Yu J S, Kim K W, Sung K B, Lee J T, Yoo H S
Department of Diagnostic Radiology, Yonsei University College of Medicine, Seoul, South Korea.
Radiology. 1997 Jun;203(3):737-42. doi: 10.1148/radiology.203.3.9169697.
To compare hepatic angiographic findings of small arterial-portal venous shunts with those of other imaging modalities, and to determine whether these shunts are related to hepatocellular carcinoma.
At hepatic angiography in 223 patients, small arterial-portal venous shunts not directly related to hepatocellular carcinoma and focal areas of parenchymal contrast material enhancement more than 1 cm in diameter were found in 28 patients. These 28 patients were prospectively evaluated with computed tomography (CT) during arterial portography (CTAP) (n = 12), CT after iodized oil administration (n = 23), intraoperative ultrasonography (n = 5), or follow-up hepatic angiography (n = 13). Magnetic resonance (MR) images (n = 10) and dynamic CT scans (n = 4) in these patients were retrospectively reviewed.
Arterial-portal venous shunts noted at angiography manifested as perfusion defects at CTAP in 10 patients and as an area of arterial contrast enhancement at dynamic CT in three patients. No lesion was seen at MR imaging, and no persistent iodized oil uptake was seen at CT. There was no evidence of hepatocellular carcinoma tumor growth around the shunts at follow-up angiography, and no tumor was present at surgery.
Understanding of the hemodynamic changes caused by these small shunts can aid in the interpretation of vascular imaging findings.
比较小动脉-门静脉分流的肝脏血管造影表现与其他成像方式的表现，并确定这些分流是否与肝细胞癌有关。
在223例患者的肝脏血管造影中，28例患者发现了与肝细胞癌无直接关系的小动脉-门静脉分流以及直径超过1 cm的实质对比剂强化灶。对这28例患者进行前瞻性评估，采用动脉门静脉造影CT（CTAP）（n = 12）、碘油注射后CT（n = 23）、术中超声检查（n = 5）或随访肝脏血管造影（n = 13）。对这些患者的磁共振（MR）图像（n = 10）和动态CT扫描（n = 4）进行回顾性分析。
血管造影时发现的动脉-门静脉分流在10例患者的CTAP上表现为灌注缺损，在3例患者的动态CT上表现为动脉期对比剂强化区。MR成像未见病变，CT未见碘油持续摄取。随访血管造影时，分流周围未见肝细胞癌肿瘤生长迹象，手术时也未发现肿瘤。
了解这些小分流引起的血流动力学变化有助于解释血管成像结果。
