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Nontumorous Hepatic Arterial-Portal Venous Shunts: MR Imaging Findings¹

¹ From the Department of Diagnostic Radiology and the Research Institute of Radiological Science, Yonsei University College of Medicine, YongDong Severance Hospital, 146-92 Dokok-Dong, Kangnam-Ku, Seoul 135-270, South Korea. Received July 14, 1999; revision requested August 25; revision received February 11, 2000; accepted March 30. Address correspondence to J.S.Y. (e-mail: yjsrad97@yumc.yonsei.ac.kr).

PURPOSE: To determine the magnetic resonance (MR) imaging findings of small nontumorous hepatic arterial–portal venous (arterioportal) shunts in the liver.

MATERIALS AND METHODS: MR images in 25 patients with 38 small nontumorous arterioportal shunts verified with surgery or follow-up imaging were included in this study. The causes of arterioportal shunts were iatrogenic causes in 11 patients and/or cirrhotic changes in the remaining patients. Nonenhanced T1- and T2-weighted images and multiphase contrast material–enhanced dynamic images were retrospectively reviewed and compared with conventional hepatic arteriograms to determine the MR characteristics related to the focal hemodynamic changes.

RESULTS: On arterial-dominant–phase dynamic MR images, 29 (76%) of the 38 arteriographically suggested nontumorous arterioportal shunts displayed abnormal findings distinguished against the surrounding hepatic parenchyma, including wedge-shaped (n = 14), nodular (n = 9), or irregularly outlined (n = 6) areas of focal contrast enhancement. The signal intensity on nonenhanced T1- and T2-weighted images of the corresponding areas appeared unremarkable except for three wedge-shaped high-signal-intensity areas (three [8%] of 38) on T2-weighted images accompanied by prolonged contrast enhancement. Most (24 [83%] of 29) areas of abnormal signal intensity were located at the periphery of the liver parenchyma.

CONCLUSION: 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.

Index terms: Liver, angiography, 761.1242 • Liver, cirrhosis, 761.794 • Liver, MR, 761.121412, 761.12143 • Shunts, arterioportal, 952.453, 957.453

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