Does advanced cirrhosis with portosystemic shunting affect the value of CT arterial portography in the evaluation of the liver?

Abstract

The purpose of this study was to determine the extent to which reduced portal blood flow in patients with advanced cirrhosis affects contrast enhancement of the liver during CT arterial portography (CTAP). We postulated that reduced and/or irregular hepatic enhancement would limit the efficacy of CTAP for the detection of hepatic tumors in these patients. We reviewed the records of 82 patients who had biopsy-proved advanced cirrhosis and who underwent CTAP. Three experienced radiologists evaluated the CTAP studies for adequacy of hepatic parenchymal enhancement. The presence or absence of varices also was documented in an attempt to select a subgroup of patients in whom CTAP showed better hepatic parenchymal enhancement. Forty-seven (57%) of 82 patients had inadequate hepatic parenchymal enhancement to allow an evaluation of the entire liver. Inadequacy was attributable to areas of hyperdense parenchymal enhancement, areas of diffuse nontumoral mottling, or zones of poor parenchymal enhancement (soft-tissue attenuation equal to that of the paraspinal muscle). Parenchymal enhancement was inadequate in 62% of patients with varices and in 28% of patients without demonstrable varices. Our results show that contrast enhancement of the liver during CTAP is altered significantly in patients with cirrhosis. Thus, it is likely that CTAP has limited usefulness for the detection or characterization of hepatic neoplasms in patients with cirrhosis.