Portal hypertension (PHT) is a common complication of liver cirrhosis, which could be measured by the means of portal vein pressure (PVP). However, there is no report about an effective and reliable way to achieve noninvasive assessment of PVP so far. In this study, firstly, we collected ultrasound images and echo signals of different ultrasound contrast agent (UCA) concentrations and different pressure ranges in a low-pressure environment based on an
Contrast Media ; Humans ; Hypertension, Portal/diagnostic imaging* ; Liver Cirrhosis ; Portal Vein/diagnostic imaging* ; Ultrasonography

Two dogs presented with vomiting and head pressing. In both dogs, a large vessel was revealed in computed tomography (CT) angiography, which was found to leave the portal vein (PV) cranial to the splenomesenteric confluence and enter the pre-hepatic caudal vena cava cranial to the right renal vein. The flow of portal blood to the liver was not identified. Based on CT angiography, the dogs were suspected to have congenital PV aplasia with portocaval shunting. Diagnostic imaging of potential malformations for PV continuation should be conducted before attempting shunt closure.
Angiography ; Animals ; Diagnostic Imaging ; Dogs ; Head ; Liver ; Portal Vein ; Portasystemic Shunt, Surgical ; Renal Veins ; Vomiting

The creation of transjugular intrahepatic portosystemic shunt (TIPS) is a widely performed technique to relieve portal hypertension, and to manage recurrent variceal bleeding and refractory ascites in patients where medical and/or endoscopic treatments have failed. However, portosystemic shunt creation can be challenging in the presence of chronic portal vein occlusion. In this case report, we describe a minimally invasive endovascular mesocaval shunt creation with transsplenic approach for the management of recurrent variceal bleeding in a portal hypertension patient with intra- and extrahepatic portal vein occlusion.
Adolescent ; Chronic Disease ; Esophageal and Gastric Varices/complications ; Esophageal and Gastric Varices/diagnostic imaging ; Esophageal and Gastric Varices/therapy ; Female ; Gastrointestinal Hemorrhage/complications ; Gastrointestinal Hemorrhage/diagnostic imaging ; Gastrointestinal Hemorrhage/therapy ; Humans ; Jejunum/pathology ; Portacaval Shunt, Surgical ; Portal Vein/diagnostic imaging ; Portal Vein/pathology ; Portal Vein/surgery ; Tomography, X-Ray Computed ; Treatment Outcome ; Venous Thrombosis/complications ; Venous Thrombosis/diagnostic imaging ; Venous Thrombosis/therapy

Objective To compare measurements of dual-energy CT iodine map parameters and liver perfusion CT parameters in patients with focal liver lesions using a third-generation dual-source CT scanner. Methods Between November 2015 and August 2016,33 patients with non-cystic focal lesions of liver were enrolled in this study. CT examinations were performed with a third-generation dual-source CT. The study CT protocol included a perfusion CT and dual-energy arterial and portal venous scans,with a time interval of 15 minutes. Iodine attenuation was measured at five region of interests including areas of high,medium,and low density within the lesion,as well as right and left liver parenchyma from the iodine map,while arterial liver perfusion (ALP),portal venous liver perfusion (PVP),and hepatic perfusion index (HPI) at the same location were measured from perfusion CT. The Pearson product-moment correlation coefficient was used to evaluate the relationship between iodine attenuation and perfusion parameters. Results The iodine attenuation at arterial phase showed significant intra-individual correlation with ALP (r=0.812,95% CI=0.728-0.885,P<0.001)and PVP (r=-0.209,95% CI=-0.323--0.073,P=0.007),but not significantly correlated with HPI (r=0.058,95% CI=0.046-0.498,P=0.461). The iodine attenuation at portal venous phase showed significant correlation with PVP (r=0.214,95% CI=0.072-0.361,P=0.005) but not with HPI(r=0.036,95% CI=-0.002-0.242,P=0.649). The mean effective dose of arterial phase and portal venous phase of dual-energy CT together [(3.53±1.17)mSv] was significantly lower than that of the perfusion CT [(14.53±0.45)mSv](t=25.212,P<0.001). Conclusion Iodine attenuation from arterial phase of dual energy CT demonstrates significant correlation with ALP and PVP,and iodine attenuation from portal venous phase demonstrates significant correlation with PVP.
Contrast Media ; Humans ; Iodine ; Liver ; diagnostic imaging ; pathology ; Perfusion ; Portal Vein ; Tomography, X-Ray Computed ; methods

Portal biliopathy is defined as abnormalities in the extra- and intrahepatic ducts and gallbladder of patients with portal hypertension. This condition is associated with extrahepatic venous obstruction and dilatation of the venous plexus of the common bile duct, resulting in mural irregularities and compression of the biliary tree. Most patients with portal biliopathy remain asymptomatic, but approximately 10% of them advance to symptomatic abdominal pain, jaundice, and fever. Magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography are currently used as diagnostic tools because they are noninvasive and can be used to assess the regularity, length, and degree of bile duct narrowing. Management of portal biliopathy is aimed at biliary decompression and reducing the portal pressure. Portal biliopathy has rarely been reported in Korea. We present a symptomatic case of portal biliopathy that was complicated by cholangitis and successfully treated with biliary endoscopic procedures.
Abdomen/diagnostic imaging ; Cholangiopancreatography, Endoscopic Retrograde ; Cholestasis/*diagnosis ; Humans ; Hypertension, Portal/*diagnosis ; Male ; Middle Aged ; Portal Vein ; *Stents ; Tomography, X-Ray Computed

Objective To explore the diagnostic value of contrast-enhanced ultrasound (CEUS)for small focal liver lesions (FLLs). Methods The clinical data,CEUS findings,and pathology of 69 patients with small FLLs were retrospectively analyzed. Patients were grouped according to size of FLLs and the performance of CEUS was compared. Results The accuracy,sensitivity,specificity,positive predictive value,and negative predictive value of CEUS for the 69 FLLs were 94.2%,95.2%,93.8%,87.0%,and 97.8%,respectively. Rate of fast wash-out in portal vein phase was lower in group of diameters ≤2 cm than that in group of diameters>2 cm (P<0.05). Conclusions CEUS has a high diagnostic value for small FLLs.However,the CEUS findings of malignant lesions smaller than 2 cm are not typical in the portal phase and therefore the diagnosis should also be based on clinical features.
Contrast Media ; Humans ; Liver Diseases ; diagnostic imaging ; Portal Vein ; Predictive Value of Tests ; Retrospective Studies ; Sensitivity and Specificity ; Ultrasonography

Cirrhosis can occur with the development of portal vein thrombosis (PVT). PVT may aggravate portal hypertension, and it can lead to hepatic decompensation. The international guideline recommends for anticoagulation treatment to be maintained for at least 3 months in all patients with acute PVT. Low-molecular-weight-heparin and changing to warfarin is the usual anticoagulation treatment. However, warfarin therapy is problematic due to a narrow therapeutic window and the requirement for frequent dose adjustment, which has prompted the development of novel oral anticoagulants for overcoming these problems. We report a 63-year-old female who experienced complete resolution of recurrent acute PVT in liver cirrhosis after treatment with rivaroxaban.
Administration, Oral ; Factor Xa Inhibitors/*therapeutic use ; Female ; Humans ; Liver Cirrhosis/*complications/diagnosis ; Middle Aged ; Portal Vein ; Recurrence ; Rivaroxaban/*therapeutic use ; Tomography, X-Ray Computed ; Venous Thrombosis/complications/diagnostic imaging/*drug therapy

Diagnostic Imaging ; Humans ; Liver Diseases ; pathology ; Portal Vein ; pathology

OBJECTIVETo study the characteristics of blood flow in common hepatic tumors by 256-slice spiral CT whole-liver perfusion imaging.

METHODSSeventy-one patients with hepatic tumors were examined retrospectively by 256-slice spiral CT whole-liver perfusion. Among them, twenty-seven cases were of primary hepatic cancer, twenty-four cases of hepatic hemangioma, and twenty cases of hepatic metastases.Regions of interest (ROIs) were placed in the tumor parenchyma (Area A), peritumoral hepatic parenchyma (Area B), and normal hepatic parenchyma (Area C), respectively. The time density curves (TDC) were drawn, and perfusion parameters including hepatic arterial perfusion(HAP), portal venous perfusion(PVP), total liver perfusion(TLP) and hepatic erfusion index(HPI) were obtained. The values of ROIs were measured, and the perfusion parameters in the areas A, B, C of different hepatic tumors were statistically analyzed.

RESULTSThe values of HAP, PVP, HPI in the tumor parenchyma of primary hepatic carcinoma were (20.00 ± 11.41)ml · min(-1) · 100 ml(-1,) (32.31 ± 21.06)ml · min(-1) · 100 ml(-1,) (52.31 ± 30.55)ml · min(-1) · 100 ml(-1,) and (39.67 ± 11.19)%, showing significant difference as compared with those in peritumoral hepatic parenchyma and in normal hepatic parenchyma(P<0.05). The values of HAP, TLP, and HPI in the tumor parenchyma of hepatic hemangioma were (40.39 ± 29.23)ml · min(-1) · 100 ml(-1,) (132.72 ± 132.65) ml · min(-1) · 100 ml(-1,) and (35.51 ± 15.12)%, were significantly different as compared with those in the peritumoral hepatic parenchyma and in normal hepatic parenchyma(P<0.05). The values of HAP, PVP, HPI in the tumor parenchyma of hepatic metastases were (17.43 ± 12.27)ml · min(-1) · 100 ml(-1,) (36.19 ± 34.99) ml · min(-1) · 100 ml(-1,) and (37.86 ± 14.49)%, significantly different as compared normal hepatic parenchyma (P<0.05). The HAP, PVP, and TLP of tumor tissue and the PVP and HPI of peritumoral tissue in different hepatic tumors were statistically significantly different (P<0.05).

CONCLUSIONSThe multi-slice spiral CT whole-liver perfusion has certain value in the diagnosis of common hepatic tumors. Perfusion parameters in different areas of common hepatic tumors have their own hemodynamic characteristics.

Carcinoma, Hepatocellular ; blood supply ; diagnostic imaging ; Hemangioma ; blood supply ; diagnostic imaging ; Hepatic Artery ; diagnostic imaging ; physiology ; Humans ; Liver ; blood supply ; Liver Neoplasms ; blood supply ; diagnostic imaging ; secondary ; Perfusion Imaging ; Portal Vein ; diagnostic imaging ; physiology ; Regional Blood Flow ; Retrospective Studies ; Tomography, Spiral Computed

Variceal bleeding occurs primarily in the esophagus or stomach in patients with liver cirrhosis, but can also occur rarely in the duodenum. Duodenal variceal bleeding has a high mortality and poor prognosis due to heavy blood flow originating from the portal vein (PV) and the technical difficulty of hemostatic procedures. Treatments including endoscopic sclerotherapy, endoscopic ligations, endoscopic clipping and transjugular intrahepatic portosystemic shunt have been tried, with only moderate and variable success. A percutaneous transsplenic approach offers another way of accessing the PV. Here we report a case of successfully treated duodenal variceal bleeding by percutaneous transsplenic embolization.
Aged ; Duodenum ; Embolization, Therapeutic ; Endoscopy, Gastrointestinal ; Esophageal and Gastric Varices/complications/*diagnosis ; Gastrointestinal Hemorrhage/*therapy ; Humans ; Liver Cirrhosis/complications/*diagnosis ; Male ; Portal Vein/diagnostic imaging ; *Portasystemic Shunt, Transjugular Intrahepatic ; Recurrence ; Tomography, X-Ray Computed