LA PRESENCE D'ANASTOMOSES PORTOSYSTEMIQUES SPONTANEES A-T-ELLE UNE INFLUENCE SUR LE DEGRE DU REHAUSSEMENT PARENCHYMATEUX HEPATIQUE AU COURS DU PORTOSCANNER EFFECTUE EN MODE HELICOIDAL?

Aim: To correlate the presence or absence of spontaneous portosystemic shunts with the degree of hepatic parenchymal enhancement during spiral CT arterial portography (SCTAP). Materials and methods: SCTAP scans of 40 patients were retrospectively analysed for degree of hepatic parenchymal enhancement and presence or absence of spontaneous portosystemic shunts. Twenty patients had hepatic metastases from colorectal cancer without portal hypertension or cirrhosis and 20 had primary hepatocellular carcinoma with histological confirmation (18 of these had an associated alcohol induced hepatic cirrhosis). Results: Marked hepatic parenchymal enhancement was observed in 34 patients; one of them (3%) had spontaneous porto-systemic shunts. Poor or moderate enhancement was seen in 6 patients; 5 of these (83%) had spontaneous portosystemic shunts (P<0.001). Among the subgroup of 18 patients with hepatic cirrhosis high degrees of hepatic parenchymal enhancement (Group A) was noted in 12 patients (67%), and poor or moderate enhancement (Group B) in 6 patients (33%). Spontaneous portosystemic shunts were present in one patient (8%) in Group A and 5 patients (83%) in Group B (P<0.001). Conclusion: The presence of spontaneous portosystemic shunts is associated with poor or moderate hepatic parenchymal enhancement on SCTAP.