Three-dimensional CT angiography of spontaneous portosystemic shunts

Spontaneous portosystemic shunts (varices) are a well-known complication of severe liver disease and portal hypertension. Computed tomographic (CT) an giography was used to image the hepatic vasculature of 198 patients with en d-stage liver disease in anticipation of liver transplantation. Performance of a delayed acquisition during the portal phase of enhancement enables ev aluation of portal and variceal anatomy without the need for an additional injection of contrast material. Three-dimensional (3D) reconstruction of po rtal-phase CT angiograms enhances the perception of the courses and anatomi c relationships of varices. This information is valuable for surgical plann ing. Common varices include the left gastric vein, short gastric veins, par aumbilical veins, and splenic vein; in cases of more unusual, complex shunt s, 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 interven tional embolization.