Intrahepatic Arterioportal Shunt Research Articles

Intrahepatic arterioportal shunt with portal-hypertension caused by liver biopsy after living-donor liver transplantation: a case report

Intrahepatic arterioportal shunt with portal-hypertension caused by liver biopsy after living-donor liver transplantation: a case report

Double-Balloon-Assisted N-Butyl-2-Cyanoacrylate Embolization of Nontumorous Intrahepatic Arterioportal Shunts

This report describes the safety and efficacy of double-balloon-assisted N-butyl-2-cyanoacrylate embolization of nontumorous intrahepatic arterioportal shunts in 5 consecutive, previously untreated patients. A proximal balloon was used for flow control and a coaxial microballoon was used to control the delivery of N-butyl-2-cyanoacrylate. Complete occlusion was achieved in 3 patients and shunt flow decreased in 2 patients, without complications. In the latter 2 patients, pre-embolization shunt flow was lower than that in patients with complete occlusion. Our results suggest that this coaxial double-balloon-assisted technique may be safe and effective for the embolization of nontumorous intrahepatic arterioportal shunts, especially in high-flow shunts.

A Case Report of Congenital Multiple Intrahepatic Arterio-Portal Shunts with Esophago-Gastric Varices

A Case Report of Congenital Multiple Intrahepatic Arterio-Portal Shunts with Esophago-Gastric Varices

Efficacy of Percutaneous Microwave Coagulation Therapy for Nodular Hepatic Tumor: A Preliminary Study

Purpose: Percutaneous microwave coagulation therapy (PMCT) uses a new energy source, microwave, in the treatment of solid neoplasms. We evaluated the efficacy of PMCT for nodular hepatic tumors in nine patients. Materials and Methods: Between December 1998 and June 1999, we performed PMCT in six patients with hepatocellular carcinoma (HCC), two with one and three metastatic nodules each from colon cancer, and one with adenomatous hyperplasia. Four patients were female and five were male, and their age ranged between 44 and 71 (mean, 58.8) years. Under sonographic guidance a 14-gauge guiding needle was inserted percutaneously toward the lesion, and within it a needle electrode was precisely positioned. Microwave 2450MHz in frequency and with 60 or 80 watt emission was generated for 80~90 seconds. We evaluated the ultrasound findings obtained during the procedure, pre-PMCT and follow-up CT images, changes in tumor marker(AFP or CA19-9) levels and the results of liver function tests, and complications arising during the six-month period following PMCT. Results: Immediately after microwave emission, characteristic hyperechogenicity appeared on the realtime sonogram. Two patients with HCC underwent CT before PMCT, and typical enhancement during the arterial phase and washout during the portovenous phase was observed. In one patient, two metastatic lesions from colon cancer showed delayed enhancement on pre-PMCT CT. Initial follow-up CT, performed between 1 and 4 weeks after the PMCT procedure, showed that eight lesions-including two HCCs which were highly enhanced on CT before PMCT-showed no contrast enhancement, and three others showed delayed enhancement. Two of the eight lesions which showed no contrast enhancement at initial follow-up CT were markedly decreased in size (from 2.9 and 4.0 cm to 1.0 and 2.0 cm, respectively) at subseqent follow-up 3 months and 6 months later, respectively. One of the three lesions showing delayed enhancement had increased in size from 4.1 to 5.5 cm at subsequent follow-up CT, 2 months later. Serum AFP or CA19-9 levels decreased in four of six patients (66.7%) who were followed up for 6 months. Transient elevation of aspartate aminotransferase(AST) levels were noted in all patients. PMCT-related complications included intrahepatic arterioportal shunt in two patients, pleural effusion in one, skin burn in one, intraperitoneal hemorrhage in one, and mild fever, abdominal pain and nausea in seven. No complications were serious, however.Conclusion: Our preliminary experiences suggest that PMCT is a safe and effective treatment modality for nodular hepatic tumors.

Intrahepatic arterioportal shunt: helical CT findings.

The purpose of this study was to characterize the appearance of intrahepatic arterioportal shunts (APS) on two-phase helical CT, with emphasis on the importance of the hepatic arterial-dominant phase (HAP) to demonstrate perfusion disorders. We review eight cases of APS diagnosed by helical CT in our institution from January 1996 to March 1997 and describe the CT findings that established diagnosis. Five of them were confirmed by angiography. In seven (87. 5 %) cases of APS we found early enhancement of the peripheral portal branches during the HAP of helical CT, whereas the superior mesenteric and splenic veins remained unenhanced. In five (62.5 %) cases of APS, transient, peripheral, triangular parenchymal enhancement was depicted during the HAP of helical CT; in four of these cases there was associated early enhancement of the portal branches. Helical CT can show perfusion alterations that might remain undiagnosed with conventional CT. An understanding of the hemodynamic changes that occur in APS can help in the interpretation of focal transient hepatic parenchymal enhancement and to differentiate APS from hypervascular tumors. We believe that the helical CT findings described herein are characteristic enough to suggest the diagnosis of APS.

Pseudotumours of hepatic imaging

The diagnosis of liver tumours with CT depends on differential attenuation coefficients and enhancement patterns. The sensitivity of CT in defining tumours is well established but there remain a variety of conditions that mimic these patterns, presenting a 'pseudotumour' appearance. A common illustrative example is hepatic steatosis, but less well recorded are the sphingolipidoses and intrahepatic arterioportal shunts, either post-traumatic or related to venous outflow block. Alpha-1-antitrypsin deficiency and hereditary tyrosinaemia provide examples in childhood.

肝細胞癌に伴う肝内Ａ‐Ｐ ｓｈｕｎｔのカラードプラ診断 門脈逆流所見による検討

肝内門脈逆流現象はA-P shuntの存在を示唆する一つの所見と考えられる.著者らは,カラードプラ法にて肝内門脈逆流所見の認められた肝細胞癌症例(n=15)を対象にして,逆流門脈部の血流ドプラ所見と血管造影上のA-P shuntの有無を対比検討し以下の結果を得た.1.拍動性の門脈逆流例(n=4)にはA-P shuntが全例(4/4)に認められた.2.定常性の門脈逆流例(n=11)の内,5例(45%)はA-P shunt陽性であり,残り6例(55%)は陰性であった.A-P shunt陽性群(n=5)の最高血流速度(Vmax)は10.6±5.3cm/secであり,陰性群(n=6)のVmax(5.3±1.8cm/sec)に比べ有意(p<0.05)に速かった.更に,A-P shuntの出現率はVmax≧10cm/sec群で100%(4/4),Vmax<10cm/sec群で14%(1/7)であり,両者間に有意差(p<0.01)を認めた.以上の結果より,肝細胞癌症例において拍動性門脈逆流,あるいはVmaxが10cm/sec以上の定常性門脈逆流はA-P shuntの存在を示唆する所見と考えられた.

Large spontaneous intrahepatic arterioportal fistula demonstrated by rapid sequential computed tomographic scan

Abstract A huge spontaneous intrahepatic arterioportal shunt with regurgitation through the portal vein trunk was demonstrated by computed tomography and confirmed by angiography in 2 patients with liver cirrhosis. Rapid sequential computed tomographic scanning was very useful in the diagnosis and follow-up after arterial embolization. Early visualization of the portal vein and increased attenuation in the ipsilateral lobe bearing the fistula were demonstrated in 1 case, and the same findings were also demonstrated by computed tomography and angiography in the other case.

Large spontaneous intrahepatic arterioportal fistula demonstrated by rapid sequential computed tomographic scan: Report of two cases

A huge spontaneous intrahepatic arterioportal shunt with regurgitation through the portal vein trunk was demonstrated by computed tomography and confirmed by angiography in 2 patients with liver cirrhosis. Rapid sequential computed tomographic scanning was very useful in the diagnosis and follow-up after arterial embolization. Early visualization of the portal vein and increased attenuation in the ipsilateral lobe bearing the fistula were demonstrated in 1 case, and the same findings were also demonstrated by computed tomography and angiography in the other case.