개에서 컴퓨터단층촬영술을 이용하여 진단한 임상증상이 없는 간외성 전신문맥단락의 영상학적 평가

Diagnostic Imaging Features of Asymptomatic Extrahepatic Portosystemic Shunt Detected by CT in Dogs

  • 최수영 (이안동물영상의학센터) ;
  • 이인 (이안동물영상의학센터) ;
  • 최호정 (충남대학교 수의과대학.동물의과학연구소) ;
  • 이영원 (충남대학교 수의과대학.동물의과학연구소)
  • Choi, Soo-Young (Ian Animal Diagnostic Imaging Center) ;
  • Lee, In (Ian Animal Diagnostic Imaging Center) ;
  • Choi, Ho-Jung (College of Veterinary Medicine.Research Institute of Veterinary Medicine, Chungnam National University) ;
  • Lee, Young-Won (College of Veterinary Medicine.Research Institute of Veterinary Medicine, Chungnam National University)
  • 심사 : 2013.08.10
  • 발행 : 2013.08.31

초록

This study was performed to compare clinical and diagnostic imaging features between asymptomatic and symptomatic extrahepatic portosystemic shunts in dogs. The data of thirty patients diagnosed with extrahepatic PSS by multi-detector CT were reviewed, and the dogs were divided into asymptomatic (9/30) and symptomatic (21/30) groups. Signalments, hematologic results, liver size, morphologic classifications and main portal vein to abdominal aortic ratio (PV/AO) at the porta hepatis level from CT images were evaluated in two groups. Shih-tzu (5/9) was the most frequent breed in asymptomatic group, and various breeds were presented in symptomatic group. Mean age of asymptomatic group ($9.2{\pm}3.2$ years) was significantly higher than that of symptomatic group ($4.5{\pm}3.2$ years). The most morphologic form of shunt vessel was the splenophrenic shunt (16/30). PV/AO of asymptomatic group ($1.1{\pm}0.19$) was significantly higher than the values of symptomatic group ($0.55{\pm}0.19$). Clinical signs, hematologic results and diagnostic imaging findings of asymptomatic PSS are too nonspecific to suspect PSS. Therefore, considering of patient's age and CT examination with application of PV/AO ratio could be useful for the diagnosis of asymptomatic PSS.

키워드

참고문헌

  1. Alonso-Gamarra E, Parron M, Perez A, Prieto C, Hierro L, Lopez-Santamaria M. Clinical and radiologic manifestations of congenital extrahepatic portosystemic shunts: a comprehensive review. Radiographics 2011; 31: 707-722. https://doi.org/10.1148/rg.313105070
  2. d'Anjou MA, Penninck D, Cornejo L, Pibarot P. Ultrasonographic diagnosis of portosystemic shunting in dogs and cats. Vet Radiol Ultrasound 2004; 45:424-437. https://doi.org/10.1111/j.1740-8261.2004.04076.x
  3. Holt DE, Schelling CG, Saunders HM, Orsher RJ. Correlation of ultrasonographic ndings with surgical, portographic, and necropsy ndings in dogs and cats with portosystemic shunts: 63 cases (1987-1993). J Am Vet Med Assoc 1995; 207: 1190- 1193.
  4. Kleber G, Steudel N, Behrmann C, et al. Hepatic arterial ow volume and reserve in patients with cirrhosis: use of intra-arterial Doppler and adenosine infusion. Gastroenterology 1999; 116: 906-914. https://doi.org/10.1016/S0016-5085(99)70074-0
  5. Lamb CR. Ultrasonographic diagnosis of congenital portosystemic shunts in dogs: results of a prospective study. Vet Radiol Ultrasound 1996; 37: 281-288. https://doi.org/10.1111/j.1740-8261.1996.tb01231.x
  6. Lamb CR. Ultrasonography of portosystemic shunts in dogs and cats. Vet Clin North Am Small Anim Pract 1998; 28: 725-753.
  7. Lautt WW. Mechanism and role of intrinsic regulation of hepatic arterial blood ow: hepatic arterial buffer response. Am J Physiol 1985; 249: G549-G556.
  8. Leen E, Goldberg JA, Anderson JR, et al. Hepatic perfusion changes in patients with liver metastases: comparison with those patients with cirrhosis. Gut 1993; 34: 554-557. https://doi.org/10.1136/gut.34.4.554
  9. Maddison JE. Hepatic encephalopathy. Current concepts of the pathogenesis. J Vet Intern Med 1992; 6: 341-353. https://doi.org/10.1111/j.1939-1676.1992.tb00367.x
  10. Mertens M, Fossum TW, Willard MD, Fosgate GT, de la Paz AG, Farmer R, Miller MW. Diagnosis of congenital portosystemic shunt in miniature schnauzers 7 years of age or older (1997-2006). J Am Anim Hosp Assoc 2010; 46: 235-240.
  11. Nelson NC, Nelson LL. Anatomy of extrahepatic portosystemic shunt in dogs as determined by computed tomography angiography. Vet Radiol Ultrasound 2011; 52: 498-506. https://doi.org/10.1111/j.1740-8261.2011.01827.x
  12. Reichen J, Egger B, Ohara N, Zeltner TB, Zysset T, Zimmermann A. Determinants of hepatic function in liver cirrhosis in the rat: multivariate analysis. J Clin Invest 1988; 82: 2069-2076. https://doi.org/10.1172/JCI113828
  13. Remer EM, Motta-Ramirez GA, Henderson JM. Imaging findings in incidental intrahepatic portal venous shunts. Am J Roentgenol 2007; 188: 162-167. https://doi.org/10.2214/AJR.05.1115
  14. Rothuizen J. Important clinical syndromes associated with liver disease. Vet Clin North Am Small Anim Pract. 2009; 39: 419-437. https://doi.org/10.1016/j.cvsm.2009.02.007
  15. Ruland K, Fischer A, Hartmann K. Sensitivity and specificity of fasting ammonia and serum bile acids in the diagnosis ofportosystemic shunts in dogs and cats. Vet Clin Pathol 2010; 39: 57-64. https://doi.org/10.1111/j.1939-165X.2009.00178.x
  16. Singh K, Kapoor A, Kapoor A, Gupta K, Mahajan G. Congenital intrahepatic portosystemic shunt - an incidental rare anomaly. Indian J Pediatr. 2006; 73: 1122-1123. https://doi.org/10.1007/BF02763062
  17. Tobias KM, Rohrbach BW. Association of breed with the diagnosis of congenital portosystemic shunts in dogs: 2,400 cases (1980-2002). J Am Vet Med Assoc. 2003; 223: 1636- 1639. https://doi.org/10.2460/javma.2003.223.1636
  18. Zwingenberger AL, Schwarz T, Saunders HM. Helical computed tomographic angiography of canine portosystemic shunts. Vet Radiol Ultrasound 2005; 46: 27-32. https://doi.org/10.1111/j.1740-8261.2005.00005.x
  19. Zwingenberger AL, Schwarz T. Dual-phase CT angiography of the normal canine portal and hepatic vasculature. Vet Radiol Ultrasound 2004; 45: 117-124. https://doi.org/10.1111/j.1740-8261.2004.04019.x