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Arterioportal Shunts in Cirrhotic Patients

Evaluation of the Difference Between Tumorous and Nontumorous Arterioportal Shunts on MR Imaging with Superparamagnetic Iron Oxide

Kensaku Mori1, Hiroshi Yoshioka, Yuji Itai, Yoshikazu Okamoto, Harushi Mori, Nobuyuki Takahashi and Yukihisa Saida

1 All authors: Department of Radiology, Tsukuba University Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576 Japan.



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  		Fig. 1A. —68-year-old man with hepatocellular carcinoma, arising from liver cirrhosis due to hepatitis C, and both tumorous and nontumorous arterioportal shunts. CT image obtained during arterial dominant phase shows fan-shaped enhancement periphery of hypervascular tumor located in segment VII, which was judged to be tumorous arterioportal shunt. There is another enhanced area in segment III that includes highly enhanced peripheral portal branch within it, which was considered to be nontumorous arterioportal shunt. The arterioportal shunt in segment III cannot be detected on any MR images shown here.

 


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  		Fig. 1B. —68-year-old man with hepatocellular carcinoma, arising from liver cirrhosis due to hepatitis C, and both tumorous and nontumorous arterioportal shunts. T2-weighted turbo spin-echo MR image obtained without superparamagnetic iron oxide (B) and T2-weighted turbo spin-echo MR image obtained with superparamagnetic iron oxide (C) show tumorous arterioportal shunt as slightly high intensity area.

 


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  		Fig. 1C. —68-year-old man with hepatocellular carcinoma, arising from liver cirrhosis due to hepatitis C, and both tumorous and nontumorous arterioportal shunts. T2-weighted turbo spin-echo MR image obtained without superparamagnetic iron oxide (B) and T2-weighted turbo spin-echo MR image obtained with superparamagnetic iron oxide (C) show tumorous arterioportal shunt as slightly high intensity area.

 


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  		Fig. 1D. —68-year-old man with hepatocellular carcinoma, arising from liver cirrhosis due to hepatitis C, and both tumorous and nontumorous arterioportal shunts. On T2*-weighted gradient-echo image obtained before infusion of superparamagnetic iron oxide, neither arterioportal shunt nor tumor can be recognized.

 


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  		Fig. 1E. —68-year-old man with hepatocellular carcinoma, arising from liver cirrhosis due to hepatitis C, and both tumorous and nontumorous arterioportal shunts. T2*-weighted gradient-echo image obtained after administration of superparamagnetic iron oxide reveals tumor and arterioportal shunt as areas of no signal loss and reduced signal loss, respectively.

 


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  		Fig. 2A. —75-year-old man with hepatocellular carcinoma, arising from liver cirrhosis due to hepatitis C, and nontumorous arterioportal shunt. CT image obtained during arterial dominant phase shows nontumorous arterioportal shunt in segment V as wedge-shaped area of enhancement without any relationship to tumors. Markedly enhanced intrahepatic portal branches are also shown within it.

 


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  		Fig. 2B. —75-year-old man with hepatocellular carcinoma, arising from liver cirrhosis due to hepatitis C, and nontumorous arterioportal shunt. On T2-weighted turbo spin-echo image obtained with superparamagnetic iron oxide, arterioportal shunt cannot be recognized.

 


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  		Fig. 2C. —75-year-old man with hepatocellular carcinoma, arising from liver cirrhosis due to hepatitis C, and nontumorous arterioportal shunt. Even on T2*-weighted gradient-echo image obtained after infusion of superparamagnetic iron oxide, arterioportal shunt cannot be detected.

 

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