Intrahepatic portal venous systems in adult patients with cavernous transformation of portal vein: Imaging features and a new classification

Xin Huang; Qian Lu; Yue-Wei Zhang; Lin Zhang; Zhi-Zhong Ren; Xiao-Wei Yang; Ying Liu; Rui Tang

doi:10.1016/j.hbpd.2023.01.002

Intrahepatic portal venous systems in adult patients with cavernous transformation of portal vein: Imaging features and a new classification

Hepatobiliary Pancreat Dis Int. 2023 Jan 14:S1499-3872(23)00002-4. doi: 10.1016/j.hbpd.2023.01.002. Online ahead of print.

Authors

Xin Huang¹, Qian Lu¹, Yue-Wei Zhang¹, Lin Zhang¹, Zhi-Zhong Ren¹, Xiao-Wei Yang¹, Ying Liu¹, Rui Tang²

Affiliations

¹ Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China.
² Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China. Electronic address: tra00346@btch.edu.cn.

PMID: 36693772
DOI: 10.1016/j.hbpd.2023.01.002

Abstract

Background: Cavernous transformation of the portal vein (CTPV) due to portal vein obstruction is a rare vascular anomaly defined as the formation of multiple collateral vessels in the hepatic hilum. This study aimed to investigate the imaging features of intrahepatic portal vein in adult patients with CTPV and establish the relationship between the manifestations of intrahepatic portal vein and the progression of CTPV.

Methods: We retrospectively analyzed 14 CTPV patients in Beijing Tsinghua Changgung Hospital. All patients underwent both direct portal venography (DPV) and computed tomography angiography (CTA) to reveal the manifestations of the portal venous system. The vessels measured included the left portal vein (LPV), right portal vein (RPV), main portal vein (MPV) and the portal vein bifurcation (PVB).

Results: Nine males and 5 females, with a median age of 40.5 years, were included in the study. No significant difference was found in the diameters of the LPV or RPV measured by DPV and CTA. The visualization in terms of LPV, RPV and PVB measured by DPV was higher than that by CTA. There was a significant association between LPV/RPV and PVB/MPV in term of visibility revealed with DPV (P = 0.01), while this association was not observed with CTA. According to the imaging features of the portal vein measured by DPV, CTPV was classified into three categories to facilitate the diagnosis and treatment.

Conclusions: DPV was more accurate than CTA for revealing the course of the intrahepatic portal vein in patients with CTPV. The classification of CTPV, that originated from the imaging features of the portal vein revealed by DPV, may provide a new perspective for the diagnosis and treatment of CTPV.

Keywords: Cavernous transformation of the portal vein; Classification; Direct portal venography; Intrahepatic portal venous system.