Arterioportal Shunt: Prevalence in Small Hemangiomas versus That in Hepatocellular Carcinomas 3 cm or Smaller at Two-Phase Helical CT

Byun, Jae Ho; Kim, Tae Kyoung; Lee, Choong Wook; Lee, Jeong Kyong; Kim, Ah Young; Kim, Pyo Nyun; Ha, Hyun Kwon; Lee, Moon Gyu

doi:10.1148/radiol.2322030966

Cited by 54 publications

(29 citation statements)

References 28 publications

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“…[30][31][32][33] However, arterioportal shunts have been observed in hepatic hemangiomas not only through use of CEUS 25 but also through use of multiphase helical CT and MRI in a significant percentage of hemangiomas (19%-26%), [34][35][36][37][38][39] which is in the range reported in our study. One possible explanation for rapidly enhancing small hemangiomas is a hyperdynamic status with large arterial inflow, rapid tumoral enhancement, and consequently, large and rapid outflow, which seems to result in early opacification of the draining portal vein via shunts 39 (Fig.…”

Section: Discussionsupporting

confidence: 63%

Contrast‐enhanced ultrasound of histologically proven liver hemangiomas†

et al. 2007

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Differentiation of small and atypical hemangiomas from other hepatic masses using imaging methods can be difficult, especially in patients with underlying malignant disease. Therefore, contrast-enhanced ultrasound was assessed in patients with histologically confirmed hemangiomas with respect to contrast-enhancing kinetics and tumor characteristics. In 58 patients with indeterminate hepatic lesions demonstrated with at least 2 imaging methods (ultrasound/computed tomography/magnetic resonance imaging), ultrasound-guided liver biopsy revealed hemangioma. In all patients a hepatic neoplasm had been suspected because of underlying malignant disease (n ‫؍‬ 41), liver cirrhosis (n ‫؍‬ 15), or growth of the lesion (n ‫؍‬ 2). All patients underwent nonlinear, low mechanical index real-time contrast-enhanced ultrasound scanning with bolus injections of SonoVue. Peripheral nodular arterial enhancement was detected in 43 patients (74%), whereas the typical metastatic peripheral rim-like enhancement was not observed at all. Strong homogenous arterial enhancement was found in 9 of 58 (16%) patients. In 6 patients (10%), the arterial contrast enhancement pattern could not be determined because of the very small size of the lesions or fibrotic nodules. Forty-five (78%) of the hemangiomas showed homogenous centripetal filling within 180 seconds. Conclusion: Contrast-enhanced ultrasound demonstrates typical hemangioma imaging characteristics, that is, peripheral nodular contrast enhancement and iris-diaphragm sign in a high percentage of patients with undetermined lesions. This technique may therefore improve noninvasive functional characterization and differentiation of hemangiomas. (HEPATOLOGY 2007;45:1139-1145

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Section: Discussionsupporting

confidence: 63%

Contrast‐enhanced ultrasound of histologically proven liver hemangiomas†

et al. 2007

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“…The arterioportal shunt of a hemangioma is somewhat different from that of an HCC because most HCCs accompanying an arterioportal shunt tend to be large tumors with portal vein invasion. In small hepatic lesions < 3 cm, the incidence of arterioportal shunt is significantly higher in a small hemangioma than in a small HCC [20] . Small hemangioma with large arterial flow and flash filling has APS and shows HPD more frequently than a large one [17,18] .…”

Section: Arterioportal Shuntsmentioning

confidence: 83%

Hepatic perfusion disorders: Etiopathogenesis and related diseases

Hui

Zhang²

2006

WJG

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In this article, we have reviewed the hepatic perfusion d i s o r d e r ( H P D ) , e t i o p a t h o g e n e s i s o f H P D a n d corresponding diseases. Review of the literature was based on computer searches (PubMed, Index Medicus) and personal experiences. We considered HPD reflects perfusion differences due to redistribution of arterial blood flow among segments, subsegments and lobes of the liver. The plain CT scan findings of HPD manifests as triangular or wedge-shaped areas of low attenuation. On contrast-enhanced CT scan, HPD manifests multiple (or single) transient wedge-shaped, rotundloid or irregular appearance, homogeneous hyperattenuation (in less cases, hypoattenuation) during the hepatic arterial phase (HAP) and isoattenuated or slightly hyperattenuated areas during the portal arterial phase. Dynamic enhanced magnetic resonance (MR) features are similar to enhanced CT scan. Angiographic findings include non-opacification of portal vein on portograms or wedge-shaped segmental staining in arterial and parenchymal phases on hepatic angiograms. The causes of HPD are arterioportal shunts (APS), intrahepatic vascular compressions and portal vein occlusion, steal phenomenon by hypervascular tumors, vascular variations and any other unknown reasons. It is very important for radiologists to be familiar with the various appearances of HPD to avoid false-positive diagnosis of pseudolesions and not to overestimate the extent of the disease.

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“…3), mimicking other either benign or malignant hypervascular liver tumors (Kim et al 2001). Transient peritumoral enhancement during the HAP is frequently observed due to associated arterio-venous shunt (Byun et al 2004; Fig. 3).…”

Section: Hepatic Cavernous Hemangiomamentioning

confidence: 95%