Magnetic resonance imaging of arterioportal shunts in the liver

Localized perfusional variations are being seen more frequently in magnetic resonance imaging (MRI) as the increased reliance of the optimized arterial-phase contrast-enhanced strategies has become more commonplace. Many of these findings are related to the various organic or functional arterioportal shunts in the liver. The associated alterations in physiologic flow, decreased or absent portal venous flow, and increased arterial flow result in a regional display of high signal intensity on arterial-phase dominant contrast-enhanced MRI. For accurate diagnosis and planning of patient management, the etiology of the shunt should be distinguished as tumor related or not, and it may need to be differentiated from a hypervascular tumor. Depending on the chronicity of diminished portal flow, substantial parenchymal changes may ensue, including focal fat sparing or the finding of functional infarct, either of which can be demonstrated on static MRI. This article reviews and illustrates the MRI findings of localized tumor-related and nontumorous arterioportal shunts in the liver.