| Purpose1,To determine the prevalence of hepatic perftision disorders (HPD) around hepatic cavernous hemangiomas during hepatic arterial phase (HAP) at contrast enhanced computed tomography (CT), describe the CT findings, correlate the presence of HPD with the size and rapidity of enhancement of hemangiomas.2,To determine the prevalence of tumorous HPD in hepatocellular carcinoma (HCC), study the imaging findings, correlation between portal vein tumor thrombus and arterioportal shunts(APS) and explore its mechanism.3, To explore the causes of HPD by establishing HPD models in pigs.Materials and Methods1, Clinical records and CT images obtained in 363 patients with 545 hemangiomas were retrospectively studied. Tumor size was definded as the greatest diameter on portal venous phase (PVP) images. Speed of intratumoral contrast material enhancement was determined with hepatic arterial phase (HAP) images and was categorized as rapid (≥50% of tumor volume) and slow (<50% of tumor volume).2,The clinical data and imaging findings were retrospectively reviewed in 780 patients with HCC. The prevalence of tumorous HPD was calculated. The relationship between HPD and portal vein tumor thrombus, APS was analyzed.3,Twelve experimental pigs were randomly divided into four groups (n = 3 in each group). In group A, B and C, intrahepatic portal, arterial branches and hepatic vein were selectively embolized. In group D, APS were attempted to established by percutaneous liver puncture and transarterial portal vein puncture. After procedure, all animals underwent two- phase contrast enhanced CT scans immediately and at 1 -week point.Results1,Seventy-nine of the 545 hemangiomas (14.5%) had HPD with 14 (17.7%) APS direct sign. The prevalence of HPD was significantly higher in hemangiomas with rapid enhancement (64/212, 30.2%) and small size(d≤ 2cm)than in those with slow enhancement (15/333, 4.5%) and large size(d>2cm) (P<.001) . In addition, the rapidity of intratumoral contrast material enhancement in small hemangiomas (51/251, 20.3) was significantly quicker than large ones (28/294, 9.5%) (P < .001).2, Fifty of the 780 patients (6.4%) had tumorous HPD. The prevalence of tumorous HPD was significantly higher in HCC with portal vein tumor thrombus (27/204, 13.2%) than in those without portal vein tumor thrombus (23/576, 3.99%) (P < 0.01). The prevalence of tumorous HPD was also significantly higher in HCC with APS (21/61, 34.4%) than in those without APS (29/719, 4.0%) (P < 0.01).3, After procedure immediately on CT, HPD were found in all animals except animals in group D which were failed in APS model establishing. It manifested multiple transient wedge-shaped hyperattenuation during the hepatic arterial phase(HAP) and isoattenuating areas during the portal venous phase(PVP). In group A, the site of HPD was in correspondence with the area of embolization. Whereas in group B, the embolized area displayed hypoattenuation and non-embolized area displayed hyerattenuation during HAP. In group C, the site of HPD was correspondence with the area of embolization in two pigs, but in one pig, the region of HPD was larger than the region of embolization. At 1-week point, HPD disappeared due to sponges absorbing and the vessels reopening in group A and B. In group C which hepatic vein was coagulated by laser, HPD remained partially.Conclusion1,HPDs are not uncommonly seen in hepatic hemangiomas at tri-phase enhanced CT. Hemangiomas with HPD tend to show rapid enhancement and small size.2, Tumorous HPD in HCC is correlated with portal vein tumor thrombus and APS. 3, Intrahepatic vascular occlusions of portal, hepatic arterial and hepatic venousbranches are the factors that cause HPD. |
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