The Role of Imaging in Portal Vein Thrombosis: From the Diagnosis to the Interventional Radiological Management

Abstract

Purpose: To illustrate diagnostic and interventional imaging for the characterization and treatment of portal vein thrombosis (PVT). Introduction: The broad spectrum of congenital and acquired PVT manifestations is illustrated, with a focus on the pediatric population; diagnostic and interventional imaging techniques are described. Description: PVT frequently presents as an incidental finding at imaging in the screening for liver diseases or for other unrelated reasons. PVT can be classified based on: extension (intrahepatic, extrahepatic, involving the spleno-mesenteric tract, etc.); degree (partial or complete); onset (acute or chronic); and with or without cavernomatous transformation. This comprehensive review relies on the experience gained from a large series of congenital and acquired PVT in a referral center for pediatric and adult liver transplantation. Diagnostic and interventional imaging techniques are described, including: color–Doppler and contrast-enhanced Ultrasound; CT and MR angiography; retrograde portography; percutaneous transhepatic, transplenic, and transmesenteric portography; transjugular intrahepatic portosystemic shunt creation. Pre- and post-operative imaging assessment of the surgical meso-rex bypass is discussed. The description is enriched with an original series of pictorial imaging findings. Conclusion: PVT is a clinical condition associated with significant morbidity and mortality. Diagnostic and interventional imaging plays a crucial role in both conservative and operative management.

Splanchnic Vein Thrombosis: The State-of-the-Art on Anticoagulant Treatment

“…MR is less widely available and has a longer acquisition time and lower spatial resolution than CT scan. 71 It does not utilize ionizing radiation and the paramagnetic contrast agent has a better safety profile.…”

“…They can also visualize the surrounding structures to identify possible complications, such as bowel ischemia, or provoking condition, such as abdominal malignancies. 71 They are often performed after CDUS to evaluate thrombus extension within the mesenteric and splenic veins, which can be underestimated by CDUS. CT utilizes ionizing radiation and an iodinated contrast agent, which can potentially be nephrotoxic in patients with preexisting chronic kidney disease (contrast-induced nephropathy).…”

“…MR is less widely available and has a longer acquisition time and lower spatial resolution than CT scan. 71 It does not utilize ionizing radiation and the paramagnetic contrast agent has a better safety profile. However, rare cases of nephrogenic systemic fibrosis have been reported in patients with chronic kidney disease.…”

Special Issue on “Advances in Image-Guided Diagnosis and Treatment of Abdominal Diseases”

“…Finally, two interesting reviews presented a comprehensive overview of different imaging modalities adopted in clinical practice, respectively, for the management of portal vein thrombosis and malignant melanoma, which are two relatively uncommon but very tricky conditions. Marra et al [9] described the wide spectrum of portal vein thrombosis appearance in pediatric patients and adults, focusing on precise disease characterization with multimodality imaging. The authors remarked on the developments in the field, especially regarding the role of invasive imaging and interventional radiology, which led to a substantial improvement in the management of this clinical entity.…”