Segmental staining on hepatic arteriography as a sign of intrahepatic portal vein obstruction.

Abstract

Peripheral obstruction of intrahepatic portal vein branches was detected by dynamic sequential computed tomography during arterial portography and subsequently confirmed surgically in 9 patients with hepatic neoplasm (7 hepatocellular carcinomas, 1 cholangiocarcinoma, and 1 metastatic lymphadenopathy from gastric carcinoma). In 1 patient, 2 obstructed segments were seen. Eight of these 10 segments showed more dense staining than other regions of the liver during infusion hepatic angiography. Retrograde opacification of the peripheral venules of the obstructed portion was seen in 2 of these 8 segments. This pattern was attributed to trans-sinusoidal or peripheral arterioportal shunting. In 5 cases, the segmental staining obscured the tumor stain, making the tumor appear larger than it actually was or causing it to be missed altogether.

Spontaneous Regression of a Large Hepatocellular Carcinoma with Portal Vein Tumor Thrombi: Report of a Case

“…19 AP shunts are reported to develop due to an interruption in the portal blood flow and arterial compensation. [20][21][22] In our case, portal vein tumor thrombus interrupted the right portal venous blood flow, which might increase the arterial blood flow and help to form the AP shunts. The shunts could also steal the blood supply from the tumor, which might also be one of the possible caused of the observed tumor regression.…”

Hepatocellular carcinoma: Prospective assessments of the T-factor with CT, US, and MR imaging

“…Survival rates of patients with portal thrombi are much poorer than those without portal thrombi [14]. Portal vein tumor thrombus has been reported using noninvasive examinations, including US [23], dynamic CT [11,12,24], and MR [25,26]. US is reportedly a valuable means of detecting portal thrombi, with 64% sensitivity and 98% specificity [23].…”

“…1). As for intrahepatic portal invasion or obstruction, segmental staining by arterioportal shunting, such as transient wedge-shaped enhancement peripheral to the tumor or transient high attenuation of lobar or segmental distribution in the lobe contralateral to that containing the main tumor on CT [11,12], was adopted (Fig. 2).…”

Wedge-Shaped Lesion in the Liver Seen on Postoperative CT

“…Decreased intrahepatic portal flow causes a compensatory increase in arterial flow (3,12), a phenomenon that has been documented as a segmental staining on angiography (9) or as a segmental enhancement in the bolus phase of dynamic CT (6, 8). Portal venous thrombosis has been reported in the literature as a complication of surgery with a thrombus spread from the splenic vein to the portal venous system after splenectomy (1,4).…”