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

Abstract

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 foci, liver parenchyma without HCC foci, 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 foci 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 foci was all decreased. As for 49 patients with severe or moderate shunts, enhancement degree of liver parenchyma without HCC foci 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.

Figure 1

Nodular pattern of HCC with mild and peripheral HAVS. A: Transient patchy enhancement lateral to HCC foci at late hepatic arterial phase; B: becoming isoattenuation at portal vein phase.

Figure 2

Nodular pattern of HCC accompanied by mild and peripheral HAVS. Stronger opacification of the third order portal vein branches than that of main portal trunk at late hepatic arterial phase with transient wedge-shaped enhancement lateral to HCC foci (A, B).

Figure 3

Massive and nodular pattern of HCC associated with severe and central HAVS. Earlier enhancement and stronger opacification of main portal trunk and the left and right first order branches with thromboses in them were shown. Enhancement degree of HCC foci was decreased, and enhancement degree of liver parenchyma without HCC foci was increased with heterogeneous density (A and B). DSA finding of the same patient (C).

Figure 4

Massive pattern of HCC complicated with severe, central and slight, peripheral HAVS. Earlier enhancement and stronger opacification of main portal trunk with small thromboses in it were seen, with patchy enhancement internal and lateral to HCC foci. A: Enhancement degrees of HCC foci and spleen were decreased, enhancement degree of liver parenchyma without HCC foci was increased with heterogeneous density; B: DSA finding of the same patient.