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Three-dimensional CT Angiography of Spontaneous Portosystemic Shunts¹

¹ From the Department of Radiology, University of Wisconsin Hospital and Clinics, 600 Highland Ave, Madison, WI 53792-3252. Recipient of a Certificate of Merit award for a scientific exhibit at the 1999 RSNA scientific assembly. Received March 20, 2000; revision requested June 9 and received August 14; accepted August 16. Address correspondence to M.A.P. (e-mail: mpozniak@facstaff.wisc.edu).

Spontaneous portosystemic shunts (varices) are a well-known complication of severe liver disease and portal hypertension. Computed tomographic (CT) angiography was used to image the hepatic vasculature of 198 patients with end-stage liver disease in anticipation of liver transplantation. Performance of a delayed acquisition during the portal phase of enhancement enables evaluation of portal and variceal anatomy without the need for an additional injection of contrast material. Three-dimensional (3D) reconstruction of portal-phase CT angiograms enhances the perception of the courses and anatomic relationships of varices. This information is valuable for surgical planning. Common varices include the left gastric vein, short gastric veins, paraumbilical veins, and splenic vein; in cases of more unusual, complex shunts, 3D rendering is indispensable. By precisely demonstrating the courses of varices, CT angiography allows the surgeon to plan the operative approach and determine the need for surgical varix ligation or preoperative interventional embolization.

Index Terms: Computed tomography (CT), angiography, 95.12916 • Computed tomography (CT), three-dimensional, 95.12917 • Hypertension, portal, 957.711 • Liver, cirrhosis, 761.794 • Shunts, portosystemic, 95.711 • Varices, 95.711

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