Capability of multidetector CT to diagnose hepatocellular carcinoma-associated arterioportal shunt

Abstract

Aim: To investigate the capability of multidetector CT (MDCT) to diagnose HCC-associated arterioportal shunt (APS).

Methods: Two hundred and eighty-two patients with HCC received both thin-slice and enhancement MDCT scanning at early hepatic arterial phase, late hepatic arterial phase and portal venous phase, and digital subtract angiography (DSA) examination. Images were analyzed jointly by two experienced radiologists blinded to the opposite examination results, including the existence or not of APS, shunt locations, types and degrees of APS, with or without thrombosis.

Results: There were 56 APS associated with HCC, including 48 central, seven peripheral and one mixed, or 42 severe, seven moderate, seven mild APS. Forty-one severe, seven moderate and central APS were all revealed with MDCT and DSA. Seven mild and peripheral APS were all displayed with MDCT; only five of them displayed DSA, two faint shunt APS associated with massive HCC were missed. One mixed APS was demonstrated as severe combined with mild shunt with both MDCT and DSA.

Conclusion: MDCT could diagnose not only DSA revealed APS, but also missed mild and peripheral APS with DSA due to faint shunt associated with massive HCC, is a simple, effective and noninvasive new technique for diagnosis of HCC-associated APS.

Figure 1

Diffuse pattern of HCC complicated with severe and central APS. Earlier enhancement and stronger opacification of main portal trunk, left and right first-order branches, with thromboses in them; decreased enhancement degrees of HCC foci and spleen, and ascites were also displayed (A, B). DSA finding of the same patient (C).

Figure 2

Massive pattern of HCC associated with mild and peripheral APS. Transient wedge-shaped enhancement anterior to HCC foci at late hepatic arterial phase (A), becoming isoattenuation at portal vein phase (B); decreased enhancement degree of HCC focus was disclosed too. The APS was missed with DSA (not shown).

Figure 3

Massive pattern of HCC accompanied with severe, central and slight, peripheral APS. Earlier enhancement and stronger opacification of main portal trunk, left and right first-order branches, with thromboses in them and transient patchy enhancement at late hepatic arterial phase (A), becoming isoattenuation at portal vein phase (B); decreased enhancement degrees of HCC focus and spleen, cirrhotic liver and ascites were also shown. DSA finding of the same patient (C).