Multisegmental high-intensity change on T2-weighted MR imaging is a more sensitive indicator of outcomes than T1-weighted signal changes because of its higher frequency in patients with advanced myelopathy.

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A 54-year-old man had an asymptomatic elevation of cytolysis-related enzymes, GGT, and alkaline phosphatase, detected at a routine laboratory study. The patient reported no alcohol abuse, no history of liver disease, and no constitutional syndrome. Physical examination showed a good general status, normal colored skin and mucosas, and no stigmata of chronic liver disease. The abdomen was soft, depressible, and slightly tender in the right hypochondrium with hepatomegaly of three finger-widths. There were no signs or symptoms of ascites. A laboratory study for liver disease was also negative. An initial ultrasound study showed the presence of multiple, well-defined anechoic lesions with posterior acoustic enhancement, distributed across the hepatic parenchyma; the kidneys were free of lesions. The study was completed with a liver MRI, which showed hypointense lesions resembling cerebrospinal fluid (CSF) on T1-weighted images, whereas in T2-weighted images with fat saturation lesions were hyperintense (Figs. 1 and 2).

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A 38-year-old male patient with HVC-related chronic liver disease refered to our Unit for percutaneous liver biopsy. Physical exam, hemogram and coagulation tests were unremarkable. Two hours after the procedure he refered an intense epigastric pain irradiated to right upper quadrant with nausea. Abdominal palpation revealed deep pain in right upper quadrant without peritoneal signs. Chest and plain abdominal X-ray did not show pneumothorax neither pneumoperitoneum, and blood tests evidenced no changes in hemoglobine concentration. Abdominal ultrasound showed an intravesicular clot without bile duct dilation or intraperitoneal free liquid. Pain killer were given to the patient with a significative improvement. Before hospital discharge the patient developed slight scleral jaundice but no other complications. On follow-up there were no new complications and jaundice solved spontaneously. Two years after the complication, an abdominal ultrasound revealed a right hepatic lobe tubular vascular image with a turbulent flow by doppler with no abnormalities in hepatic veins neither portal vein blood flow (Fig. 1). A trifasic-CT scan evidenced a prompt arterial filling of such vascular tract that depended upon the right branch of the hepatic artery with a contrast-media captation in the surrounding parenchyma (Fig. 2). DISCUSSION Liver biopsy is safe when performed by experienced operators. The mortality rate following percutaneous liver biopsy is approximately 1 in 10.000 to 12.000 (1). Sixty percent of complications occur within two hours of the procedure and 96% within 24 hours. Complications after percutaneous liver biopsy can be classified as minor or mayor. Minor complications include transient localized discomfort at the biopsy site, pain sufficient to require analgesia, and mild transient hypotension. Significant intraperitoneal hemorrhage is the most serious bleeding complication of liver biopsy (2). Postbiopsy arterioportal fistula was first described by Preger in 1967 (3). In the portal tract, the three vessel systems exist in close proximity (4). An arterioportal fistula occurs when liver biopsy produces an abnormal comunication between the hepatic artery an the portal vein (5). Okuda et al. demonstrated on celiac angiograms in 5.4% fistula arteriovenous intrahepatic in 93 patients having had needle biopsy previously but no other transhepatic procedure.