Imaging Diagnosis of Hepatic Metastases of Pancreatic Carcinomas : Significance of Transient Wedge-shaped Contrast Enhancement Mimicking Arterioportal Shunt

目标。本文旨在探讨胰腺癌肝转移的影像表现，尤其是楔形强化及其病因。对87例胰腺癌肝转移瘤患者行动态CT和MR检查，51例行肝动脉门脉造影(CTAP)和肝动脉造影(CTHA)。结果37例患者中，37例均有1个以上转移灶，动态增强扫描和肝动脉造影均呈楔形强化，CTAP呈楔形灌注缺损区。6例患者表现为多个楔形强化，最初诊断为多发性动-门静脉分流(AP分流)。然而，在随诊的CT和/或MR图像上，转移性肿瘤始终出现在楔形强化区域，87例患者中有43例(49%)在肝转移灶附近有AP分流样增强。结论胰腺癌肝转移瘤常表现为一过性楔形强化，不应误诊为非肿瘤性动-门静脉分流。

OBJECTIVE. We aimed to evaluate the imaging findings of hepatic metastases from pancreatic carcinomas, especially wedge-shaped enhancement and its etiology.MATERIALS AND METHOD. Dynamic CT and MR images were performed in 87 patients with liver metastases from pancreatic carcinomas, and CT during arterial portography (CTAP) and CT during hepatic arteriography (CTHA) in 51 patients.RESULTS. In 37 patients, more than one metastatic lesions accompanied with wedge-shaped enhancement on dynamic studies and CHTA, and wedge shaped perfusion defect on CTAP. Six patients showed multiple wedge-shaped enhancement which was initially diagnosed as multiple arterioportal shunts (AP shunts). However, metastatic tumors appeared within the area of wedge-shaped enhancement on follow-up CT and/or MR images After all, 43 of 87 patients (49%) had AP shunt like contrast enhancement adjacent to liver metastases.CONCLUSION. Liver metastases from pancreatic carcinomas frequently show transient wedge-shaped enhancement, and should not be misdiagnosed as nontumorous arterioportal shunts.