Diagnosis of arterioportal shunts in cases of hepatocellular carcinoma using multidetector CT: Impact on clinical management

To study the ability of multidetector CT (MDCT) to diagnose arterioportal shunts (APS) associated with hepatocellular carcinoma (HCC) and its impact on further management of the patient. 252 Patients with HCC were examined by triphasic MDCT scanning. Images were analyzed for the presence, locations, types and degrees of APS, being with or without thrombosis. Digital subtraction angiographies (DSA) were performed for 22 patients as a part of further therapeutic management. MDCT revealed APS in 37 patients including 20 central, 9 peripheral and 8 mixed. According to the degree we had 13 severe, 15 moderate and 9 mild APS. 18 patients had associated portal venous thrombosis. During DSA examinations; APS were demonstrated in 19 out of 22 as 3 mild and peripheral shunts were faint and missed. Embolization of the shunt was performed in 17 patients prior to injection of the cytotoxic drug-lipiodol mixture. In one patient the APS was closed to improve the hepatic status without further chemotherapy and in one patient the shunt was ignored and not closed. Good understanding of MDCT findings of APS complicating HCC contributes to the diagnosis and improves the therapeutic outcome of the chemoembolization procedures.