Haemodynamic changes in non-alcoholic (viral) liver cirrhosis studied by computed tomography (CT) arterial portography and CT arteriography

Aims: To evaluate haemodynamic and vascular changes in non-alcoholic (viral ) cirrhosis on conventional computed tomography (CT), CT arteriography (CTA ) and CT arterial portography (CTAP), and to determine the cause of the obs erved reticular stain on angiography. Methods: Using surgically resected liver specimens from 31 patients with vi ral hepatitis associated hepatocellular carcinoma, images of conventional C T, CTA, CTAP and the sinusoidal phase of hepatic arteriography were retrosp ectively analysed and compared with pathology of the non-cancerous portion of the liver. Results: Computed tomography arteriography showed inhomogeneous enhancement (diffuse, low-density nodules) in a total of 16 samples (52%); in eight of 10 (80%) cirrhotic livers, three of six (50%) precirrhotic livers, five of 12 (42%) livers with chronic active hepatitis and none of three with no ac tive liver disease. The frequency of inhomogeneous enhancement became signi ficantly higher with increasing severity of parenchymal damage (P<0.05). In contrast, conventional CT and CTAP showed homogeneous enhancement in all 3 1 (100%) patients. There was no correlation between inhomogeneous enhanceme nt on CTA and reticular staining on sinusoidal-phase hepatic angiograms. In homogeneous enhancement was frequently seen in patients with hepatitis B su rface antigen and/or anti-hepatitis C virus antibody compared with those wi thout them (P<0.05). Conclusion: The CTA was much more sensitive in detecting haemodynamic chang es in the cirrhotic liver than CTAP, conventional CT and sinusoidal-phased hepatic angiography. Further study is required to clarify the mechanism of inhomogeneous enhancement on CTA and homogeneous enhancement on CTAP seen i n cirrhosis. (C) 1999 Blackwell Science Asia Ptv Ltd.