Preliminary Experimental Evaluation of Temporary Segmental Hepatic Venous Occlusion: Angiographic, Pathologic, and Scintigraphic Findings

Kanazawa, Susumu; Wright, Kenneth C.; Kasi, Leela P.; Charnsangavej, Chusilp; Wallace, Sidney

doi:10.1016/s1051-0443(93)71969-7

Cited by 27 publications

(16 citation statements)

References 18 publications

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“…5). According to previous studies of hepatic venous occlusion, 5,7,9,11,12,21 we can summarize the temporal changes of hepatic congested segment as follows: (1) immediately after hepatic venous occlusion, sinusoidal stagnation occurs, followed by a decrease in both arterial and hepatopetal portal flow; 21 (2) a decrease in hepatopetal portal flow induces a compensatory increase in arterial flow; 7,21 (3) after the sinusoids are fully expanded with blood and their pressure exceeds the portal pressure, most of increased arterial flow then drains into the portal vein via the transplexal routes, although it also partially drains into the intrahepatic venovenous collaterals; 5,7,9,11,12 and (4) the development of venovenous collaterals decompresses the sinusoidal congestion and finally restores the hemodynamics alteration induced by hepatic venous occlusion. 9,21Y23 Although altered hemodynamics 1 and 2 occur within several seconds to minutes after hepatic vein ligation, altered hemodynamics 3 may last several hours or days.…”

Section: Discussionmentioning

confidence: 99%

Hepatic Venous Congestion After Right-lobe Living-donor Liver Transplantation

Park¹,

Lee²,

Kim³

et al. 2007

Journal of Computer Assisted Tomography

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Section: Discussionmentioning

confidence: 99%

Hepatic Venous Congestion After Right-lobe Living-donor Liver Transplantation

Park¹,

Lee²,

Kim³

et al. 2007

Journal of Computer Assisted Tomography

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“…When the hepatic vein is acutely obstructed, the postsinusoidal pressure increases with stasis of blood within the sinusoids, hepatic arterial flow drains into the portal vein, and the portal flow is reversed [8,61]. Murata [62] temporarily occluded hepatic veins in patients with hepatic tumors and found that acute hepatic venous occlusion produces a well-demarcated, wedge-shaped area of hypoattenuation on CTAP and/or hyperattenuation on CTA.…”

Section: Hepatic Veinmentioning

confidence: 99%

“…He also clarified the extent of parenchyma affected in the individual hepatic vein with the use of helical CT. The presence of inferior right hepatic veins may modify the affected site of the right hepatic vein to different degrees according to its size and number [61]. In the case of dual-phase helical CT after intravenous contrast enhancement, the findings may be unpredictable because portal venous enhancement is much stronger than arterial enhancement, and it is difficult to obtain images at the purely arterial phase (Fig.…”

Section: Hepatic Veinmentioning

confidence: 99%

Hepatic abnormalities related to blood flow: evaluation with dual-phase helical CT

et al. 1999

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Dual-phase contrast-enhanced helical computed tomography (CT) has become a popular technique for the detection and characterization of hepatic lesions [1][2][3][4][5][6][7]. In addition to improved detection of small hypervascular lesions, dual-phase helical CT can provide useful information for the differential diagnosis of various liver lesions by showing contrast enhancement features on scans obtained during the hepatic arterial (more precisely, arterial-dominant) phase (HAP) and the portal venous phase (PVP). Furthermore, careful analysis of the patterns of contrast enhancement at both the HAP and PVP of dualphase helical CT is helpful in the evaluation of hepatic hemodynamic alterations [6,7]. Therefore, at many institutions including ours, dual-phase helical CT is routinely performed for the evaluation of all hepatic lesions [5][6][7][8].Hepatic abnormalities related to blood flow include normal vascular anatomic variants; vascular obstructions such as portal venous obstruction, hepatic venous obstruction, hepatic arterial obstruction, and mediastinal or thoracic venous obstruction; focal liver lesions such as arterioportal shunt, hypervascular tumor, and inflammatory processes; and uncertain etiologies [8 -10].The use of helical CT is apparently increasing the chances of encountering these abnormalities in daily practice, and the importance of knowledge of the hemodynamics of hepatic blood flow has been increasing. Thus, familiarity with the helical CT appearances of different types of hepatic abnormalities related to blood flow allows the radiologist to separate clinically insignificant flow phenomena from perfusion disorders caused by underlying parenchymal or vascular disease.In this article, we discuss how hepatic blood flow can affect the appearance of hepatic abnormalities on dualphase helical CT scans. Physiology of hepatic blood flowThe liver has a dual supply of the portal vein and hepatic artery. The hepatic artery delivers about 20 -25% of blood to the liver, whereas the portal vein delivers about 75-80% [8]. These two hepatic vessels have mutual communication systems including transvasal and transplexal routes [10]. Among them, the most prominent route is transplexal via peribiliary plexus.These routes play an important role when hepatic vessels are compromised. Therefore, knowledge of mutual communication systems of hepatic vessels is essential to understand the pathophysiology and hemodynamics of hepatic abnormalities related to blood flow (Fig. 1). Dual-phase helical CT techniquesWith the advent of helical CT technology, it has become possible to image the liver during the HAP and PVP of enhancement after a single bolus infusion of iodinated contrast material. This dual-phase helical technique is ideally suited to imaging the liver, which is unique among abdominal organs by virtue of its dual blood supply [5,7]. Helical CT images are obtained during a 20 -30-s breath-holding. Scan parameters are collimation, 5-10 mm; pitch, 1-1.5; 120 -140 kV; 150 -290 mA; and rotation time, 0.75-1 s. Images...

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“…In the patients with localized decrease of portal venous flow from venous injury or thrombosis in the portal or hepatic vein, transplexal APS could produce more localized THED without direct filling of contrast material in the shunt vessels ( Fig. 7) [16,[19][20][21].…”

Section: Dynamic Ctmentioning

confidence: 99%

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

Ahn

Hwang

et al. 2009

Eur Radiol

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

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Preliminary Experimental Evaluation of Temporary Segmental Hepatic Venous Occlusion: Angiographic, Pathologic, and Scintigraphic Findings

Cited by 27 publications

References 18 publications

Hepatic Venous Congestion After Right-lobe Living-donor Liver Transplantation

Hepatic Venous Congestion After Right-lobe Living-donor Liver Transplantation

Hepatic abnormalities related to blood flow: evaluation with dual-phase helical CT

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

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