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

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

Research output: Contribution to journalReview articlepeer-review

50 Citations (Scopus)

Abstract

The intrahepatic non-tumorous arterioportal shunt (APS) is one of the important causes of transient hepatic enhancement differences (THED) on dynamic CTor 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, isoattenuation 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.

Original languageEnglish
Pages (from-to)385-394
Number of pages10
JournalEuropean Radiology
Volume20
Issue number2
DOIs
Publication statusPublished - 2010 Feb
Externally publishedYes

Keywords

  • Arterio-portal shunts
  • CT
  • Contrast agent
  • Diffusion-weighted imaging
  • Magnetic resonance (MR)

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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