CT and MRI Imaging and Interpretation of Hepatic Arterioportal Shunts

Overview

Journal Transl Gastroenterol Hepatol

Publisher AME Publishing Company

Specialty Gastroenterology

Date 2019 Jun 25

PMID 31231701

Citations 10

Authors

Qiushi Wang

Leonidas G Koniaris

Daniel P Milgrom

Aash Patel

Maoqing Hu

Enming Cui

Yu Deng

Fatih Akisik

Affiliations

Soon will be listed here.

Abstract

Hepatic arterioportal shunts (HAPS) occur due to organic or functional fistulization of blood flow between arterial hepatic vasculature and venous portal systems. It is a type of hemodynamic abnormality of the liver being observed increasingly with the use of temporal imaging modalities. HAPS occur due to other underlying hepatic abnormalities including the presence of an underlying tumor or malignancy. When a HAPS is present, the appearance of these abnormalities on imaging studies suggests an underlying abnormality, must be considered atypical even if asymptomatic, and warrants careful evaluation. Over time, and as a function of degree of fistulae, symptoms and potential life-threatening complications may arise from the HAPS. These systemic complications may include the development of portal hypertension, splenomegaly, as well as accelerated metastasis in patients with malignant tumors. This manuscript reviews common underlying conditions associated with HAPS and their radiologic interpretation.

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References

Balci N, Semelka R, Noone T, Siegelman E, de Beeck B, Brown J . Pyogenic hepatic abscesses: MRI findings on T1- and T2-weighted and serial gadolinium-enhanced gradient-echo images. J Magn Reson Imaging. 1999; 9(2):285-90. DOI: 10.1002/(sici)1522-2586(199902)9:2<285::aid-jmri20>3.0.co;2-s. View

Itai Y, Matsui O . 'Nonportal' splanchnic venous supply to the liver: abnormal findings on CT, US and MRI. Eur Radiol. 1999; 9(2):237-43. DOI: 10.1007/s003300050661. View

Choi B, Chung J, Itai Y, Matsui O, Han J, Han M . Hepatic abnormalities related to blood flow: evaluation with dual-phase helical CT. Abdom Imaging. 1999; 24(4):340-56. DOI: 10.1007/s002619900512. View

Sato M, Ishida H, Konno K, Komatsuda T, Hamashima Y, Naganuma H . Longstanding arterioportal fistula after laparoscopic liver biopsy. Abdom Imaging. 1999; 24(4):383-5. DOI: 10.1007/s002619900519. View

Quiroga S, Sebastia M, MOREIRAS M, Pallisa E, Rius J, Alvarez-Castells A . Intrahepatic arterioportal shunt: helical CT findings. Eur Radiol. 1999; 9(6):1126-30. DOI: 10.1007/s003300050805. View

Kjeldsen A, Vase P, Green A . [Hereditary hemorrhagic telangiectasia. A population-based study on prevalence and mortality among Danish HHT patients]. Ugeskr Laeger. 2000; 162(25):3597-601. View

Quiroga S, Sebastia C, Pallisa E, Castella E, Perez-Lafuente M, Alvarez-Castells A . Improved diagnosis of hepatic perfusion disorders: value of hepatic arterial phase imaging during helical CT. Radiographics. 2001; 21(1):65-81; questionnaire 288-94. DOI: 10.1148/radiographics.21.1.g01ja0165. View

Gabata T, Kadoya M, Matsui O, Kobayashi T, Kawamori Y, Sanada J . Dynamic CT of hepatic abscesses: significance of transient segmental enhancement. AJR Am J Roentgenol. 2001; 176(3):675-9. DOI: 10.2214/ajr.176.3.1760675. View

Kim K, Kim T, Han J, Kim A, Lee H, Choi B . Hepatic hemangiomas with arterioportal shunt: findings at two-phase CT. Radiology. 2001; 219(3):707-11. DOI: 10.1148/radiology.219.3.r01ma05707. View

10.

Dakeishi M, Shioya T, Wada Y, Shindo T, Otaka K, Manabe M . Genetic epidemiology of hereditary hemorrhagic telangiectasia in a local community in the northern part of Japan. Hum Mutat. 2002; 19(2):140-8. DOI: 10.1002/humu.10026. View

11.

Choi B, Lee K, Han J, Lee J . Hepatic arterioportal shunts: dynamic CT and MR features. Korean J Radiol. 2002; 3(1):1-15. PMC: 2713981. DOI: 10.3348/kjr.2002.3.1.1. View

12.

Koniaris L, McKillop I, Schwartz S, Zimmers T . Liver regeneration. J Am Coll Surg. 2003; 197(4):634-59. DOI: 10.1016/S1072-7515(03)00374-0. View

13.

Ianora A, Memeo M, Sabba C, Cirulli A, Rotondo A, Angelelli G . Hereditary hemorrhagic telangiectasia: multi-detector row helical CT assessment of hepatic involvement. Radiology. 2003; 230(1):250-9. DOI: 10.1148/radiol.2301021745. View

14.

McKillop I, Moran D, Jin X, Koniaris L . Molecular pathogenesis of hepatocellular carcinoma. J Surg Res. 2006; 136(1):125-35. DOI: 10.1016/j.jss.2006.04.013. View

15.

Okuda K, Musha H, Yoshida T, Kanda Y, Yamazaki T . Demonstration of growing casts of hepatocellular carcinoma in the portal vein by celiac angiography: The thread and streaks sign. Radiology. 1975; 117(2):303-9. DOI: 10.1148/117.2.303. View

16.

Torabi M, Hosseinzadeh K, Federle M . CT of nonneoplastic hepatic vascular and perfusion disorders. Radiographics. 2008; 28(7):1967-82. DOI: 10.1148/rg.287085067. View

17.

Ahn J, Yu J, Hwang S, Chung J, Kim J, Kim K . Nontumorous arterioportal shunts in the liver: CT and MRI findings considering mechanisms and fate. Eur Radiol. 2009; 20(2):385-94. DOI: 10.1007/s00330-009-1542-z. View

18.

Haratake J, Hisaoka M, Yamamoto O, Horie A . Morphological changes of hepatic microcirculation in experimental rat cirrhosis: a scanning electron microscopic study. Hepatology. 1991; 13(5):952-6. View

19.

DiPasco P, Misra S, Koniaris L . Conformational technique for non-anatomic resection of liver lesions. J Gastrointest Surg. 2012; 16(10):1972-5. DOI: 10.1007/s11605-012-1957-8. View

20.

Plauchu H, de Chadarevian J, Bideau A, Robert J . Age-related clinical profile of hereditary hemorrhagic telangiectasia in an epidemiologically recruited population. Am J Med Genet. 1989; 32(3):291-7. DOI: 10.1002/ajmg.1320320302. View