Characteristics and diagnosis of multi-slice computed tomography examination of portal vein diseases / 中华消化外科杂志

ABSTRACT

Objective To summarize the characteristics of multi-slice computed tomography (MSCT) of portal vein diseases and investigate the CT diagnosis of its primary and secondary diseases.Methods The imaging data of 62 patients from Xi'an Xidian Group Hospital,28 patients from Nuclear Industry 215 Hospital of Shanxi Province and 16 patients from Xi'an Gaoxin Hospital with portal vein diseases from January 2012 to March 2015 were retrospectively analyzed.The CT findings,primary and secondary diseases of portal vein lesions were recorded through plain scan and enhanced scan of MSCT.Results Changes in the width of portal veinamong 106 patients,dilation of main portal vein was detected in 45 cases,stenosis of stem or branches of portal vein in 39 cases,portal vein obstruction in 49 cases (21 patients accompanied with enlargement in stem of portal vein and 6 patients with normal width).The diameters of dilated portal vein were 1.4-2.2 cm with a mean diameter of 1.8 cm.The diameters of portal vein with stenosis and occlusion caused by carcinomas were 1.8-4.0 cm with a mean diameter of 2.3cm.Portal vein fistula and pneumatosishepatic artery-portal vein fistulas were detected in 12 patients,posterior right branches of portal vein-inferior vena cava fistulas in 2 patients,inferior vena cavaportal vein fistulas and portal-hepatic vein fistulas in 2 patients,pneumatosis in 2 patients.Lesions of portal vein occlusionsocclusions located at main portal veins were detected in 4 cases,left and right branches in 34 cases,both main portal veins and left or right branches in 11 cases.Malignant stenosis and occlusion were detected in 29 and 42 cases,benign stenosis and occlusion were detected in 10 and 7 cases,respectively.Protopathies of portal vein dilationthere were 43 patients with liver cirrhosis and 2 patients with inferior vena cava-portal vein-hepatic vein fistula of Budd-Chiari syndrome.Protopathies of benign stenosis and occlusionportal vein thrombosis in liver cirrhosis,giant cavernous haemangioma,polycystic disease of liver,pylephlebitis caused by liver abscess,portal vein thrombosis caused by polycythemia vera.Protopathies of hepatic artery portal vein fistula and portal veininferior vena cava fistulaliver cancer and liver cirrhosis,protopathy of inferior vena cava-portal vein fistula and portal vein-hepatic vein fistula were Budd-Chiari syndrome.Protopathies of pneumatosisintestinal infarction after superior mesenteric artery embolus and acute gastric dilatation.Portacaval collateral circulation occurred in 58 patients (partial patients complicated with multi-point varices and shunts),ascites in 44 patients,portal vein cavernous transformation in 12 patients,ischemia and edema of intestinal wall in 5 patients,intrahepatic cholangiectasis in 19 patients including 17 cases of biliary obstruction caused by malignant tumors and 2 cases of portal vein cavernous transformation complicated with intrahepatic cholangiectasis (portal hypertensive biliopathy).Conclusions The MSCT for portal vein diseases is presented as portal vein stenosis,occlusion or dilation,pneumatosis.Secondary lesions are portacaval collateral circulation,portal vein cavernous transformation,intestinal ischemia and portal hypertensive biliopathy,and primary lesions are mainly liver cirrhosis and malignant tumors.MSCT can show clearly the portal vein lesions and diagnose accurately its primary and secondary lesions.