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Arterioportal Shunt
Atif Zaheer, MD; Michael P. Federle, MD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Abbreviations

                • Arterioportal (AP) shunt
              • Definitions

                • Communication between branch of hepatic artery and portal venous system

              IMAGING

              • General Features

                • Imaging Recommendations

                  • CT Findings

                    • MR Findings

                      • Ultrasonographic Findings

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Gross Pathologic & Surgical Features

                              • Microscopic Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          • Image Interpretation Pearls

                                            • Reporting Tips

                                              Selected References

                                              1. Renzulli M et al: Imaging-based diagnosis of benign lesions and pseudolesions in the cirrhotic liver. Magn Reson Imaging. 75:9-20, 2021
                                              2. Wang Q et al: CT and MRI imaging and interpretation of hepatic arterioportal shunts. Transl Gastroenterol Hepatol. 4:34, 2019
                                              3. Schawkat K et al: Diffuse liver disease: cirrhosis, focal lesions in cirrhosis, and vascular liver disease. In: Hodler J et al. Diseases of the Abdomen and Pelvis 2018-2021: Diagnostic Imaging - IDKD Book [Internet]. New York: Springer, 2018
                                              4. Ronot M et al: Focal lesions in cirrhosis: not always HCC. Eur J Radiol. 93:157-68, 2017
                                              5. Kim TK et al: Imaging findings of mimickers of hepatocellular carcinoma. Clin Mol Hepatol. 21(4):326-43, 2015
                                              6. Sonomura T et al: N-butyl cyanoacrylate embolization with blood flow control of an arterioportal shunt that developed after radiofrequency ablation of hepatocellular carcinoma. Korean J Radiol. 15(2):250-3, 2014
                                              7. Kim TK et al: Hepatocellular nodules in liver cirrhosis: contrast-enhanced ultrasound. Abdom Imaging. 36(3):244-63, 2011
                                              8. Nakamura Y et al: Clinical significance of the transitional phase at gadoxetate disodium-enhanced hepatic MRI for the diagnosis of hepatocellular carcinoma: preliminary results. J Comput Assist Tomogr. 35(6):723-7, 2011
                                              9. Vogl TJ et al: Portal vein thrombosis and arterioportal shunts: effects on tumor response after chemoembolization of hepatocellular carcinoma. World J Gastroenterol. 17(10):1267-75, 2011
                                              10. Ahn JH et al: Nontumorous arterioportal shunts in the liver: CT and MRI findings considering mechanisms and fate. Eur Radiol. 20(2):385-94, 2010
                                              11. Mita K et al: Diagnostic sensitivity of imaging modalities for hepatocellular carcinoma smaller than 2 cm. World J Gastroenterol. 16(33):4187-92, 2010
                                              12. Yoo HJ et al: Hepatocellular carcinoma in cirrhotic liver: double-contrast-enhanced, high-resolution 3.0T-MR imaging with pathologic correlation. Invest Radiol. 43(7):538-46, 2008
                                              13. Goto T et al: Osler-Weber-Rendu disease with esophageal varices and hepatic nodular change. Intern Med. 46(12):849-54, 2007
                                              14. Kitade M et al: Intrahepatic cholangiocarcinoma associated with central calcification and arterio-portal shunt. Intern Med. 44(8):825-8, 2005
                                              15. Sakata H et al: Prognostic factors for hepatocellular carcinoma presenting with macroscopic portal vein tumor thrombus. Hepatogastroenterology. 51(60):1575-80, 2004
                                              16. Yoshimitsu K et al: Pitfalls in the imaging diagnosis of hepatocellular nodules in the cirrhotic and noncirrhotic liver. Intervirology. 47(3-5):238-51, 2004
                                              17. Yoshimitsu K et al: Unusual hemodynamics and pseudolesions of the noncirrhotic liver at CT. Radiographics. 21 Spec No:S81-96, 2001
                                              18. Koizumi J et al: Computed tomography during arterial portography under temporary balloon occlusion of the hepatic artery: evaluation of pseudolesions caused by arterio-portal venous shunts. Abdom Imaging. 25(6):583-6, 2000
                                              19. Aithal GP et al: Portal hypertension secondary to arterio-portal fistulae: two unusual cases. Liver. 19(4):343-7, 1999
                                              20. Chen WP et al: Spectrum of transient hepatic attenuation differences in biphasic helical CT. AJR Am J Roentgenol. 172(2):419-24, 1999
                                              21. Suzuki O et al: Appropriate blood flow for arterio-portal shunt in acute hypoxic liver failure. Eur Surg Res. 31(4):324-32, 1999
                                              22. Yoshimitsu K et al: Pseudolesions of the liver possibly caused by focal rib compression: analysis based on hemodynamic change. AJR Am J Roentgenol. 172(3):645-9, 1999
                                              23. Kim TK et al: Nontumorous arterioportal shunt mimicking hypervascular tumor in cirrhotic liver: two-phase spiral CT findings. Radiology. 208(3):597-603, 1998
                                              24. Srivastava DN et al: Pedunculated hepatic haemangioma with arterioportal shunt: treated with angio-embolization and surgery. Australas Radiol. 42(2):151-3, 1998
                                              25. Gryspeerdt S et al: Evaluation of hepatic perfusion disorders with double-phase spiral CT. Radiographics. 17(2):337-48, 1997
                                              26. Itai Y et al: Blood flow and liver imaging. Radiology. 202(2):306-14, 1997
                                              27. Yoshimitsu K et al: Anatomy and clinical importance of cholecystic venous drainage: helical CT observations during injection of contrast medium into the cholecystic artery. AJR Am J Roentgenol. 169(2):505-10, 1997
                                              28. Matsui O et al: Pseudolesion in segment IV of the liver at CT during arterial portography: correlation with aberrant gastric venous drainage. Radiology. 193(1):31-5, 1994
                                              Related Anatomy
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                                              Related Differential Diagnoses
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                                              References
                                              Tables

                                              Tables

                                              KEY FACTS

                                              • Terminology

                                                • Imaging

                                                  • Top Differential Diagnoses

                                                    • Pathology

                                                      • Clinical Issues

                                                        • Diagnostic Checklist

                                                          TERMINOLOGY

                                                          • Abbreviations

                                                            • Arterioportal (AP) shunt
                                                          • Definitions

                                                            • Communication between branch of hepatic artery and portal venous system

                                                          IMAGING

                                                          • General Features

                                                            • Imaging Recommendations

                                                              • CT Findings

                                                                • MR Findings

                                                                  • Ultrasonographic Findings

                                                                    DIFFERENTIAL DIAGNOSIS

                                                                      PATHOLOGY

                                                                      • General Features

                                                                        • Gross Pathologic & Surgical Features

                                                                          • Microscopic Features

                                                                            CLINICAL ISSUES

                                                                            • Presentation

                                                                              • Demographics

                                                                                • Natural History & Prognosis

                                                                                  • Treatment

                                                                                    DIAGNOSTIC CHECKLIST

                                                                                    • Consider

                                                                                      • Image Interpretation Pearls

                                                                                        • Reporting Tips

                                                                                          Selected References

                                                                                          1. Renzulli M et al: Imaging-based diagnosis of benign lesions and pseudolesions in the cirrhotic liver. Magn Reson Imaging. 75:9-20, 2021
                                                                                          2. Wang Q et al: CT and MRI imaging and interpretation of hepatic arterioportal shunts. Transl Gastroenterol Hepatol. 4:34, 2019
                                                                                          3. Schawkat K et al: Diffuse liver disease: cirrhosis, focal lesions in cirrhosis, and vascular liver disease. In: Hodler J et al. Diseases of the Abdomen and Pelvis 2018-2021: Diagnostic Imaging - IDKD Book [Internet]. New York: Springer, 2018
                                                                                          4. Ronot M et al: Focal lesions in cirrhosis: not always HCC. Eur J Radiol. 93:157-68, 2017
                                                                                          5. Kim TK et al: Imaging findings of mimickers of hepatocellular carcinoma. Clin Mol Hepatol. 21(4):326-43, 2015
                                                                                          6. Sonomura T et al: N-butyl cyanoacrylate embolization with blood flow control of an arterioportal shunt that developed after radiofrequency ablation of hepatocellular carcinoma. Korean J Radiol. 15(2):250-3, 2014
                                                                                          7. Kim TK et al: Hepatocellular nodules in liver cirrhosis: contrast-enhanced ultrasound. Abdom Imaging. 36(3):244-63, 2011
                                                                                          8. Nakamura Y et al: Clinical significance of the transitional phase at gadoxetate disodium-enhanced hepatic MRI for the diagnosis of hepatocellular carcinoma: preliminary results. J Comput Assist Tomogr. 35(6):723-7, 2011
                                                                                          9. Vogl TJ et al: Portal vein thrombosis and arterioportal shunts: effects on tumor response after chemoembolization of hepatocellular carcinoma. World J Gastroenterol. 17(10):1267-75, 2011
                                                                                          10. Ahn JH et al: Nontumorous arterioportal shunts in the liver: CT and MRI findings considering mechanisms and fate. Eur Radiol. 20(2):385-94, 2010
                                                                                          11. Mita K et al: Diagnostic sensitivity of imaging modalities for hepatocellular carcinoma smaller than 2 cm. World J Gastroenterol. 16(33):4187-92, 2010
                                                                                          12. Yoo HJ et al: Hepatocellular carcinoma in cirrhotic liver: double-contrast-enhanced, high-resolution 3.0T-MR imaging with pathologic correlation. Invest Radiol. 43(7):538-46, 2008
                                                                                          13. Goto T et al: Osler-Weber-Rendu disease with esophageal varices and hepatic nodular change. Intern Med. 46(12):849-54, 2007
                                                                                          14. Kitade M et al: Intrahepatic cholangiocarcinoma associated with central calcification and arterio-portal shunt. Intern Med. 44(8):825-8, 2005
                                                                                          15. Sakata H et al: Prognostic factors for hepatocellular carcinoma presenting with macroscopic portal vein tumor thrombus. Hepatogastroenterology. 51(60):1575-80, 2004
                                                                                          16. Yoshimitsu K et al: Pitfalls in the imaging diagnosis of hepatocellular nodules in the cirrhotic and noncirrhotic liver. Intervirology. 47(3-5):238-51, 2004
                                                                                          17. Yoshimitsu K et al: Unusual hemodynamics and pseudolesions of the noncirrhotic liver at CT. Radiographics. 21 Spec No:S81-96, 2001
                                                                                          18. Koizumi J et al: Computed tomography during arterial portography under temporary balloon occlusion of the hepatic artery: evaluation of pseudolesions caused by arterio-portal venous shunts. Abdom Imaging. 25(6):583-6, 2000
                                                                                          19. Aithal GP et al: Portal hypertension secondary to arterio-portal fistulae: two unusual cases. Liver. 19(4):343-7, 1999
                                                                                          20. Chen WP et al: Spectrum of transient hepatic attenuation differences in biphasic helical CT. AJR Am J Roentgenol. 172(2):419-24, 1999
                                                                                          21. Suzuki O et al: Appropriate blood flow for arterio-portal shunt in acute hypoxic liver failure. Eur Surg Res. 31(4):324-32, 1999
                                                                                          22. Yoshimitsu K et al: Pseudolesions of the liver possibly caused by focal rib compression: analysis based on hemodynamic change. AJR Am J Roentgenol. 172(3):645-9, 1999
                                                                                          23. Kim TK et al: Nontumorous arterioportal shunt mimicking hypervascular tumor in cirrhotic liver: two-phase spiral CT findings. Radiology. 208(3):597-603, 1998
                                                                                          24. Srivastava DN et al: Pedunculated hepatic haemangioma with arterioportal shunt: treated with angio-embolization and surgery. Australas Radiol. 42(2):151-3, 1998
                                                                                          25. Gryspeerdt S et al: Evaluation of hepatic perfusion disorders with double-phase spiral CT. Radiographics. 17(2):337-48, 1997
                                                                                          26. Itai Y et al: Blood flow and liver imaging. Radiology. 202(2):306-14, 1997
                                                                                          27. Yoshimitsu K et al: Anatomy and clinical importance of cholecystic venous drainage: helical CT observations during injection of contrast medium into the cholecystic artery. AJR Am J Roentgenol. 169(2):505-10, 1997
                                                                                          28. Matsui O et al: Pseudolesion in segment IV of the liver at CT during arterial portography: correlation with aberrant gastric venous drainage. Radiology. 193(1):31-5, 1994