Portal Vein Thrombosis and Cavernous Transformation

Thrombosis of the portal vein is a pathology that is frequently found in liver cirrhosis, pancreatitis, ascending portal thrombophlebitis or after scle-rotherapy of a gastroesophageal varix [1]. In this condition it is important to acquire accurate information regarding portal-venous patency (Fig. 16). 3D CE MR portography provides detailed information not only about the location and length of portal vein obstruction, but also about portal collateral pathways (Fig. 17). Over time, a network of small collateral vessels develops to bypass the portal-venous occlusion. This network of collaterals, known as a cavernous transformation, is identified by its characteristic enhancement pattern in the hepatic hilum during the portal-venous and equilibrium phases of imaging (Fig. 18).

While color Doppler ultrasonography often fails to evaluate portal venous patency, 3D CE MR portography usually provides accurate information [7]. Furthermore, CE MRA can be used to assess surgical portosystemic shunts which are frequently placed to reduce portal-venous pressure. In this scenario CE MRA is used to evaluate the patency of the shunt (Fig. 19) and possible complications such as stenosis at the anastomosis.

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