Frequency of arteriovenous shunts in hepatic cavernous hemangiomas in adults as seen on selective arteriography and postembolization radiography

Purpose: To study the frequency and angiographic findings of arteriovenous shunts (AVS) associated with adult cavernous hemangiomas of the liver (CHL) on hepatic artery digital subtraction angiography (DSA) and optimize the i maging technique of DSA to improve its diagnostic efficacy. Methods: We retrospectively analyzed 43 intraarterial DSA procedures perfor med on 30 adults with CHL. Of the 30 patients 22 were found to have an AVS. Transcatheter arterial embolization with Lipiodol (L-TAE) was performed on 21 of these and radiographs were taken immediately after embolization to o bserve the distribution of the injected iodized oil. The results were compa red with those of the AVS found on DSA images. Results. AVS were identified by DSA in 22 (73.3%) of 30 patients. All AVS w ere located in the peritumoral liver tissue and had a parallel track appear ance, or early filling of small draining veins during the arterial phase of DSA. Radiographs taken immediately after L-TAE in 21 of the 22 cases with AVS showed iodized oil filling a few portal branches or draining veins as a result of incompletely occluded shunts in 11 patients. in 10 patients ther e was complete occlusion and no filling of any vein, or only the originatin g end of draining veins filled with iodized oil. No evidence of AVS was fou nd in the other eight patients in this series, and in six of these the DSA was not considered diagnostic. Conclusion: The present study indicates that AVS are frequently seen in adu lts with CHL. DSA with high-quality images is helpful in identifying small AVS of CHL. The formation of an AVS in CHL may be closely related to the pa thological changes in the peritumoral liver tissue.