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Main Portal Vein (main + portal_vein)
Selected AbstractsChanges in hepatic venous morphology with cirrhosis on MRIJOURNAL OF MAGNETIC RESONANCE IMAGING, Issue 5 2009Yang Zhang MD Abstract Purpose To identify changes in vascular morphology on magnetic resonance imaging (MRI) in patients with cirrhosis and to compare these findings to liver donors. Materials and Methods Patients undergoing liver transplantation with biopsy-proven cirrhosis (n = 74) and liver donor candidates (n = 85) underwent dynamic gadolinium-enhanced 3D MR at 1.5T. Vessel diameters were measured independently by three radiologists and features of cirrhosis were identified and correlated with cirrhosis. Results Hepatic veins were smaller in patients with cirrhosis (4.9, 4.5, and 5.0 mm for right, middle, and left vs. 9.9, 7.6, and 8.9 mm in donors, P , 0.001) and were negatively correlated with cirrhosis (P < 0.001). Right hepatic vein (RHV) <5 mm diagnosed cirrhosis with 59% sensitivity and 99% specificity; the sensitivity and specificity were 88% and 85% for RHV <7 mm. Main portal vein was minimally larger in cirrhosis, 14 versus 12 mm (P < 0.001) in donors. Right portal veins were smaller in cirrhotic patients, 6.5 and 6.2 mm compared to 8.4 and 7.6 mm (P , 0.001), respectively, in donors. Conclusion Vascular features of cirrhosis include small hepatic veins, minimally enlarged main portal vein, and small intrahepatic portal veins; these features may facilitate identification of cirrhosis. J. Magn. Reson. Imaging 2009;29:1085,1092. © 2009 Wiley-Liss, Inc. [source] Nonoperative therapies for combined modality treatment of hepatocellular cancer: expert consensus statementHPB, Issue 5 2010Roderich E. Schwarz Abstract Although surgical resection and liver transplantation are the only treatment modalities that enable prolonged survival in patients with hepatocellular carcinoma (HCC), the majority of HCC patients presents with advanced disease and do not undergo resective or ablative therapy. Transarterial chemoembolization (TACE) is indicated in intermediate/advanced stage unresectable HCC even in the setting of portal vein involvement (excluding main portal vein). Sorafenib has been shown to improve survival of patients with advanced HCC in two controlled randomized trials. Yttrium 90 is a safe microembolization treatment that can be used as an alternative to TACE in patients with advanced liver only disease or in case of portal vein thrombosis. External beam radiation can be helpful to provide local control in selected unresectable HCC. These different treatment modalities may be combined in the treatment strategy of HCC and also used as a bridge to resection or liver transplantation. Patients should undergo formal multidisciplinary evaluation prior to initiating any such treatment in order to individualize the best available options. [source] Reconstruction of the main portal vein for a large saccular aneurysmHPB, Issue 3 2003Vojko Flis Background A large aneurysm of the main portal vein is rare, and the appropriate surgical procedure is uncertain. Reconstruction of a main portal vein affected by a large saccular aneurysm is described. Case outline Abdominal pain led to the diagnosis of a large saccular aneurysm of the main portal vein in a 58-year-old woman who had undergone cholecystectomy 10 years earlier. At laparotomy a dorsolateral approach to the hepatoduodenal ligament was performed with no attempt at extensive separate exposure of the anatomical structures in the hepatoduodenal ligament, so as to avoid the devascularisation of the common hepatic duct and additional weakening of the portal vein wall. The aneurysm was longitudinally incised, and the portal vein was reconstructed from the walls of the aneurysm with a longitudinal running suture. The rest of the aneurysmal wall was wrapped around the portal vein, leaving it normal in size and contour. Recovery was uneventful. Follow-up CT scan showed a patent portal vein in the region of the former aneurysm. Discussion Large saccular aneurysms can rupture, bleed and cause death. The potential hazards of manipulation of large portal vein aneurysms are negligible in comparison with the possible complications of the aneurysm itself. In our opinion the ease with which the main portal vein was dissected and reconstructed make an elective operation in such cases a reasonable approach. [source] Changes in hepatic venous morphology with cirrhosis on MRIJOURNAL OF MAGNETIC RESONANCE IMAGING, Issue 5 2009Yang Zhang MD Abstract Purpose To identify changes in vascular morphology on magnetic resonance imaging (MRI) in patients with cirrhosis and to compare these findings to liver donors. Materials and Methods Patients undergoing liver transplantation with biopsy-proven cirrhosis (n = 74) and liver donor candidates (n = 85) underwent dynamic gadolinium-enhanced 3D MR at 1.5T. Vessel diameters were measured independently by three radiologists and features of cirrhosis were identified and correlated with cirrhosis. Results Hepatic veins were smaller in patients with cirrhosis (4.9, 4.5, and 5.0 mm for right, middle, and left vs. 9.9, 7.6, and 8.9 mm in donors, P , 0.001) and were negatively correlated with cirrhosis (P < 0.001). Right hepatic vein (RHV) <5 mm diagnosed cirrhosis with 59% sensitivity and 99% specificity; the sensitivity and specificity were 88% and 85% for RHV <7 mm. Main portal vein was minimally larger in cirrhosis, 14 versus 12 mm (P < 0.001) in donors. Right portal veins were smaller in cirrhotic patients, 6.5 and 6.2 mm compared to 8.4 and 7.6 mm (P , 0.001), respectively, in donors. Conclusion Vascular features of cirrhosis include small hepatic veins, minimally enlarged main portal vein, and small intrahepatic portal veins; these features may facilitate identification of cirrhosis. J. Magn. Reson. Imaging 2009;29:1085,1092. © 2009 Wiley-Liss, Inc. [source] Accuracy of magnetic resonance imaging for preoperative detection of portal vein thrombosis in liver transplant candidatesLIVER TRANSPLANTATION, Issue 11 2006Tilak U. Shah The detection of main portal vein thrombosis (PVT) on preoperative imaging of liver transplant candidates has important technical implications for the transplantation procedure. Data are scarce regarding the accuracy of magnetic resonance imaging (MRI) at detecting PVT. The aim of our study was to compare preoperative findings of the portal vein on MRI to operative findings at liver transplantation. Abdominal MRI and clinical records of 172 consecutive patients who received liver transplants between January 1999 and September 2004 were reviewed. Two radiologists independently evaluated the last abdominal magnetic resonance examinations obtained before liver transplantation, blinded to the original reading, operative findings, and clinical data. Findings on MRI were compared with intraoperative findings at transplantation. Main PVT was detected in 12 patients, in whom 8 were found to have thrombus at surgery, with 6 requiring a jump graft or thrombectomy. Sensitivity and specificity of MRI for detecting main PVT were 100% and 98%, respectively. The cause of discordance between findings on MRI and at transplantation in 2 cases was a diminutive caliber of the main portal vein that was interpreted as recanalized chronic thrombosis on MRI. In conclusion, in our study group MRI detected PVT in all liver transplant recipients requiring jump grafts at transplantation. The major reason for a false-positive MRI was a diminutive but patent portal vein. Liver Transpl 2006. © 2006 AASLD. [source] | ||||||||||