Pattern analysis of Hemodynamic Changes of the Liver on Combined CT Hepatic Arteriography and CT Arterial Portography

ABSTRACT

PURPOSE: To evaluate the patterns of hemodynamic changes caused by various pathologic liver conditions. MATERIALS & METHODS: Combined CT hepatic arteriography(CTHA) and CT arterial portography(CTAP), performed in 185 consecutive patients, including 150 with hepatocellular carcinoma, were retrospectively analysed. Of these patients, 48 showed various patterns of hemodynamic change. such change caused by occlusion, stenosis and/or cavernous transformation of the portal vein, by occlusion or stenosis of the hepatic artery, or by the presence of arterioportal(AP) shunt could be classified as follows type 1, decreased or absent portal flow ; type 2,decreased or absent hepatic arterial flow ; type 3, AP shunt without portal tumor thrombus(PTT) ; and type 4, PTT with transvasal AP shunt, including the presence of cavernous transformation of the portal vein. RESULTS: Type I (n=20) showed hyperattenuation of both PTT and absent portal flow area on CTHA, and reciprocally consistent hypoattenuation on CTAP. Type II (n=6) showed a hypoattenuating area on CTHA, and isoattenuation or slightly hyperattenuation on CTAP. Type III (n=9) showed an oval or wedge-shaped hyperattenuating area on CTHA, anddefective perfusion at the same area on CTAP. In Type IV (n=13), both CTHA and CTAP showed variable findings, according to the amount of transvasal AP shunt, the location and extent of PTT, and/or cavernous transformation ofthe portal vein. CONCLUSION: Pattern analyses of hemodynamic changes on both CTHA and CTAP are helpful inclarifying the primary causes of hemodynamic changes in the liver.