Iodized oil retention due to postbiopsy arterioportal shunt: a false positive lesion in the investigation of hepatocellular carcinoma

BACKGROUND

Iodized-oil computed tomography (CT) is useful for the diagnosis of hepatocellular carcinoma, but there may be false-positive results in patients who have undergone some percutaneous transhepatic interventional procedures. The purpose of the present study was to verify the correlation between subsegmental hepatic parenchymal retention of iodized oil on CT and the arterioportal shunt caused by liver biopsy.

METHODS

Iodized-oil CT scans were reviewed in 24 patients with hepatic tumors who had liver biopsy and subsequent iodized oil chemoembolization. Iodized oil chemoembolization was performed shortly after biopsy (1-10 days; mean = 2.6 days). The results were correlated with hepatic arteriography, with a special emphasis on the presence of hepatic arterioportal shunt.

RESULTS

Wedge-shaped subsegmental retention of iodized oil along or adjacent to the biopsy needle path was observed in iodized-oil CT in 17 of the 24 patients. In three patients, there was subsegmental enhancement on prebiopsy helical dynamic liver CT at the same area of iodized oil retention, and therefore iodized oil retention was considered to be due to hepatocellular carcinoma. In the remaining 13 (54%) patients, the peripheral iodized oil retention was considered to be due to biopsy-induced arterioportal shunt. In all these patients, arterioportal shunt was confirmed by hepatic arteriography.

CONCLUSION

Wedge-shaped hepatic parenchymal retention of iodized oil is commonly observed in iodized-oil CT due to biopsy-induced arterioportal shunt, and this appearance should not be confused with a hepatocellular carcinoma.