Clinical Implications

3D CE MR portography permits accurate evaluation of the intra- and extrahepatic portal-venous system as well as the hepatic veins (Fig. 15). Due to the large field of view, the short time of acquisition, the lack of radiation, the non-invasive nature of the procedure and the low risk of complications, MR portography is regarded as superior to conventional catheter digital subtraction angiography (DSA). Clinical applications of 3D CE MR portography include the assessment of portal hypertension (portosystemic shunt, portal vein obstruction, hepatic vein obstruc-

Normal Hepatic Vein Anatomy

Fig. 14. Normal anatomy of the portal-venous system. A Portal vein. B Superior mesenteric vein (SMV). C Inferior mesenteric vein (IMV). D Lienal (splenic) vein. I Right branch of the portal vein. II Left branch of the portal vein. a Coronary and pyloric veins. b Right and left gastroepiploic veins. c Superior hemorrhoidal vein. d Hemorrhoidal plexus. e Middle and inferior hemorrhoidal veins. From Magnetic Resonance Angiography, Schneider G. et al (eds.), p 243. Springer, 2005

Mrv Brain PlanningMra Liver Images
Fig. 15a, b. Normal anatomy of the portal-venous system on CE MRA MIP reconstruction (a) and volume-rendered image (b). A Portal vein. B Superior mesenteric vein (SMV). C Inferior mesenteric vein (IMV). D Lienal (splenic) vein. I Right branch of the portal vein. II Left branch of the portal vein

tion), hepatic encephalopathy, ascending portal thrombophlebitis, hepatocellular carcinoma (HCC) and pancreatobiliary tumors, gastrointestinal hemorrhage, and differentiation of splanchnic arterial disease from portal-venous disease [22,33].

In patients with portal hypertension, 3D MR portography can be used to evaluate portosys-temic shunts, hepatorenal collateral pathways, and obstruction of the portal or hepatic veins. In planning treatment for hepatic encephalopathy, it is important to identify the causative portosystemic shunt. In suspected cases of ascending portal thrombophlebitis, it is important to assess the severity of portal vein obstruction as well as portal collateral vessels. In patients with HCC or pancre-atobiliary tumors, the presence or absence of portal vein invasion should be determined when planning treatment.

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