Hepatic arterioportal shunt:MSCT diagnosis

Objective To evaluate the dynamic enhanced multi-slice spiral CT(MSCT) features and the formative mechanisms of APS(arterioportal shunt),and to assess its CT diagnostic ability and clinical value.Methods 1 100 patients received dynamic enhanced MSCT scan of the liver and 80 cases with APS were found.Of the 80 cases with APS,71 were hepatocellular carcinoma(HCC),2 with metastatic tumor,6 with hepatocirrhosis,1 without definite hepatic disease.All the 71 patients with HCC received DSA of the liver.MSCT signs and its diagnostic ability for APS were analyzed and compared with the golden standard of DSA.Results All the 71 patients with HCC had positive CT findings related to APS in arterial phase.The MSCT signs of APS were divided into two types: the central type and the peripheral type.In the 52 cases of central type: ①in the arterial phase,the main portal vein(PV) and the left/right branches of were revealed earier;②the network artery in and around embolus of were revealed;③the PV casting was formed with the enhanced walls against the low attenuation embolus.While in the 19 cases of peripheral type: ①in the arterial phase,wedge and patchy high attenuation appeared in the non-tumor parenchyme of the hepatic lobes,the tumorous rim and the margin of the hepatic lobes,while in the phase,this attenuation became the same as that of the normal liver;②the branches enhanced in shape of lines,accompanied with hepatic arteries(so-called the rail sign);③earlier revelation of inside the tumor.Conclusion The dynamic enhanced MSCT can be used as an important tool for the diagnosis of hepatic APS,and its accuracy could be comparable to that of DSA.It is possible that MSCT angiography(MSCTA) may replace DSA.MSCT diagnosis of APS is of great clinical significance in the treatment of HCC.