Hepatic pseudolesion in the left lobe around the falciform ligament at helical CT.

Ohashi, Isamu; Ina, Hiroyasu; Gomi, Naoya; Himeno, Yoshiro; Okada, Yoichi; Hanafusa, Kaoru; Suzuki, Syoichi; Shibuya, Hitoshi

doi:10.1148/radiology.196.1.7784576

Cited by 52 publications

(31 citation statements)

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“…On scans of dual-phase helical CT, PVP images show low-attenuating lesions. None of these lesions demonstrate high attenuation on HAP images [37].…”

Section: Portal Veinmentioning

confidence: 91%

“…Anatomically, the paraumbilical veins collect a portion of the blood from the anterior abdominal wall around the umbilicus, run along the ligamentum teres in the falciform ligament, and drain into the left branch of the portal vein. The phenomenon that some of the areas around the falciform ligament were enhanced on CTA with internal thoracic artery injection and pseudolesions occurred less frequently in patients with cirrhosis seems to accurately reflect the anatomy and hemodynamics of the paraumbilical veins [37].…”

Section: Portal Veinmentioning

confidence: 97%

“…In addition, hepatic pseudolesions seen around the falciform ligament on CT have been described in the literature [34 -36]. The prevalence of hepatic pseudolesions around the falciform ligament has been reported as 14% with helical CT [37]. Anatomically, the paraumbilical veins collect a portion of the blood from the anterior abdominal wall around the umbilicus, run along the ligamentum teres in the falciform ligament, and drain into the left branch of the portal vein.…”

Section: Portal Veinmentioning

confidence: 99%

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Hepatic abnormalities related to blood flow: evaluation with dual-phase helical CT

et al. 1999

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Dual-phase contrast-enhanced helical computed tomography (CT) has become a popular technique for the detection and characterization of hepatic lesions [1][2][3][4][5][6][7]. In addition to improved detection of small hypervascular lesions, dual-phase helical CT can provide useful information for the differential diagnosis of various liver lesions by showing contrast enhancement features on scans obtained during the hepatic arterial (more precisely, arterial-dominant) phase (HAP) and the portal venous phase (PVP). Furthermore, careful analysis of the patterns of contrast enhancement at both the HAP and PVP of dualphase helical CT is helpful in the evaluation of hepatic hemodynamic alterations [6,7]. Therefore, at many institutions including ours, dual-phase helical CT is routinely performed for the evaluation of all hepatic lesions [5][6][7][8].Hepatic abnormalities related to blood flow include normal vascular anatomic variants; vascular obstructions such as portal venous obstruction, hepatic venous obstruction, hepatic arterial obstruction, and mediastinal or thoracic venous obstruction; focal liver lesions such as arterioportal shunt, hypervascular tumor, and inflammatory processes; and uncertain etiologies [8 -10].The use of helical CT is apparently increasing the chances of encountering these abnormalities in daily practice, and the importance of knowledge of the hemodynamics of hepatic blood flow has been increasing. Thus, familiarity with the helical CT appearances of different types of hepatic abnormalities related to blood flow allows the radiologist to separate clinically insignificant flow phenomena from perfusion disorders caused by underlying parenchymal or vascular disease.In this article, we discuss how hepatic blood flow can affect the appearance of hepatic abnormalities on dualphase helical CT scans. Physiology of hepatic blood flowThe liver has a dual supply of the portal vein and hepatic artery. The hepatic artery delivers about 20 -25% of blood to the liver, whereas the portal vein delivers about 75-80% [8]. These two hepatic vessels have mutual communication systems including transvasal and transplexal routes [10]. Among them, the most prominent route is transplexal via peribiliary plexus.These routes play an important role when hepatic vessels are compromised. Therefore, knowledge of mutual communication systems of hepatic vessels is essential to understand the pathophysiology and hemodynamics of hepatic abnormalities related to blood flow (Fig. 1). Dual-phase helical CT techniquesWith the advent of helical CT technology, it has become possible to image the liver during the HAP and PVP of enhancement after a single bolus infusion of iodinated contrast material. This dual-phase helical technique is ideally suited to imaging the liver, which is unique among abdominal organs by virtue of its dual blood supply [5,7]. Helical CT images are obtained during a 20 -30-s breath-holding. Scan parameters are collimation, 5-10 mm; pitch, 1-1.5; 120 -140 kV; 150 -290 mA; and rotation time, 0.75-1 s. Images...

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“…On scans of dual-phase helical CT, PVP images show low-attenuating lesions. None of these lesions demonstrate high attenuation on HAP images [37].…”

Section: Portal Veinmentioning

confidence: 91%

Section: Portal Veinmentioning

confidence: 97%

Section: Portal Veinmentioning

confidence: 99%

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Hepatic abnormalities related to blood flow: evaluation with dual-phase helical CT

et al. 1999

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“…Ohashi et al [22] described that pseudolesions were seen on 64 (14%) of 472 helical CT scans, and 96% correlated with portal perfusion defects on CTAP. They were not more enhanced than the surrounding liver parenchyma on CT arteriography with hepatic artery injection, but were enhanced in two patients on CT arteriography with internal thoracic artery injection.…”

Section: ) Pseudolesion In the Drainage Area Of Parabiliary Venous Smentioning

confidence: 99%

Radiologic manifestation of hepatic pseudolesions and pseudotumors in the third inflow area

Kobayashi¹,

Gabata²,

Matsui³

2010

Imaging in Medicine

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SummaryWe sometimes encounter hepatic pseudolesions and pseudotumors of the third inflow area on imaging. Generally, to differentiate these lesions of true hepatic neoplasm on radiological examinations are easy with the knowledge of common site in the liver and characteristic findings of these lesions. However, it occasionally mimic hepatocellular carcinoma in various imaging modalities. In this article, we are going to provide current knowledge about pseudolesions and pseudotumors in the third inflow area on imaging.To have knowledge about pseudolesions and pseudotumors in the third inflow area can aid in correct diagnosis and avoid unnecessary treatment.

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“…A alteração de perfusão na face posterior do segmento IV é uma das mais conhecidas (Figura 6), estando ligada a irrigação anômala através das veias gástricas, principalmente da direita (15) . São comuns alterações perfusionais laterais ao ligamento falciforme (Figura 7), por irrigação aberrante pelas veias epigás-tricas e paraumbilical, exceto em cirróticos com fluxo hepatofugal, nos quais se deve sempre considerar a possibilidade de carcinoma hepatocelular (16)(17)(18) . Alterações perfusionais podem também existir na fossa da vesícula biliar, por irrigação anômala a partir de veias císticas …”

Section: -Alterações Perfusionais Focais Por Retorno Venoso Anômalounclassified

Pseudolesões hepáticas na tomografia computadorizada helicoidal: ensaio iconográfico

Meirelles

D'Ippólito

2003

Radiol Bras

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INTRODUÇÃONos dias atuais, a tomografia computadorizada (TC) é um método rotineiro na avaliação do fígado, com ampla aceitação para a detecção e caracterização de tumores e com grande importância no planejamento clínico-cirúrgico e no prognóstico da doença(1) . O advento dos aparelhos de TC helicoidais resultou em importante melhora na avaliação hepática, ao demonstrar, com maior eficácia, lesões parenquimatosas, o que levou a uma maior utilização do mé-todo. No entanto, várias armadilhas diagnósticas surgiram, principalmente ligadas a defeitos de perfusão decorrentes da rá-pida injeção do meio de contraste e aquisição das imagens, dificultando a análise e prejudicando a diferenciação entre lesões e pseudolesões(1-4) . Consideramos pseudolesões hepáticas aquelas imagens que simulam lesões hepá-ticas focais, podendo levar a diagnósticos equivocados. O objetivo deste estudo é apresentar uma revisão dessas pseudolesões, propondo uma classificação sistemá-tica por meio de casos ilustrativos e estratégias para diferenciá-las de lesões parenquimatosas. CLASSIFICAÇÃO DAS PSEUDOLESÕES HEPÁTICASVárias são as pseudolesões hepáticas encontradas na TC helicoidal. As principais encontram-se listadas no Quadro 1.A tomografia computadorizada helicoidal é largamente empregada na avaliação do parênquima hepático e tem grande importância no planejamento clínico e cirúrgico. O fígado é o órgão que mais se beneficia de aquisições helicoidais, em fases diferentes da perfusão do parênquima, pela sua dupla vascularização e pela diferença de aporte sanguíneo entre tumores e parênquima sadio. Entretanto, várias armadilhas diagnósti-cas podem ser encontradas, dificultando a análise e prejudicando a diferenciação entre lesões verdadeiras e pseudolesões, principalmente aos olhos de radiologistas menos experientes. Essas pseudolesões têm forma, localização e características variadas, podendo simular lesões parenquimatosas. É de fundamental importância que estejamos aptos a reconhecê-las, no sentido de interpretar corretamente as imagens tomográfi-cas. O objetivo deste ensaio é classificar e ilustrar as diversas pseudolesões hepáticas pela tomografia computadorizada helicoidal, com uma breve descrição dessas lesões e com alternativas para diferenciá-las das lesões do parênquima. Unitermos: Fígado; Tomografia computadorizada helicoidal; Erros de diagnóstico.Helical computed tomography of hepatic pseudolesions: a pictorial essay. Helical computed tomography has been widely used in the evaluation of the liver parenchyma for clinical and surgical management. The liver is probably the organ for which helical computed tomography examination is best indicated due to hepatic dual blood perfusion and the difference in blood supply between liver tumors and normal parenchyma. However, there are pitfalls in the interpretation of the images that may impair differentiation of true lesions from pseudolesions, particularly for the inexperienced radiologist. These pseudolesions present different shapes, location and characteristics that may mimic parenchymal...

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Hepatic pseudolesion in the left lobe around the falciform ligament at helical CT.

Abstract: Pseudolesions are caused by portal perfusion defects and may receive an aberrant blood supply.

Cited by 52 publications

References 0 publications

Hepatic abnormalities related to blood flow: evaluation with dual-phase helical CT

Hepatic abnormalities related to blood flow: evaluation with dual-phase helical CT

Radiologic manifestation of hepatic pseudolesions and pseudotumors in the third inflow area

Pseudolesões hepáticas na tomografia computadorizada helicoidal: ensaio iconográfico

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