Study on hepatocelluar carcinoma-associated hepatic arteriovenous shunt using multidetector CT

AIM: To investigate multidetector CT (MDCT) findings of hepatocelluar carcinoma (HCC)-associated hepatic arteriovenous shunt (HAVS) and to evaluate their clinical significance. METHODS: Thin-slice and dynamic enhancement MDCT of HAVS was performed on 56 patients with HCC. MDCT findings, including those of portal veins, hepatic veins, superior mesenteric veins, splenic veins, HCC loci, liver parenchyma without HCC loci, spleens, and thromboses in portal veins and hepatic veins, were all confirmed by digital subtract angiography and analyzed. RESULTS: MDCT demonstrated earlier enhancement of main portal trunks and/or the first order branches than that of superior mesenteric veins or splenic veins (n=-31). One patient had strong early enhancement of left hepatic vein with thromboses in left hepatic vein and upper part of inferior vena cava and 1 patient had transient patchy enhancement peripheral to HCC loci in late hepatic arterial phase among them. It demonstrated stronger opacification of main portal trunks and/or the first order branches than that of superior mesenteric veins or splenic veins (n=18), and earlier enhancement of the second order and smaller branches of portal veins than that of main portal trunks (n=4), stronger opacification of the second order and smaller branches of portal veins than that of main portal trunks (n=3), with transient patchy enhancement (n=3) or wedge-shaped enhancement (n=4) peripheral to HCC foci in late hepatic arterial phase. Enhancement degree of HCC loci was all decreased. As for 49 patients with severe or moderate shunts, enhancement degree of liver parenchyma without HCC loci was increased with heterogeneous density, but enhancement degree of spleens was decreased. There were thromboses in main portal trunks and/or the first order branches in 32 patients. CONCLUSION: The main MDCT findings of HCC-associated HAVS are earlier enhancement and stronger opacification of portal veins and/or hepatic veins. Understanding of these findings will contribute to the diagnosis and prognosis of the disease and improve therapy for the patients.

Relationship between encephalopathy and portal vein-vena cava shunt:Value of computed tomography during arterial portography

AIM: TO assess the value of computed tomography during arterial portography (CTAP) in portal vein-vena cava shunt,and analysis of the episode risk in encephalopathy.METHODS: Twenty-nine patients with portal-systemic encephalopathy due to portal hypertension were classified by West Haven method into grade Ⅰ(29 cases), gradeⅡ(16 cases), grade Ⅲ(10 cases), grade Ⅳ( 4 cases). All the patients were scanned by spiraI-CT. Plane scans, artery phase and portal vein phase enhancement scans were performed, and the source images were thinly reconstructed to 1.25 mm. We reconstructed the celiac trunk, portal vein,inferior vena cava and their branches and subjected them to three-dimensional vessel analysis by volume rendering(VR) technique and multiplanar volume reconstruction (MPVR) technique. The blood vessel reconstruction technique was used to evaluate the scope and extent of portal vein-vena cava shunt, portal vein emboli and the fistula of hepatic artery- portal vein. The relationship between the episode risk of portal-systemic encephalopathy and the scope and extent of portal vein-vena cava shunt,portal vein emboli and fistula of hepatic artery- portal vein was studied.RESULTS: The three-dimensional vessel reconstruction technique of spiraI-CT could display celiac trunk, portal vein,inferior vena cava and their branches at any planes and angles and the scope and extent of portal vein-vena cavashunt, portal vein emboli and the fistula of hepatic artery- portal vein. In twenty-nine patients with portal-systemicencephalopathy, grade Ⅰ accounted for 89.7% esophageal varices, 86.2% paragastric varices; grade Ⅱ accounted for 68.75% cirsomphalos, 56.25% paraesophageal varices,62.5% retroperitoneal varices and 81.25% dilated azygos vein; grade Ⅲ accounted for 80% cirsomphalos, 60%paraesophageal varices, 70% retroperitoneal varices, 90% dilated azygos vein, and part of the patients in grades Ⅱand Ⅲ had portal vein emboli and fistula of hepatic arteryportal vein; grade Ⅳ accounted for 75% dilated left renal vein, 50% paragallbladder varices, all the patients had fistula of hepatic artery- portal vein.CONCLUSION: The three-dimensional vessel reconstruction technique of spiraI-CT can clearly display celiac trunk, portal vein, inferior vena cava and their branches at any planes and angles and the scope and extent of portal vein-vena cava shunt. The technique is valuable for evaluating the episode risk in portal-systemic encephalopathy.

Fathal pulmonary hypertension after distal splenorenal shunt in schistosomal portal hypertension

Mansonic schistosomiasis is the main cause of portal hypertension in Brazil. Hepatosplenic (HS) form is manifested by hepatomegaly mainly on the left hepatic lobe associated with large splenomegaly and bleeding due to esophageal varices with high mortality rates.

Study of the Capability of Multislice CT to Diagnose Arterioportal Shunt in Hepatocellular Carcinoma

OBJECTIVE This study was designed to evaluate the capability of multislice CT (MSCT) for the diagnosis of arterioportal shunt (APS) associated with hepatocellular carcinoma (HCC).METHODS A total of 282 patients with HCC were examined by both enhanced thin slice MSCT scanning and digital subtraction angiography (DSA) in the early hepatic-arterial phase, late hepatic-arterial phase and portal-venous phase. The criteria for diagnosis of APS were: (1) Earlier enhancement or stronger opacification of the main portal trunk and/or the first order branches compared with that of the superior mesenteric vein or splenic vein; (2) Earlier enhancement or stronger opacification of the second order and smaller portal venous branches compared with that of the main portal trunk. The presence and degree of APS demonstrated with MSCT and DSA were analyzed by a double-blind method.RESULTS In 282 HCC patients, 56 were complicated with APS. MSCT demonstrated central APS in 48 patients of which 41 had a severe, and 7 a moderate shunt. One revealed no APS by DSA due to a giant HCC focus.Among the 7 patients with mild peripheral APS, 2 lesions were not detected by DSA due to faint shunt, and one lesion in the patient with a mixed APS was detected by both MSCT and DSA.CONCLUSION MSCT is a simple, effective and noninvasive new technique for the diagnosis of APS associated with HCC.