Dynamic Radionuclide Angiographic Demonstration of Arterial-Origin Collaterals in Patients with Advanced Liver Cirrhosis

Abstract

Purpose: In healthy adults, portal venous flow is typically continuous hepatopetal with minimal variations related to cardiac or respiratory activity. The prevalence of hepatofugal flow in the portal venous system in studies of patients with cirrhosis evaluated with Doppler US varies between 3% and 23%. Spontaneous portosystemic shunts have been described in 39% of cirrhotics most often manifested as spleno-renal and patent umbilical veins or paraumbilical veins. In a retrospective review of Radionuclide Angiography (RA) on patients with liver cirrhosis at the Brooklyn Hospital Center, we identified unusual hepatopetal collateral which arise from the iliac artery and run along the umbilical vein and reach the portal system. Methods: Retrospective review of routine radionuclide images of all patients with a diagnosis of liver cirrhosis for the past 20 years. The scans included liver spleen, lower gastrointestinal bleeding, MUGA and hepatobiliary. Results: Cine display of RA on 12 patients (8 men and 4 women; ages 53 to 81) demonstrated the presence of the iliac artery-to-umbilical vein-to-portal collaterals. The origin of the collaterals (iliac artery), the flow direction (hepatopetal), and the end-point of collaterals (portal region) were consistently demonstrated in all 12 patients. Conclusion: The pathophysiology of this unusual pattern is not clearly evident. We hypothesize that the blood flows from the iliac artery to the recanalized umbilical vein/paraumbilical vein through connections with a recanalized umbilical artery. We report this as an unusual but reproducible finding on Radionuclide Angiography on patients with liver cirrhosis.Figure