Thrombosis and cavernomatous transformation of the portal vein among hepatic diseases and hepatic arterial buffer response

Portal vein thrombosis [PVT] and cavernomatous portal vein [CPV] are rare conditions that may affect both children and adults. In this study the incidence of PVT and CPV among different liver conditions were recorded and the results were evaluated. From January 1993 to December 1999, 353 patients with different liver conditions were evaluated, regarding the clinical presentation, the liver pathology and the ultrasonographic findings in the portal system and hepatic artery. Of the 353 patients, 224 were males [63.5%] and 129 were females [36.5], with a mean age of 36 years [range 9 to 58 years]. The early clinical presentation was abdominal pain and vomiting and/or fever, while the late presentations were that due to portal hypertension such as variceal bleeding. The liver pathology was periportal fibrosis [PPF] in 124 cases [35.1%], cirrhosis in 48 cases [13.6%], mixed cirrhosis and PPF in 163 cases [46.2%], hepatocellular carcinoma [HCCa] in 16 cases [4.5%] and post-splenectomy acute PVT in 2 cases [0.6%]. By ultrasonography, PVT was found in 22/353 patients [6.2%] with the different liver conditions. CPV transformation was found in 4/353 of such cases [1.1%]. By studying the hepatic arterial buffer response, the resistive index [RI] was found to be as low as 0.558 in cirrhosis and HCCa patients with PVT and as low as 0.490 in postsplenectomy patients with acute PVT. We concluded that Early diagnosis of PVT or CPV transformation, in patients with risk factors, by their clinical presentation and a meticulous technique of duplex scanning of the portal system, is very important to avoid early bowel ischaemia or late variceal hemorrhage

Value of MRI in grading of supratentorial diffuse astrocytomas

The present study included 15 patients [8 males and 7 females] with their age ranged from 25 years to 68 years. The MR images in the studied patients with biopsy-proven diffuse ostrocytomas were analyzed in order to demonstrate which MRI features of gliomas that correlate with the histopathologically determined tumor grade. According to the histopathological diagnosis, 3 patients had grade II astrocytomas, 5 patients had grade III astrocytomas and 7 patients had glioblastoma multiformes [GBMs]. The MRI features studied included tumor heterogeneity, edema, mass effect, border sharpness, contrast enhancement, hemorrhage and the presence of flow voids. Contrast enhancement was found to be the best predictor of histological grade followed by necrosis, signal heterogeneity and border sharpness. Hemorrhage, flow void and necrosis were common in the GBM group and were absent in grade II astrocytoma group. In particular, flow void was found only in GBM [n=3 patients], hemorrhage was present in GBM [n= 3 patients] and in grade III astrocytoma [one patient]. Necrosis was found in all 7 GBM cases and in 5 patients with histological diagnosis of anaplastic astrocytoma [grade III astrocytoma]. No areas of necrosis detected in grade II astrocytoma [3 patients]. All GBM cases [n = 7] showed grade 3 edema [larger than the tumor volume], marked and heterogeneous enhancement, midline shift and heterogeneous signal intensity on both Tl-W and T2-W images. In grade III astrocytomas [n = 5 patients], there is edema of grade 2 [less than the tumor volume], moderate contrast enhancement, midline shift and heterogeneous signal intensity on T2-W images. In grade II astrocytomas [n = 3 patients], there is edema of grade 1 [none-to mild], subarachnoid space effacement, none- to mild contrast enhancement and homogeneous signal intensity. The frontal lobe was the most commonly affected lobe, frontal gliomas were present in 9 patients, fronto-parietal gliomas in 4 patients and fronto-temporal gliomas in 2 patients. In conclusion, all MRI features can help to distinguish the pathological grade of diffuse astrocytic tumours and help in planning treatment strategies