Published online before print November 26, 2003, 10.1148/radiol.2301021745
(Radiology 2004;230:250.)
A more recent version of this article appeared on January 1, 2004
Hereditary Hemorrhagic Telangiectasia: Multi–Detector Row Helical CT Assessment of Hepatic Involvement1
Amato Antonio Stabile Ianora, MD,
Maurizio Memeo, MD,
Carlo Sabbà, MD,
Anna Cirulli, MD,
Antonio Rotondo, MD and
Giuseppe Angelelli, MD
1 From the Department of Radiology (A.A.S.I., M.M., A.R., G.A.) and HHT Centre (C.S., A.C.), University Hospital, Policlinico of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy. Received December 23, 2002; revision requested March 3, 2003; revision received April 18; accepted June 13. Address correspondence to M.M. (e-mail: doc.mauri@libero.it).
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Figure 1a. Early arterial phase contrast material-enhanced CT images in a patient with arterioportal shunts, telangiectases, and large confluent vascular masses. Transverse (a) CT scan and (b) MIP reconstructed image show the early opacification of portal veins (white arrowheads) caused by the presence of intraparenchymal shunts. Some circular highly enhanced vascular pools (black arrowheads) and several small enhanced lesions (arrows) corresponding to large confluent vascular masses and telangiectases, respectively, are also evident, especially in b.
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Figure 1b. Early arterial phase contrast material-enhanced CT images in a patient with arterioportal shunts, telangiectases, and large confluent vascular masses. Transverse (a) CT scan and (b) MIP reconstructed image show the early opacification of portal veins (white arrowheads) caused by the presence of intraparenchymal shunts. Some circular highly enhanced vascular pools (black arrowheads) and several small enhanced lesions (arrows) corresponding to large confluent vascular masses and telangiectases, respectively, are also evident, especially in b.
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Figure 2a. (a, b) Transverse MIP reconstructed images created from early arterial phase contrast-enhanced CT images in a patient with arteriosystemic shunts and telangiectases. Note early simultaneous opacification of the celiac trunk (arrow) and its branches and the main hepatic veins (arrowheads). The hepatic parenchyma is heterogeneous because of the presence of several telangiectases.
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Figure 2b. (a, b) Transverse MIP reconstructed images created from early arterial phase contrast-enhanced CT images in a patient with arteriosystemic shunts and telangiectases. Note early simultaneous opacification of the celiac trunk (arrow) and its branches and the main hepatic veins (arrowheads). The hepatic parenchyma is heterogeneous because of the presence of several telangiectases.
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Figure 3a. (a-d) Early arterial phase contrast-enhanced CT images in a young patient with arterioportal and arteriosystemic shunts and perfusion disorders. Scans obtained at different hepatic levels show the simultaneous opacification of the intra- and extrahepatic arteries (black arrowhead), main hepatic veins (white arrowheads), and right portal vein and its branches (arrow). Multiple high-attenuation segmental or subsegmental areas (star) with a prevalently triangular shape and straight margins (the transient hepatic parenchymal enhancement phenomenon) are also evident in the parenchymal hepatic periphery.
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Figure 3b. (a-d) Early arterial phase contrast-enhanced CT images in a young patient with arterioportal and arteriosystemic shunts and perfusion disorders. Scans obtained at different hepatic levels show the simultaneous opacification of the intra- and extrahepatic arteries (black arrowhead), main hepatic veins (white arrowheads), and right portal vein and its branches (arrow). Multiple high-attenuation segmental or subsegmental areas (star) with a prevalently triangular shape and straight margins (the transient hepatic parenchymal enhancement phenomenon) are also evident in the parenchymal hepatic periphery.
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Figure 3c. (a-d) Early arterial phase contrast-enhanced CT images in a young patient with arterioportal and arteriosystemic shunts and perfusion disorders. Scans obtained at different hepatic levels show the simultaneous opacification of the intra- and extrahepatic arteries (black arrowhead), main hepatic veins (white arrowheads), and right portal vein and its branches (arrow). Multiple high-attenuation segmental or subsegmental areas (star) with a prevalently triangular shape and straight margins (the transient hepatic parenchymal enhancement phenomenon) are also evident in the parenchymal hepatic periphery.
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Figure 3d. (a-d) Early arterial phase contrast-enhanced CT images in a young patient with arterioportal and arteriosystemic shunts and perfusion disorders. Scans obtained at different hepatic levels show the simultaneous opacification of the intra- and extrahepatic arteries (black arrowhead), main hepatic veins (white arrowheads), and right portal vein and its branches (arrow). Multiple high-attenuation segmental or subsegmental areas (star) with a prevalently triangular shape and straight margins (the transient hepatic parenchymal enhancement phenomenon) are also evident in the parenchymal hepatic periphery.
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Figure 4a. Late arterial phase contrast-enhanced CT images in a patient with arterioportal shunts, telangiectases, and large confluent vascular masses. (a) Transverse MIP and (b) three-dimensional MIP reconstructed images show the hepatic arteries and portal and hepatic veins to be already enhanced. Despite the heterogeneous parenchyma, the presence of three large confluent vascular masses (arrows) and multiple telangiectases (arrowheads) is evident.
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Figure 4b. Late arterial phase contrast-enhanced CT images in a patient with arterioportal shunts, telangiectases, and large confluent vascular masses. (a) Transverse MIP and (b) three-dimensional MIP reconstructed images show the hepatic arteries and portal and hepatic veins to be already enhanced. Despite the heterogeneous parenchyma, the presence of three large confluent vascular masses (arrows) and multiple telangiectases (arrowheads) is evident.
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Figure 5a. Early arterial phase contrast-enhanced CT images in a patient with telangiectases. (a) Transverse CT scan shows apparently normal hepatic parenchyma with visualization of the intraparenchymal arterial branches (arrowheads). (b) Transverse MIP reconstructed image shows the presence of multiple small circular telangiectases (arrowheads) with peripheral localization and relationships with arterial vessels. (c) Coronal multiplanar reformatted image demonstrates the origin of the right hepatic artery (black arrow) from the superior mesenteric artery and the origin of the left hepatic artery (white arrow) from the left gastric artery.
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Figure 5b. Early arterial phase contrast-enhanced CT images in a patient with telangiectases. (a) Transverse CT scan shows apparently normal hepatic parenchyma with visualization of the intraparenchymal arterial branches (arrowheads). (b) Transverse MIP reconstructed image shows the presence of multiple small circular telangiectases (arrowheads) with peripheral localization and relationships with arterial vessels. (c) Coronal multiplanar reformatted image demonstrates the origin of the right hepatic artery (black arrow) from the superior mesenteric artery and the origin of the left hepatic artery (white arrow) from the left gastric artery.
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Figure 5c. Early arterial phase contrast-enhanced CT images in a patient with telangiectases. (a) Transverse CT scan shows apparently normal hepatic parenchyma with visualization of the intraparenchymal arterial branches (arrowheads). (b) Transverse MIP reconstructed image shows the presence of multiple small circular telangiectases (arrowheads) with peripheral localization and relationships with arterial vessels. (c) Coronal multiplanar reformatted image demonstrates the origin of the right hepatic artery (black arrow) from the superior mesenteric artery and the origin of the left hepatic artery (white arrow) from the left gastric artery.
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Copyright © 2003 by the Radiological Society of North America.
