Small Arterioportal Shunt: A Pseudolesion Mimicking Hepatocellular Carcinoma in Angiography

Yu, Jeong Sik; Kim, Ki Whang; Sung, Kyu Bo

Abstract

PURPOSE
To document the findings of a small arterioportal(AP) shunt on hepatic angiography through the various diagnostic modalities, and to determine whether this shunt is related to hepatocelluar carcinoma.
MATERIALS AND METHODS
During the hepatic angiography in 223 patients, a small AP shunt and subsequent focalparenchymal staining more than 1cm in diameter were found in 28 patients. We compared this angiographic abnormality using MR imaging(n=10), CTAP(n=12), iodized-oil CT(n=23), intraoperative ultrasonography(n=5) and follow-up hepatic angiography(n=11), as well as with conventional ultrasonography and CT scan.
RESULTS
Arterioportal shunts noted on angiographic study matched with perfusion defects noted in CTAP(10/12) and also with the area of arterial enhancement seen on dynamic CT scan(3/4). In no case was a lesion found on MR and no Lipiodol uptake was seen on CT. There was no evidence of tumor growth around the AP shunts on follow-up angiographies, andno tumor was found during surgery.
CONCLUSION
A small AP shunt was not related to the presence of a tumor. Ifthe hemodynamic changes resulfing from a small AP shunt are understood, confusion can be avoided in the interpretation of vascular imaging including CTAP and dynamic CT.