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

 Jhii-Hyun Ahn  ;  Jeong-Sik Yu  ;  Sung Ho Hwang  ;  Jae-Joon Chung  ;  Joo Hee Kim  ;  Ki Whang Kim 
 EUROPEAN RADIOLOGY, Vol.20(2) : 385-394, 2010 
Journal Title
Issue Date
Arteriovenous Fistula/diagnosis* ; Diagnosis, Differential ; Hepatic Artery/abnormalities* ; Hepatic Artery/diagnostic imaging ; Hepatic Artery/pathology ; Humans ; Liver Neoplasms/diagnosis ; Magnetic Resonance Imaging/methods* ; Portal Vein/abnormalities* ; Portal Vein/diagnostic imaging ; Portal Vein/pathology ; Tomography, X-Ray Computed/methods* ; Vascular Neoplasms/diagnosis
Arterio-portal shunts ; CT ; Magnetic resonance (MR) ; Contrast agent ; Diffusion-weighted imaging
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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1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Ki Whang(김기황)
Kim, Joo Hee(김주희) ORCID logo https://orcid.org/0000-0001-5383-3602
Ahn, Jhii Hyun(안지현)
Yu, Jeong Sik(유정식) ORCID logo https://orcid.org/0000-0002-8171-5838
Chung, Jae Joon(정재준) ORCID logo https://orcid.org/0000-0002-7447-1193
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