Nontumorous Hepatic Arterial-Portal Venous Shunts: MR Imaging Findings

Yu, Jaesang; Kim, Ki Whang; Jeong, Mi-Gyoung; Lee, Jong Tae; Yoo, Hyung Sik

doi:10.1148/radiology.217.3.r00dc13750

Cited by 107 publications

(63 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It has been reported [8] that the combination of the higher enhancing capability of gadobenate dimeglumine and the VIBE sequence tends to maximize sensitivity in detection of enhancing hepatic lesions regardless of the presence of an arterioportal shunt or of a true hypervascular liver lesion. Therefore, in our study, the advanced cirrhotic state of the livers was associated with foci of nonmalignant hypervascularity, including nonneoplastic arterial hypervascular lesions and enhancing dysplastic or regenerative nodules, thereby accounting for the false-positive findings [32,36]. In addition in our study, the major causes of false-positive diagnoses of lesions of smaller than 1 cm on MRI were different from those for lesions 1 cm in diameter or A C Fig.…”

Section: Bmentioning

confidence: 47%

“…Because some dysplastic nodules [27,28] and lesions of focal nodular hyperplasia [29,30] also become enhanced during the hepatic arterial phase, the presence of arterial phase enhancement is not specific for the presence of malignancy. In addition, arterial phase enhancement can be seen with hemangiomas, arterial-portal venous shunts, and aberrant venous drainage [31,32].…”

Section: Choi Et Almentioning

confidence: 99%

See 1 more Smart Citation

Hepatocellular Carcinoma in Liver Transplantation Candidates: Detection with Gadobenate Dimeglumine–Enhanced MRI

Choi

Lee

et al. 2008

American Journal of Roentgenology

View full text Add to dashboard Cite

529sis determines patient eligibility for and the potential success of curative treatments. Therefore, CT and MRI aided by technologic advances that afford improved spatial, temporal, and contrast resolution are regarded as promising alternative surveillance tools for detecting HCC [4,5]. Contrast-enhanced dynamic multiphasic imaging has substantial performance benefits because most HCCs are hypervascular lesions that typically become enhanced during the hepatic arterydominant phase of imaging [6]. OBJECTIVE. The purpose of this study was to retrospectively evaluate the diagnostic performance of dynamic gadobenate dimeglumine-enhanced MRI with explant pathologic correlation in the detection of hepatocellular carcinoma (HCC) in patients undergoing liver transplantation. Hepatocellular Carcinoma in H e p a t o b i l i a r y I m ag i ng • O r ig i n a l R e s e a rc hMATERIALS AND METHODS. Forty-seven patients (28 men, 19 women; mean age, 49 years) underwent dynamic gadobenate dimeglumine-enhanced MRI within 3 months before primary liver transplantation. Dynamic imaging was performed before (unenhanced) and after (hepatic arterial, portal venous, equilibrium, and 1-hour delayed phases) IV bolus administration of gadobenate dimeglumine at 0.1 mmol/kg body weight. Retrospective image analysis to detect HCC nodules was performed independently by two abdominal radiologists who had no pathologic information. On a per-nodule basis, the sensitivity and positive predictive value were calculated for the two observers. Sensitivity and specificity in the diagnosis of HCC also were evaluated. Fisher's exact test was performed to determine whether there was a detection difference between HCC nodules 1 cm in diameter or larger and nodules smaller than 1 cm and to evaluate the differences in causes of false-positive MRI findings based on lesion size (≥ 1 cm vs < 1 cm).RESULTS. Twenty-seven patients had 41 HCCs. In HCC detection, gadobenate dimeglumine-enhanced MRI had a sensitivity of 85% (35 of 41 HCCs) and a positive predictive value of 66% (35 of 53 readings) for observer 1 and a sensitivity of 80% (33 of 41 HCCs) and a positive predictive value of 65% (34 of 52 readings) for observer 2. For both observers, sensitivity in the detection of HCCs 1 cm in diameter and larger (91-94%) was significantly different (p < 0.05) from that in detection of HCCs smaller than 1 cm (29-43%). Nonneoplastic arterial hypervascular lesions more often caused false-positive diagnoses of lesions smaller than 1 cm in diameter (80-86%) on MR images than of those 1 cm in diameter and larger (0-25%). The difference was statistically significant (p < 0.05) for both observers. In diagnosis, gadobenate dimeglumine-enhanced MRI had a sensitivity of 87% (20 of 23 patients) and a specificity of 79% (19 of 24 patients) for both observers.CONCLUSION. Dynamic gadobenate dimeglumine-enhanced MRI has a sensitivity of 80-85% and a positive predictive value of 65-66% in the detection of HCC. The technique, however, is of limited value for detecting and characterizi...

show abstract

Section: Bmentioning

confidence: 47%

Section: Choi Et Almentioning

confidence: 99%

Hepatocellular Carcinoma in Liver Transplantation Candidates: Detection with Gadobenate Dimeglumine–Enhanced MRI

Choi

Lee

et al. 2008

American Journal of Roentgenology

View full text Add to dashboard Cite

show abstract

“…However, we excluded lesions that showed water-like T2W hyperintensity and sustained contrast enhancement on delayed-phase imaging compatible with typical hemangiomas (n03). In addition, to reduce selection bias in the future analysis of the imaging features, we also excluded subcapsular wedge-shaped hypervascular lesions on AP that were not distinguished from the background parenchyma on any other imaging sequences (n 033), which is suggestive of typical pseudolesions (4). Finally, a total of 74 benign lesions determined by long-term imaging follow-up (from 24 months to 60 months, mean 38.6 months) were included in the comparative group, and all of the 143 small hypervascular lesions including HCC and benign lesions were marked by electronic arrows and saved on the AP images.…”

Section: Patients and Mr Imagingmentioning

confidence: 99%

Small hypervascular hepatocellular carcinoma: limited value of portal and delayed phases on dynamic magnetic resonance imaging

Lee

Chung

et al. 2008

Acta Radiol

View full text Add to dashboard Cite

Yu JS, Lee JH, Chung JJ, Kim JH, Kim KW. Small hypervascular hepatocellular carcinoma: limited value of portal and delayed phases on dynamic magnetic resonance imaging. Acta Radiol 2008;49:735Á743.Background: Characterization of small nodules in the cirrhotic liver is always challenging in clinical practice. In the differential diagnosis of small hypervascular lesions, it has been reported that portal venous or delayed hypointensity is a useful sign to characterize hepatocellular carcinomas (HCCs) during dynamic magnetic resonance (MR) imaging. However, few studies have assessed the diagnostic value of this sign. Purpose: To determine the diagnostic value of portal-phase (PP) and delayed-phase (DP) images for the diagnosis of small hypervascular HCCs during intravenous (IV) contrastenhanced dynamic MR imaging of cirrhotic liver. Material and Methods: A total of 69 small (6Á20 mm) hypervascular HCCs in 53 cirrhotic patients were subjected to a retrospective analysis of the signal intensities (hypo-, iso-, or hyperintense) and rim enhancement on PP and 5-min DP images from three-phased dynamic MR imaging according to the pre-contrast T1-and T2-weighted imaging features. After exclusion of 33 subcapsular wedge-shaped pseudolesions and three hemangiomas by typical imaging features, 74 centrally located small hypervascular benign or pseudolesions were used as a control group for comparative analyses. Results: The sensitivities of PP hypointensity, DP hypointensity, and rim enhancement in the diagnosis were 11%, 29%, and 18%, respectively, for 6Á10-mm hypervascular HCCs, and 42%, 63%, and 58%, respectively, for 16Á20-mm lesions. After exclusion of the 48 lesions showing T2-weighted hyperintensity (HCCs, n039; benign lesions, n09), the overall sensitivity for diagnosis of small hypervascular HCCs decreased (8.3%, 25.0%, and 8.3%, respectively). Conclusion: Although DP provides a better sensitivity than PP, both PP and DP have very limited diagnostic value for diagnosis of small hypervascular HCCs during dynamic MR imaging of the cirrhotic liver.

show abstract

“…We excluded typical haemangiomas depending on the imaging findings: bright hyperintensity on T 2 weighted images and gradual peripheral, globular and centrifugal enhancement or the bright dot sign on dynamic enhancing MRI [12]. Typical non-tumorous arterioportal venous shunts were also excluded in the presence of the following imaging findings: a subcapsular wedge-shaped arterial enhancement area in the liver without any distinguishable abnormal signal intensity on the pre-contrast T 1 and T 2 weighted images in addition to equilibrium phase post-contrast images [13]. All of the pre-excluded lesions were verified again by no change or disappearance on follow-up imaging studies.…”

Section: Patient Populationsmentioning

confidence: 99%

Small hypervascular hepatocellular carcinomas: value of diffusion-weighted imaging compared with “washout” appearance on dynamic MRI

Yu²,

Kim³

et al. 2012

BJR

View full text Add to dashboard Cite

Objective: To compare the value of diffusion-weighted MRI (DWI) with the venous ''washout'' appearance during dynamic MRI for the assessment of small arterial hypervascular lesions in cirrhotic liver. Methods: After exclusion of benign hypervascular lesions, including haemangiomas and subcapsular non-tumorous arterioportal shunts, indicated by typical imaging features, a total of 109 small arterial hypervascular lesions (0.5-3.0 cm in the longest diameter) in 65 patients with cirrhosis who underwent gadopentetate dimeglumine-enhanced dynamic MRI and DWI (b550, 400, 800 s mm 22) at 1.5 T during a 16-month period were retrospectively analysed to determine the presence of venous washout during dynamic imaging or sustained hyperintensity upon increasing the b factor size on DWI. Results: Among the 99 hypervascular hepatocellular carcinomas (HCCs), sustained hyperintensity on DWI (92/99, 93%) was more prevalent than the washout appearance (72/99, 72%) on dynamic MRI (p,0.001). Depending on the lesion size, subcentimetresized HCCs had a significantly lower prevalence of venous washout (13/30, 43%) than the sustained hyperintensity on DWI (27/30, 90%) (p50.001). In all 10 hypervascular benign conditions, there was no venous washout on dynamic MRI and no sustained hyperintensity on DWI. Sensitivity and specificity for diagnosis of hypervascular HCCs were 92.9% and 100% in DWI and 72% and 100% in dynamic MRI, respectively. Conclusion: Compared with the venous washout during dynamic imaging, DWI provides more reliable information in the MRI assessment of small hypervascular HCCs, distinguishing them from atypical hypervascular benign or pseudolesions. DWI could complement the early diagnosis of small hypervascular HCCs that do not display venous washout during dynamic imaging.

show abstract

Nontumorous Hepatic Arterial-Portal Venous Shunts: MR Imaging Findings

Abstract: A small nontumorous arterioportal shunt should be considered one of the causes of focal parenchymal hyperperfusion abnormalities on contrast-enhanced dynamic MR images of the liver in the absence of abnormal signal intensity on static MR images.

Cited by 107 publications

References 22 publications

Hepatocellular Carcinoma in Liver Transplantation Candidates: Detection with Gadobenate Dimeglumine–Enhanced MRI

Hepatocellular Carcinoma in Liver Transplantation Candidates: Detection with Gadobenate Dimeglumine–Enhanced MRI

Small hypervascular hepatocellular carcinoma: limited value of portal and delayed phases on dynamic magnetic resonance imaging

Small hypervascular hepatocellular carcinomas: value of diffusion-weighted imaging compared with “washout” appearance on dynamic MRI

Contact Info

Product

Resources

About