[Multidetector spiral CT findings of arteriovenous fistula associated with hepatocellular carcinoma]

Abstract

Background & objective: In clinical practice, a large number of patients might not undergo transcatheter hepatic angiography as a routine examination, which resulted in missed diagnosis of arteriovenous fistula (AVF) associated with hepatocellular carcinoma (HCC) and loss of embolism opportunity. The study was designed to investigate multidetector spiral CT (MDSCT) findings of AVF associated with HCC, so as to improve its diagnosis and differential diagnosis.

Methods: Thin-slice and dynamic enhancement MDSCT findings of AVF proved by digital subtraction angiography of 56 patients with HCC were analyzed.

Results: MDSCT demonstrated earlier enhancement of main portal trunks and/or the first order branches than superior mesenteric veins or spleen veins (n=31), 1 patient had early enhancement and strong enhancement of left hepatic vein with thromboses in it and upper part of inferior vena cava, 1 patient had transient patchy enhancement peripheral to HCC focus in late hepatic arterial phase and became isoattenuation at portal vein phase among them; stronger opacification of main portal trunks and/or the first order branches than superior mesenteric veins or spleen veins (n=18); earlier enhancement of the second order branches and smaller of portal veins than main portal trunks (n=4), stronger opacification of the second order branches and smaller of portal veins than main portal trunks (n=3), accompanying with transient patchy enhancement (n=3) or wedge-shaped enhancement (n=4) peripheral to HCC foci at late hepatic arterial phase and became isoattenuation at portal vein phase. Enhancement degrees of HCC foci and spleens were all decreased, and enhancement degrees of liver parenchyma without HCC foci were increased and heterogeneous in 49 patients with severe or moderate and central AVF.

Conclusion: There are complex MDSCT findings of AVF associated with HCC, and its main manifestations are earlier enhancement and stronger opacification of portal veins and/or hepatic veins.