Medical Radiology and Radiation Safety. 2024. Vol. 69. № 4
DOI:10.33266/1024-6177-2024-69-4-77-80
A.P. Dunaev1, 2, 3, A.N. Bashkov3, 4, Zh.V. Sheikh3, 5, 6, E.V. Esin3,
I.V. Shipuleva1, M.V. Popov4, T.Yu. Kudryavtseva1, O.V. Lazebnaya1
CT and MRI in the Diagnostics of Intrahepatic Portocaval Shunt.
Review of Lite rature and Case Reports
1 Moscow City Oncology Hospital No. 62, Moscow, Russia
2 Central State Medical Academy, Moscow, Russia
3 Russian University of People’s Frendship, Moscow, Russia
4 A.I. Burnazyan Federal Medical Biophysical Center, Moscow, Russia
5 S.P. Botkin City Clinical Hospital, Moscow, Russia
6 Russian Medical Academy of Postgraduate Education, Moscow, Russia
Contact person: A.P. Dunaev, e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
Abstract
Purpose: To describe two cases of diagnostic of intrahepatic portacaval shunt based on the computed (CT) and magnetic resonance tomography (MRI). Provide a brief review of the literature on this pathology.
Material and methods: Two case reports of patients with intrahepatic portacaval shunts which were diagnosed by CT and MRI with contrast enhancement.
Results and discussion: A peculiarity of the presented case reports was that in both cases the patients had oncopathology and were examined for the purpose of staging the disease. Due to the risk of cancer when analyzing CT and MRI images, focal changes in the liver can be mistakenly interpreted as metastases. In various situations, the attending physician may choose tactics for further observation, or decide to verify the identified changes in the liver. In the latter case, minimally invasive intervention can damage the shunt wall and cause bleeding. To avoid any complications, the radiologist have to identify and interpret vascular abnormalities in the liver confidently and unambiguously. The two presented case reports demonstrated typical signs of an intrahepatic porthocaval shunt, both according to CT and MRI. These include the connection of the lesion with the main vessels with similar dynamics of contrast enhancement, and the absence of signs of diffusion restriction.
Conclusion: The presented semiotics of the intrahepatic portacaval shunt according to CT and MRI data allows to diagnose it confidently and thus avoid the need for repeated studies or surgical intervention.
Keywords: computed tomography, magnetic resonance imaging, intrahepatic portocaval shunt
For citation: Dunaev AP, Bashkov AN, Sheikh ZhV, Esin EV, Shipuleva IV, Popov MV, Kudryavtseva TYu, Lazebnaya OV. CT and MRI in the Diagnostics of Intrahepatic Portocaval Shunt. Review of Literature and Case Reports. Medical Radiology and Radiation Safety. 2024;69(4):77–80. (In Russian). DOI:10.33266/1024-6177-2024-69-4-77-80
References
1. Brown K.M., Hal H. Asymptomatic Congenital Intrahepatic Portosystemic Shunt. Radiology Case Reports. 2009;4:255.
2. Remer E.M., Motta-Ramirez G.A., Henderson J.M. Imaging Findings in Incidental Intrahepatic Portal Venous Shunts. AJR Am J Roentgenol. 2007;188;2:W162-167. doi: 10.2214/AJR.05.1115.
3. Tsitouridis I., Sotiriadis C., Michaelides M., Dimarelos V., Tsitouridis K., Stratilati S. Intrahepatic Portosystemic Venous Shunts: Radiological Evaluation. Diagn Interv Radiol. 2009;15:182–187.
4. Murray C.P., Yoo S.J., Babyn P.S. Congenital Extrahepatic Portosystemic Shunts. Pediatr Radiol. 2003;33:614–620.
5. Park J.H., Cha S.H., Han J.K., Han M.C. Intrahepatic Portosystemic Venous Shunt. AJR Am. J. Roentgenol. 1990;155;3:527-528. doi: 10.2214/ajr.155.3.2117349.
6. Ramanathan S., Raghu V., Virmani V., Sheikh A., Al Heidous M., Tirumani S. Unveiling the Unreal: Comprehensive Imaging Review of Hepatic Pseudolesions. Clin Imaging. 2021;80:439-453. doi: 10.1016/j.clinimag.2021.09.008.
7. Кармазановский Г.Г. Роль МСКТ и МРТ в диагностике очаговых заболеваний печени // Анналы хирургической гепатологии. 2019. Т.24, № 4. С. 91-110. [Karmazanovskiy G.G. The Role of MDCT and MRI in the Diagnosis of Focal Liver Diseases. Annaly Khirurgicheskoy Gepatologii = Annals of HPB Surgery. 2019;24;4:91-110. (In Russ.)]. https://doi.org/10.16931/1995-5464.2019491-110.
8. Башков А.Н., Шейх Ж.В., Восканян С.Э., Дунаев А.П., Попов М.В., Удалов Ю.Д., Самойлов А.С. Возможность снижения лучевой нагрузки на пациентов за счет оптимизации протокола компьютерной томографии органов брюшной полости и забрюшинного пространства в зависимости от нозологии злокачественного процесса // Радиационная гигиена. 2019. Т.12, № 3. С. 6-15. [Bashkov A.N., Sheykh Zh.V., Voskanyan S.E., Dunaev A.P., Popov M.V., Udalov Yu.D., Samoylov A.S. Prospects for the Reduction of the Patient Doses Based on the Optimization of the CT Abdomen Protocols for the Different Types of Malignancies. Radiatsionnaya Gygiena = Radiation Hygiene. 2019;12;3:6-15 (In Russ.)]. https://doi.org/10.21514/1998-426X-2019-12-3-6-15.
PDF (RUS) Full-text article (in Russian)
Conflict of interest. The authors declare no conflict of interest.
Financing. The study had no sponsorship.
Contribution. Article was prepared with equal participation of the authors.
Article received: 20.03.2024. Accepted for publication: 25.04.2024.