Fig 1.
Arteriovenous hepatic malformations (shunts) in one exemplary case with HHT.
CEUS image and TIC-analysis illustrating peak enhancement. Intrahepatic tortuos vascularization in segment IV and VIII of the liver being appreciable by early hyperenhancement in the course of the arterial phase following injection of 2.0 ml contrast agent. For TIC analysis three regions of interest (ROIs) were positioned in the shunt region (yellow), hilus region (purple) and hepatic parenchyma (white). TIC analysis demonstrated significant highest PE in the shunt region, next in the hilus and lowest in the hepatic parenchyma. The VueBox screen is segmented in four quadrants: the original image with the ROIs is showed in the upper left quadrant, the corresponding parametric image is depicted in the upper right quadrant, the corresponding TICs are displayed in the lower left quadrant in the color corresponding to the ROI in the image above and the numeric values of the chosen curve parameter is shown in the lower right quadrant.
Table 1.
Basic characteristics of 34 patients with HHT.
Fig 2.
Quantitative perfusion data (TIC) analyzed by CEUS combinend with VueBox color-coded perfusion software within shunt region, hilus region and hepatic parenchyma in 31 patients with diagnosed HHT.
Percentage in relation to PE (A), WiAUC (B) and WiPI (C) of the shunt region (100%). Marked significant distinctions (p<0.0001) in PE, WiAUC and WiPI values was identified between the three regions, to the effect that uppermost values were detected in the shunt region (100%), next up in the hilus (PE 32.6%; WiAUC 33.9%; WiPI 34.1%) and the lowest were demonstrated in the liver parenchyma (PE 10.2%; WiAUC 12.0%; WiPI 9.5%).
Fig 3.
Subset analysis of quantitative perfusion data (TIC) evaluated by CEUS combinend with VueBox color-coded perfusion software within shunt region, hilus region and hepatic parenchyma in 31 patients with diagnosed HHT.
Percentage in relation to PE (A), WiAUC (B) and WiPI (C) of the shunt region (100%). Marked significant distinctions (p<0.0001) in PE, WiAUC and WiPI values was identified between the two groups concerning the three selected regions, to the effect that in group 1 (hilus PE 12.1%; WiAUC 15.1%; WiPI 17.2%; liver parenchyma PE 7.2%; WiAUC 8.7%; WiPI 7.4%) obvious lower perfusion parameters could be demonstrated when compared to group 2 (hilus PE 69.8%; WiAUC 73.5%; WiPI 69.6%; liver parenchyma PE 15.5%; WiAUC 18.9%; WiPI 14.9%).
Fig 4.
Clinical parameters in group 1 vs. group 2 of our patient cohort.
Intrahepatic portal vein diameter in cm (A), portal vein peak velocity in cm/s (B) and Buscarini grading (C) in group 1 compared to group 2 of our patient cohort. Significant distinctions (A: p<0.05; B: p<0.001; C: p<0.01) was identified between the two groups, to the effect that in group 1 the intrahepatic portal vein diameter was significantly higher (13.6 cm vs. 10.0 cm; n = 3), while portal vein peak velocity was significantly lower (22.8 cm/s vs. 37.0 cm/s; n = 5–7) than in group 2. Moreover, Buscraini grading was significantly elevated in group 1 compared to group 2 (3.2 vs. 2.0; n = 4–11).
Fig 5.
Correlation between clinical parameters and TIC parameters of our study cohort.
Regression analysis showing the relationship between portal vein diameter (in cm), portal vein peak velocity (in cm/s), Buscarini grading and PE (A-C), WiAUC (D-F), WiPI(G-I) (each: hilus/shunt in %). Regression formula and coefficient of determination (R2) is indicated for each diagram.