Non Tumorous Perfusion Defect of the Liver Appearing on Portal Angiographic Computed Tomography

Toshiya Ochiai^{1) 2)}, Kenichi Takayasu, Fumihiko Wakao¹⁾, Noriyuki Moriyama¹⁾, Yukio Muramatsu¹⁾, Susumu Yamasaki²⁾, Masatoshi Makuuchi³⁾

1) Department of diagnostic Radiology, National Cancer Center Hospital
2) Department of Surgery, National Cancer Center Hospital
3) The First Department of Surgery, Shinsyu University

In 85 patients with hepatocellular carcinoma (HCC) who underwent ultrasonography, enhanced computed tomography (CT), angiography and portal angiographic CT (P-CT) followed by surgery from June 1987 to January 1991, the non tumorous perfusion defect (NTPD) which appears on P-CT was studied radiologically. NTPD of the liver, ranging from 0.2 to 7.0 cm in diameter, was obseved in 16 patients (18.8%) and did not show any specific location in the liver. The most common NTPD was round (66.8%). More sophisticated studies than angiography suggested the following possible cause of NTPD in five cases (31.2%): i) direct inflow into the intrahepatic portal vein via the cystic vein, accessory portal vein or pericholedochal vein in one patient each; ii) obstruction of the peripheral portal vein due to macroscopic tumor thrombi in one patient and iii) a precancerous lesion in one, because it had grown and was enhanced by contrast medium 4 months later, which strongly suggested overt HCC. When a diagnostic perfusion defect is seen on P-CT, one should consider the NTPD described above which is independent of overt HCC.

Key words
portal angiographic CT, hepatocellular carcinorma, non tumorous perfusion defect

Reprint requests
Toshiya Ochial Department of Diagnostic Radiology, National Cancer Center Hospital
5-1-l Tsukiji, Chuo-ku, Tokyo, 104 JAPAN

Accepted
February 12, 1992

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