Macro- and microcirculation patterns of intrahepatic blood flow changes in patients with hereditary hemorrhagic telangiectasia

Figure 4 Arteriovenous hepatic malformation (shunt) in a 36-year-old woman. Contrast-enhanced ultrasound image and time intensity curve (TIC) analysis. A: Intrahepatic tortuos hepatic artery in segment IV (central) and VIII of the liver being evident by early hyperenhancement during the arterial phase after injection of 2.0 mL contrast agent. Enhanced mean diameter of the extrahepatic hepatic artery (9.7 mm) without dilation intrahepatic (4.2 mm) and of the portal vein (7.5 mm); B: For TIC analysis eight regions of interest (ROIs) with a diameter of 5 mm were placed in the perfused hepatic artery (yellow, turquoise), portal vein (red, green), shunt region (orange, purple) and hepatic parenchyma (white, blue), two ROIs per region. TIC analysis showed significant lowest time to peak (TTP) and highest area under the curve (AUC) in the hepatic artery and highest TTP and lowest AUC in the portal vein and hepatic parenchyma. Appropriate to the idea that the shunt region represents mixed arteriovenous perfusion, TTP and AUC values were between those of hepatic artery and portal vein. (Caselitz-Kriteria: 1 Major + 2 Minor; Buscarini grade 1; no color spots in peripheral regions).