Portal venous thrombosis or sclerosis in liver transplantation candidates:Preoperative CT findings and correlation with surgical procedure

PURPOSE: To review computed tomographic (CT) findings in patients with surg ically proved portal venous (PV) thrombosis or sclerosis and to correlate t hese findings with the surgical procedure used at orthotopic liver transpla ntation (OLT). MATERIALS AND METHODS: Among 379 OLTs, PV thrombosis or sclerosis was found at surgery in 39 patients (10.3%). Before OLT, surgical records and CT ima ges were retrospectively reviewed in 35 patients with available Ci studies. Diameter of the extrahepatic PV and patency of the PV system were evaluate d. Cavernous transformation, calcifications of the venous wail or thrombus, lesions suggestive of tumor, mesenteric varices, edema, or splenorenal shu nt were recorded. A nonpaired Student t test and the Fisher exact test were used to analyze the results. RESULTS: Of 35 patients, 23 (66%) underwent thrombectomy with direct PV-to- PV anastomosis and 12 (34%) had placement of venous grafts or other anastom oses. The extrahepatic PV was 8.2 mm, but it significantly (P less than or equal to .05) decreased in patients with splenorenal shunt. In 30 patients, CT depicted thrombosis, PV calcification, or other abnormalities. The thro mbus extended to or beyond the confluence of the splenic and superior mesen teric veins in 21 (60%) and 11 (31%) patients, respectively. Eleven patient s (31%) had cavernous transformation of the PV; eight (23%), a cordlike scl erotic PV; 19 (54%), a splenorenal shunt; 11 (31%), PV calcification; 17 (4 9%), mesenteric edema; 14 (40%), mesenteric varices. Patients with a cordli ke or calcified PV were significantly (P less than or equal to .05) more li kely to require modification of the surgical technique. CONCLUSION: Before OLT, CT can aid in assessment of PV and associated findi ngs and in surgical management.