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Scientific Reports Feb 2020Idiopathic portal hypertension (IPH) mimics liver cirrhosis in many aspects, and no efficient imaging method to differentiate the two diseases has been reported to date....
Idiopathic portal hypertension (IPH) mimics liver cirrhosis in many aspects, and no efficient imaging method to differentiate the two diseases has been reported to date. In this study, the imaging and pathological characteristics were analysed for both IPH and cirrhosis. From January 2015 to March 2019, ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI) images and pathological results from 16 IPH and 16 liver cirrhosis patients, as well as imaging results of 16 normal patients as a control group, were retrospectively reviewed. The age of the patients was 39 ± 20 years. There was a significant difference in the mean lumen diameter, wall thickness and ratio of thickness to diameter between the IPH and liver cirrhosis patients in the main and sagittal portal veins (P < 0.05), as well as in the lumen diameter and ratio of thickness to diameter between the IPH and liver cirrhosis patients in the Segment 3 (S3) portal vein (P < 0.05). In IPH patients, the main imaging changes were portal vein wall thickening, stenosis or occlusion, a low enhancement area along the portal vein in the delay phase in contrast-enhanced imaging, and a non-homogeneous change in T1WI. The corresponding pathological changes included interlobular vein thickening, stenosis, occlusion, portal area fibrosis, and atrophy or apoptosis of hepatocytes. The main imaging characteristic of liver cirrhosis was a nodular change in T1WI, and the related pathological change was pseudolobule formation. The imaging characteristics of IPH include thickening of the portal vein vascular wall, stenosis of the portal vein lumen and the absence of diffuse cirrhosis-like nodules. These imaging features have a definite pathological basis and could help make differential diagnoses between IPH and cirrhosis.
Topics: Adult; Diagnosis, Differential; Female; Humans; Hypertension, Portal; Liver Cirrhosis; Magnetic Resonance Imaging; Male; Middle Aged; Portal Vein; Tomography, X-Ray Computed; Ultrasonography
PubMed: 32051517
DOI: 10.1038/s41598-020-59286-8 -
World Journal of Gastroenterology Oct 2021Endoscopic ultrasound (EUS) is one of the significant breakthroughs in the field of advanced endoscopy. In the last two decades, EUS has evolved from a diagnostic tool... (Review)
Review
Endoscopic ultrasound (EUS) is one of the significant breakthroughs in the field of advanced endoscopy. In the last two decades, EUS has evolved from a diagnostic tool to a real-time therapeutic modality. The luminal gastrointestinal (GI) tract provides a unique opportunity to access multiple vascular structures, especially in the mediastinum and abdomen, thus permitting a variety of EUS-guided vascular interventions. The addition of the doppler and contrast-enhanced capability to EUS has further helped provide real-time visualization of blood flow in vessels through the GI tract. EUS-guided vascular interventions rely on standard endoscopic accessories and interventional tools such as fine-needle aspiration needles and fine-needle biopsy. EUS allows the visualization of various structures in real-time by differentiating tissue densities and vascularity, thus, avoiding radiation exposure. EUS-guided techniques also allow real-time microscopic examination after target biopsy. Furthermore, many necessary interventions can be done during the same procedure after diagnosis. This article provides an overview of EUS-guided vascular interventions such as variceal, non-variceal bleeding interventions, EUSguided portal vein (PV) access with the formation of an intrahepatic portosystemic shunt, and techniques related to diagnosis of GI malignancies. Furthermore, we discuss current insights and future outlook of therapeutic modalities like PV embolization, PV sampling, angiography, drug administration, and portal pressure measurement.
Topics: Endosonography; Humans; Portal Pressure; Portal Vein; Portasystemic Shunt, Surgical; Ultrasonography, Interventional
PubMed: 34790012
DOI: 10.3748/wjg.v27.i40.6874 -
Journal of Hepato-biliary-pancreatic... Mar 2022Current conventional algorithms used for 3-dimensional simulation in virtual hepatectomy still have difficulties distinguishing the portal vein (PV) and hepatic vein...
BACKGROUND/PURPOSE
Current conventional algorithms used for 3-dimensional simulation in virtual hepatectomy still have difficulties distinguishing the portal vein (PV) and hepatic vein (HV). The accuracy of these algorithms was compared with a new deep-learning based algorithm (DLA) using artificial intelligence.
METHODS
A total of 110 living liver donor candidates until 2017, and 46 donor candidates until 2019 were allocated to the training group and validation groups for the DLA, respectively. All PV or HV branches were labeled based on Couinaud's segment classification and the Brisbane 2000 Terminology by hepato-biliary surgeons. Misclassified and missing branches were compared between a conventional tracking-based algorithm (TA) and DLA in the validation group.
RESULTS
The sensitivity, specificity, and Dice coefficient for the PV were 0.58, 0.98, and 0.69 using the TA; and 0.84, 0.97, and 0.90 using the DLA (P < .001, excluding specificity); and for the HV, 0.81, 087, and 0.83 using the TA; and 0.93, 0.94 and 0.94 using the DLA (P < .001 to P = .001). The DLA exhibited greater accuracy than the TA.
CONCLUSION
Compared with the TA, artificial intelligence enhanced the accuracy of extraction of the PV and HVs in computed tomography.
Topics: Artificial Intelligence; Hepatectomy; Hepatic Veins; Humans; Portal Vein; Tomography, X-Ray Computed
PubMed: 34779139
DOI: 10.1002/jhbp.1080 -
HPB : the Official Journal of the... Feb 2021The therapeutic effect of portal vein (PV) stenting for PV stenosis following nontransplant hepato-pancreato-biliary (HPB) surgery has not been fully investigated.
BACKGROUND
The therapeutic effect of portal vein (PV) stenting for PV stenosis following nontransplant hepato-pancreato-biliary (HPB) surgery has not been fully investigated.
METHODS
Changes in portal venous pressure (PVP) gradient before and after stenting, complications, symptomatic improvement, and stent patency were evaluated.
RESULTS
We identified 14 consecutive patients undergoing PV stenting for malignant (n = 8) and benign (n = 6) PV stenosis. Signs of PV stenosis were composed of refractory ascites in 6 patients, varices with hemorrhagic tendencies in 5, and abnormal liver function in 5. The median PVP gradient after PV stenting was 3.0 cm HO (range, 1.5-3.0), which was significantly smaller than that before PV stenting (median, 15 cm HO [range, 2.5-25]; P < 0.01). Thirteen out of 14 (93%) achieved clinical success with symptomatic improvement, except one patient with sustained refractory ascites because of peritoneal seeding. During the median follow-up time of 7.3 months (range, 1.0-87), stent occlusion occurred in two patients (14%) because of intrastent tumor growth. The 1-year cumulative stent patency rate was 76% in the entire cohort.
CONCLUSIONS
Based on durable effect on patency, we deemed PV stenting for PV stenosis after HPB surgery to be safe and beneficial for improving symptoms.
Topics: Constriction, Pathologic; Humans; Portal Pressure; Portal Vein; Retrospective Studies; Stents; Treatment Outcome
PubMed: 32600950
DOI: 10.1016/j.hpb.2020.06.003 -
Journal of Clinical Ultrasound : JCU Sep 2023The pathogenesis of portal vein thrombosis (PVT) in cirrhosis is multifactorial, with altered hemodynamics being proposed as a possible contributor. The present... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The pathogenesis of portal vein thrombosis (PVT) in cirrhosis is multifactorial, with altered hemodynamics being proposed as a possible contributor. The present systematic review was conducted to study the role of assessment of portal hemodynamics for the prediction of PVT in patients with cirrhosis.
METHODS
Three databases (Medline, Embase, and Scopus) were searched from inception to February 2023 for studies comparing portal venous system parameters in patients with cirrhosis developing PVT with those not. Results were presented as mean difference (MD) or odds ratio (OR) with their 95% confidence intervals (CIs).
RESULTS
A total of 31 studies (patients with cirrhosis: 19 studies, patients with cirrhosis undergoing splenectomy: 12 studies) were included. On pooling the data from multivariable analyses of the included studies, a larger portal vein diameter was a significant predictor of PVT in patients with cirrhosis without or with splenectomy with OR 1.74 (1.12-2.69) and OR 1.55 (1.26-1.92), respectively. On the other hand, a lower portal vein velocity (PVV) was a significant predictor of PVT in cirrhotics without or with splenectomy with OR 0.93 (0.91-0.96) and OR 0.71 (0.61-0.83), respectively. A PVV of <15 cm/s was the most commonly used cut-off for the prediction of PVT. Patients developing PVT also had a significantly higher splenic length, thickness, and splenic vein velocity.
CONCLUSION
The assessment of portal hemodynamic parameters at baseline evaluation in patients with cirrhosis may predict the development of PVT. Further studies are required to determine the optimal cut-offs for various parameters.
Topics: Humans; Portal Vein; Liver Cirrhosis; Portal System; Venous Thrombosis; Hemodynamics; Risk Factors
PubMed: 37459439
DOI: 10.1002/jcu.23523 -
Pediatrics International : Official... Jan 2022Congenital porto-systemic shunt (CPSS) is a rare disease and can cause fatal complications. Accurate angiographic assessment is mandatory for proper treatment. Although...
BACKGROUND
Congenital porto-systemic shunt (CPSS) is a rare disease and can cause fatal complications. Accurate angiographic assessment is mandatory for proper treatment. Although technically difficult, we developed assessment techniques and assessed their accuracy. One technique came from evaluating patients with extrahepatic portal vein obstruction (EHPVO).
METHODS
We conducted a single center retrospective study to evaluate the efficacy of angiographic diagnostic procedure for the assessment of CPSS and EHPVO, and its impact on patients' subsequent interventions and clinical course. Eight patients with CPSS and two patients with EHPVO who underwent diagnostic angiography were included. Assessment of the intrahepatic portal vein was performed in all patients. The route of the shunt, and portal vein pressure under shunt occlusion, were also evaluated for patients with CPSS. Evaluation was first attempted with a balloon angiographic catheter (standard method). Three additional techniques were performed as needed: (i) direct wedge-catheter injection without balloon inflation, (ii) use of occlusion balloon in two patients, and (iii) hybrid angiography with sheath placement directly into the superior mesenteric vein.
RESULTS
The standard method was sufficient in four patients. On the other hand, all three techniques were required in two patients each. One lost contact during follow up, but all other patients underwent optimal intervention. There were no complications related to the angiographic procedure.
CONCLUSIONS
Use of direct wedge-catheter injection without balloon inflation, occlusion balloon, and hybrid catheterization improved the diagnostic yield in patients with CPSS or EHPVO.
Topics: Angiography; Child; Humans; Hypertension, Portal; Portal Vein; Retrospective Studies; Vascular Diseases
PubMed: 34048141
DOI: 10.1111/ped.14856 -
World Journal of Gastroenterology Aug 2022This letter is regarding the study titled 'Targeted puncture of left branch of intrahepatic portal vein in transjugular intrahepatic portosystemic shunt (TIPS) to reduce...
This letter is regarding the study titled 'Targeted puncture of left branch of intrahepatic portal vein in transjugular intrahepatic portosystemic shunt (TIPS) to reduce hepatic encephalopathy'. Prior to the approval of TIPS dedicated stents (Viatorr stents) in China in October 2015, Fluency covered stents were typically used. As Fluency covered stents have a strong support force and axial elastic tension, a 'cap' may form if the stent is located too low at the end of the hepatic vein or too short at the end of the portal vein during surgery, leading to stent dysfunction. Since the blood shunted by the stent is from the main trunk of the portal vein, the correlation between the incidence of postoperative hepatic encephalopathy and the location of the puncture target (left or right portal vein branch) is worth discussion. Notably, no studies in China or foreign countries have proven the occurrence of left and right blood stratification after the accumulation of splenic vein and mesenteric blood flow in the main trunk of the portal vein in patients with cirrhotic portal hypertension.
Topics: Hepatic Encephalopathy; Humans; Hypertension, Portal; Jugular Veins; Portal Vein; Portasystemic Shunt, Transjugular Intrahepatic; Retrospective Studies; Stents; Treatment Outcome
PubMed: 36159008
DOI: 10.3748/wjg.v28.i31.4467 -
Experimental Animals Feb 2022The current ischemic models of liver failure are difficult and usually time-consuming to produce. The aim of this study was to develop a simplified and reproducible...
The current ischemic models of liver failure are difficult and usually time-consuming to produce. The aim of this study was to develop a simplified and reproducible porcine model of acute liver failure for use in preclinical research. Eighteen Bama miniature pigs were randomly divided into Groups A, B, and C. The hepatic artery and common bile duct were ligated in all groups. While the portal vein was completely preserved in Group A, it was narrowed by 1/3 and 1/2 in Groups B and C, respectively. Results of biochemical analyses, encephalopathy scores, and survival times were compared among the groups. Results of hematoxylin-eosin staining, terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling, Masson staining, and Ki-67 analyses were recorded. Survival times in Groups B and C were 11.67 ± 1.86 and 2.16 ± 0.75 days, respectively, shorter than that in Group A (>15 days). Following surgery, alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase, alkaline phosphatase, total bilirubin, and direct bilirubin levels significantly increased relative to baseline values in all groups (P<0.05). Groups B and C exhibited a significant decrease in encephalopathy scores and a significant increase in ammonia levels, which were negatively correlated with one another. Pathological analysis revealed obvious necrosis of liver cells, which correlated closely with the degree of portal vein constriction. Our simple, highly reproducible model effectively mimics the clinical characteristics of acute liver failure in humans and provides a foundation for further research on artificial liver support system development.
Topics: Animals; Hepatocytes; Ischemia; Liver; Liver Failure; Liver Failure, Acute; Portal Vein; Swine
PubMed: 34497163
DOI: 10.1538/expanim.21-0076 -
Medical Physics May 2021The liver segments divided by Couinaud classification method are used to understand the functional anatomy of liver, which is significant in hepatic resection surgery....
PURPOSE
The liver segments divided by Couinaud classification method are used to understand the functional anatomy of liver, which is significant in hepatic resection surgery. In Couinaud classification method, each third-order branch of the portal vein (PV) defines the supplied territory of a corresponding liver segment. However, the accuracies of the reconstruction and classification of PV are affected by the complicated structure of the vein. The purpose of this paper is to develop a separation and classification method that can accurately extract the liver segments.
METHODS
In this paper, a multiple feature-based method is proposed to obtain liver segments. Because the portal and hepatic veins usually connect in the vessel segmentation result, the PV is first completely separated based on the different strategies for minimal node cut using fused features of topology and appearance. Meanwhile, all bifurcation nodes of PV are detected. The bifurcation nodes are initial ordered through their linkages to classify the branches. Then, the feature of the vascular topology is used to refine the orders of bifurcation nodes. The bifurcation nodes with the refined orders classify the branches between them, and the third-order branches of PV are obtained. The liver segments are eventually obtained through the third-order branches.
RESULTS
The separation and classification in the proposed method are evaluated on the CT and MR datasets. The average values of Dice, Jaccard, Recall, and Precision obtained by the proposed method are 93.00%, 87.90%, 93.47%, and 93.19%, respectively. Compared with the state-of-the-art methods, the separation results obtained by the proposed method are more accurate. The branches of PV are classified based on the separation result. According to the third-order branches, eight liver segments correspond to the different functional areas are precisely extracted.
CONCLUSIONS
The proposed method achieves a high accuracy for the liver segment extraction. And the extracted liver segments are significant for the preplanning of resection surgery.
Topics: Hepatic Veins; Liver; Portal Vein
PubMed: 33529390
DOI: 10.1002/mp.14745 -
Revista Espanola de Enfermedades... Jan 2024Abernethy syndrome (AS or extrahepatic portosystemic shunt) is an uncommon congenital malformation consisting of agenesis or hypoplasia of the portal vein (PV) in such a...
Abernethy syndrome (AS or extrahepatic portosystemic shunt) is an uncommon congenital malformation consisting of agenesis or hypoplasia of the portal vein (PV) in such a way that splanchnic venous blood drains directly into the systemic circulation through aberrant communications, resulting in a portosystemic shunt that bypasses the liver AS is an underdiagnosed condition with unknown incidence and complication rate given that symptoms are usually absent. AS identification is increasingly common because of improved imaging techniques, hence prognostic implications and clinical management need be understood. This editorial reviews the natural history of AS and its diagnostic-therapeutic implications, illustrating the process with a series of cases from our institution.
Topics: Humans; Liver Neoplasms; Vascular Malformations; Portal Vein; Portasystemic Shunt, Surgical; Syndrome
PubMed: 37522317
DOI: 10.17235/reed.2023.9781/2023