considerable overlap (1, 16).

Bottom Line: With the increased temporal resolution available in dynamic computed tomography (CT) and magnetic resonance imaging (MRI), hepatic arterioportal shunts are now more frequently encountered than in the past.The condition occurs in various hepatic diseases in which portal or hepatic venous flow is compromised.Familiarity with the pathophysiology of arterioportal shunt also allows investigation of the hepatic hemodynamic changes occurring in various hepatic diseases.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, College of Medicine, Seoul National University Hospital, 28 Yongon-dong, Chongno-gu, Seoul 110-744, Korea. choibi@radcom.snu.ac.kr

ABSTRACT
With the increased temporal resolution available in dynamic computed tomography (CT) and magnetic resonance imaging (MRI), hepatic arterioportal shunts are now more frequently encountered than in the past. The condition occurs in various hepatic diseases in which portal or hepatic venous flow is compromised. The underlying mechanism and the degree of shunt affect its appearance at dynamic imaging. The dynamic CT and MRI findings have been summarized as early enhancement of peripheral portal veins, and wedge-shaped transient parenchymal enhancement during the hepatic arterial phase. Recognition of arterioportal shunt can suggest the presence of a previously unsuspected disorder and avoids false-positive diagnosis or overestimation of a hepatic disease. Familiarity with the pathophysiology of arterioportal shunt also allows investigation of the hepatic hemodynamic changes occurring in various hepatic diseases.

Show MeSH
Related in: MedlinePlus