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Radiology Apr 2023
Topics: Humans; Portal Vein; Aneurysm
PubMed: 36749214
DOI: 10.1148/radiol.221311 -
IEEE Transactions on Image Processing :... 2022Segmenting portal vein (PV) and hepatic vein (HV) from magnetic resonance imaging (MRI) scans is important for hepatic tumor surgery. Compared with single phase-based...
Segmenting portal vein (PV) and hepatic vein (HV) from magnetic resonance imaging (MRI) scans is important for hepatic tumor surgery. Compared with single phase-based methods, multiple phases-based methods have better scalability in distinguishing HV and PV by exploiting multi-phase information. However, these methods just coarsely extract HV and PV from different phase images. In this paper, we propose a unified framework to automatically and robustly segment 3D HV and PV from multi-phase MR images, which considers both the change and appearance caused by the vascular flow event to improve segmentation performance. Firstly, inspired by change detection, flow-guided change detection (FGCD) is designed to detect the changed voxels related to hepatic venous flow by generating hepatic venous phase map and clustering the map. The FGCD uniformly deals with HV and PV clustering by the proposed shared clustering, thus making the appearance correlated with portal venous flow robustly delineate without increasing framework complexity. Then, to refine vascular segmentation results produced by both HV and PV clustering, interclass decision making (IDM) is proposed by combining the overlapping region discrimination and neighborhood direction consistency. Finally, our framework is evaluated on multi-phase clinical MR images of the public dataset (TCGA) and local hospital dataset. The quantitative and qualitative evaluations show that our framework outperforms the existing methods.
Topics: Hepatic Veins; Magnetic Resonance Imaging; Portal Vein
PubMed: 35275817
DOI: 10.1109/TIP.2022.3157136 -
Acta Radiologica (Stockholm, Sweden :... Feb 2023The portal vein is the largest vessel supplying the liver. A number of radiological interventions are performed through the portal vein, namely for primary pathologies... (Review)
Review
The portal vein is the largest vessel supplying the liver. A number of radiological interventions are performed through the portal vein, namely for primary pathologies of the portal vein, for inducing liver hypertrophy or to treat the sequelae of portal hypertension among others. The routes used include direct transhepatic, transjugular, and, uncommonly, trans-splenic and through subcutaneous varices. Portal vein embolization and transjugular intrahepatic portosystemic shunt are among the most common portal vein interventions that are performed to induce hypertrophy of the future liver remnant and to treat complications of portal hypertension, respectively. Other interventions include transhepatic obliteration of varices and shunts, portal vein thrombolysis, portal vein recanalization, pancreatic islet cell transplantation, and embolization of portal vein injuries. We present a detailed illustrative review of the various radiological portal vein interventions.
Topics: Humans; Portal Vein; Hypertension, Portal; Portasystemic Shunt, Transjugular Intrahepatic; Varicose Veins
PubMed: 35187977
DOI: 10.1177/02841851221080554 -
Medicina Clinica Nov 2022Familial Mediterranean fever (FMF) is an autoinflammatory disease characterized by polyserositis and arthritis attacks, which are mediated by increased plasma levels of...
INTRODUCTION
Familial Mediterranean fever (FMF) is an autoinflammatory disease characterized by polyserositis and arthritis attacks, which are mediated by increased plasma levels of cytokines. Our hypothesis was that the increase in specific cytokines can also lead to portal hypertension, even in the absence of overt hepatic steatosis.
METHODS
We designed a comparative cross-sectional study with 41 patients and 30 healthy individuals to show if there is a relationship between portal hypertension and FMF. B mode ultrasound and Doppler ultrasound were utilized to evaluate liver echogenicity, portal vein diameter, peak portal blood flow velocity, and portal vein flow direction, which are important diagnostic criteria for portal hypertension.
RESULTS
Spleen and liver sizes and portal vein diameters of the FMF patients and the healthy controls were not significantly different. Imaging of 4 patients revealed periportal cuffing and one patient with periportal cuffing also had a fine granular appearance of the liver. The peak portal blood flow velocity of the FMF patients was lower than that of the control group (p<0.007).
CONCLUSION
The FMF group had significantly lower peak portal blood flow velocity than the control group, indicating the existence of portal hypertension. However, the differences between the other findings that correlate with portal hypertension were not significant.
Topics: Humans; Familial Mediterranean Fever; Cross-Sectional Studies; Hypertension, Portal; Portal Vein; Cytokines
PubMed: 35305808
DOI: 10.1016/j.medcli.2021.12.019 -
Surgery Nov 2021
Topics: Hepatectomy; Humans; Ligation; Liver; Portal Vein
PubMed: 34218954
DOI: 10.1016/j.surg.2021.06.006 -
Techniques in Vascular and... Dec 2023Liver transplantation continues to rapidly evolve, and in 2020, 8906 orthotopic liver transplants were performed in the United States. As a technically complex surgery... (Review)
Review
Liver transplantation continues to rapidly evolve, and in 2020, 8906 orthotopic liver transplants were performed in the United States. As a technically complex surgery with multiple vascular anastomoses, stenosis and thrombosis of the venous anastomoses are among the recognized vascular complications. While rare, venous complications may be challenging to manage and can threaten the graft and the patient. In the last 20 years, endovascular approaches have been increasingly utilized to treat post-transplant venous complications. Herein, the evaluation and interventional treatment of post-transplant venous outflow complications, portal vein stenosis, portal vein thrombosis, and recurrent portal hypertension with transjugular intrahepatic portosystemic shunt (TIPS) are reviewed.
Topics: Humans; Constriction, Pathologic; Liver Transplantation; Portal Vein; Portasystemic Shunt, Transjugular Intrahepatic; Thrombosis; Treatment Outcome
PubMed: 38123283
DOI: 10.1016/j.tvir.2023.100924 -
Cellular and Molecular Gastroenterology... 2023The detection of nutrients in the gut influences ongoing and future feeding behavior as well as the development of food preferences. In addition to nutrient sensing in... (Review)
Review
The detection of nutrients in the gut influences ongoing and future feeding behavior as well as the development of food preferences. In addition to nutrient sensing in the intestine, the hepatic portal vein plays a considerable role in detecting ingested nutrients and conveying this information to brain nuclei involved in metabolism, learning, and reward. Here, we review mechanisms underlying hepatic portal vein sensing of nutrients, particularly glucose, and how this is relayed to the brain to influence feeding behavior and reward. We additionally highlight several gaps where future research can provide new insights into the effects of portal nutrients on neural activity in the brain and feeding behavior.
Topics: Portal Vein; Glucose; Feeding Behavior; Reward; Eating
PubMed: 37172823
DOI: 10.1016/j.jcmgh.2023.03.012 -
Journal of Digestive Diseases Sep 2021The presence of portal vein thrombosis (PVT) has previously been considered a contraindication to the insertion of transjugular intrahepatic portosystemic shunts... (Review)
Review
The presence of portal vein thrombosis (PVT) has previously been considered a contraindication to the insertion of transjugular intrahepatic portosystemic shunts (TIPSS). However, patients with PVT may have portal hypertension complications and may thus benefit from TIPSS to reduce portal venous pressure. There is an increasing body of literature that discusses the techniques and outcomes of TIPSS in PVT. This review summarizes the techniques, indications and outcomes of TIPSS in PVT in published case reports, case series and comparative trials, especially regarding the reduction in portal hypertensive complications such as variceal bleeding. A comprehensive literature search was conducted using MEDLINE and PubMed databases. Manuscripts published in English between 1 January 1990 and 1 March 2021 were used. Abstracts were screened and data from potentially relevant articles analyzed. TIPSS in PVT has been reported with high levels of technical success, short-term portal vein recanalization and long-term PV patency and TIPSS patency outcomes. Several comparative studies, including randomized controlled trials, have shown favorable outcomes of TIPSS compared with non-TIPSS treatment of PVT complications. Outcomes of TIPSS with PVT appear similar to those in TIPSS without PVT. However, TIPSS may be more technically difficult in the presence of PVT, and such procedures should be performed in expert high-volume centers to mitigate the risk of procedural complications. The presence of PVT should no longer be considered a contraindication to TIPSS. TIPSS for PVT has been acknowledged as a therapeutic strategy in recent international guidelines, although further studies are needed before recommendations can be strengthened. KEY POINTS: Portal vein thrombosis (PVT) is no longer a contraindication to the insertion of transjugular intrahepatic portosystemic shunts (TIPSS) TIPSS often leads to the spontaneous dissolution of PVT, but can be combined with mechanical or pharmacological thrombectomy TIPSS reduces portal hypertensive complications of PVT, such as variceal bleeding, and can also facilitate liver transplantation where PVT may otherwise interfere with vascular anastomoses Studies have shown favorable long-term outcomes of TIPSS compared with TIPSS without PVT; as well as compared with non-TIPSS treatment of PVT complications TIPSS in PVT should be performed in high-volume specialist centers due to technical difficulties.
Topics: Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; Humans; Liver Cirrhosis; Portal Vein; Portasystemic Shunt, Transjugular Intrahepatic; Treatment Outcome; Venous Thrombosis
PubMed: 34323378
DOI: 10.1111/1751-2980.13035 -
Chirurgia (Bucharest, Romania : 1990) Aug 2021Hepatectomy is the only potentially curative treatment of hepatic tumors, but remains challenging in case of multiple, bilobar lesions and those located in the vicinity... (Review)
Review
Hepatectomy is the only potentially curative treatment of hepatic tumors, but remains challenging in case of multiple, bilobar lesions and those located in the vicinity of the hepatic hilum and hepatic veins. Regenerative liver surgery utilizes the unique ability of the liver to re-grow after tissue loss and vascular deprivation. All concepts subsumed under this term aim to increase the resectability of hepatic tumors by stimulating growth of future liver remnant. Many of these techniques have evolved over the last decades. ALPPS (associated liver partition and portal vein ligation for staged hepatectomy) is an advanced technique combining portal vein ligation and parenchymal transection which gave rise to many variants, all with the common goal of extending resectability. This article reviews techniques currently available for regenerative liver surgery focusing on ALPPS, its mechanisms of liver regeneration, indications, advantages, drawbacks, results and future perspectives.
Topics: Hepatectomy; Humans; Ligation; Liver; Liver Neoplasms; Liver Regeneration; Portal Vein; Treatment Outcome
PubMed: 34498560
DOI: 10.21614/chirurgia.116.4.387 -
HPB : the Official Journal of the... Apr 2021Contemporary practice for superior mesenteric/portal vein (SMV-PV) reconstruction during pancreatectomy with vein resection involves biological (autograft, allograft,... (Review)
Review
BACKGROUND
Contemporary practice for superior mesenteric/portal vein (SMV-PV) reconstruction during pancreatectomy with vein resection involves biological (autograft, allograft, xenograft) or synthetic grafts as a conduit or patch. The aim of this study was to systematically review the safety and feasibility of the different grafts used for SMV-PV reconstruction.
METHODS
A systematic search was performed in PubMed and Embase according to the PRISMA guidelines (January 2000-March 2020). Studies reporting on ≥ 5 patients undergoing reconstruction of the SMV-PV with grafts during pancreatectomy were included. Primary outcome was rate of graft thrombosis.
RESULTS
Thirty-four studies with 603 patients were included. Four graft types were identified (autologous vein, autologous parietal peritoneum/falciform ligament, allogeneic cadaveric vein/artery, synthetic grafts). Early and overall graft thrombosis rate was 7.5% and 22.2% for synthetic graft, 5.6% and 11.7% for autologous vein graft, 6.7% and 8.9% for autologous parietal peritoneum/falciform ligament, and 2.5% and 6.2% for allograft. Donor site complications were reported for harvesting of the femoral, saphenous, and external iliac vein. No cases of graft infection were reported for synthetic grafts.
CONCLUSION
In selected patients, autologous, allogenic or synthetic grafts for SMV-PV reconstruction are safe and feasible. Synthetic grafts seems to have a higher incidence of graft thrombosis.
Topics: Humans; Mesenteric Veins; Pancreatectomy; Pancreatic Neoplasms; Pancreaticoduodenectomy; Portal Vein; Treatment Outcome; Vascular Patency
PubMed: 33288403
DOI: 10.1016/j.hpb.2020.11.008