Evaluation of extrahepatic portal hypertension and surgical portal systemic shunts by intravenous CT portography

The purpose of this study was to evaluate the splenoportal (SP) axis and pa tency of portal systemic shunts in extrahepatic portal venous obstruction ( EHO) by intravenous CT portography (CTP). Fifty-five patients of preshunt E HO, and 21 patients of postshunt (surgical portal systemic shunts) EHO, wer e subjected to intravenous CTP on a subsecond helical CT scanner. Thin, axi al sections and three dimensional (3-D) reconstructions, including maximum intensity projection (MIP) and shaded surface display (SSD), were obtained. The findings were correlated with Color Doppler Flow Imaging (CDFI). In th e EHO preshunt group, the site of the block demonstrated on CTP correlated with CDFI in 53 of 55 cases. in the postshunt group, shunt patency evaluati on by CTP was in agreement with CDFI in 19 of 21 patients (8 patent; 13 blo cked). Two patients in each group could not be evaluated on CDFI, while CTP could provide the appropriate information. There was no false positivity o r negativity with CTP in patients evaluated on both modalities. The etiolog y of EHO, the global view of collaterals, and the 3-D anatomy of SP axis co uld be well depicted and was well accepted by the surgeons. We conclude tha t CTP is an impressive new technique that can effectively evaluate pre- and postshunt cases of EHO. (C) Elsevier Science Inc., 2000.