Evaluation of portal vein variations in multidetector CT

Mahinur Ulusoy; Güneş Bolatlı; Mustafa Koplay; Musa Acar; İsmail Zararsız

doi:10.28982/josam.717046

Authors

Mahinur Ulusoy https://orcid.org/0000-0002-0647-8828
Güneş Bolatlı https://orcid.org/0000-0002-7648-0237
Mustafa Koplay https://orcid.org/0000-0001-7513-4968
Musa Acar https://orcid.org/0000-0002-5646-693X
İsmail Zararsız https://orcid.org/0000-0002-0551-337X

DOI:

https://doi.org/10.28982/josam.717046

Keywords:

Portal vein, Multidetector CT, Variation of the Portal Vein, Couinaud segmentation, Liver

Abstract

Aim: It is important for surgeons to have a comprehensive knowledge of vascular anatomy when performing liver interventions. For example, liver transplantation requires a vast understanding of vascular anatomy and variations. This study aimed to evaluate the intrahepatic branching pattern of the portal vein to find out unknown variations. Methods: Multidetector computed tomography images of the abdomen region were used from the PACS archives of Selcuk University Medical Faculty Hospital. Images of 838 patients (464 females and 374 males) who had no hepatic pathologies were examined. Images were evaluated in terms of the presence of variations, and the cases were divided into groups, all of which were compared in terms of gender. Results: A previously unknown variation of the portal vein was detected in 4.9% of the patients: The left portal vein curved reversely after its origination from the main portal vein, supplying liver segments II and IV, after which it branched to supply segment III. In addition, four types of previously known variations of the portal vein were detected. Normal anatomic branching of portal vein was detected in 82.6% of the patients. Conclusion: A previously unknown variation was detected. Awareness of this variation and other known variations is significant in hepatic transplantation, surgery, and interventions.

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References

Matesanz R, Rosa G. Liver transplantation: The Spanish experience. Digestive and Liver Disease Supplements. 2009;3:75-81.

Hu GH, Shen LG, Yang J, Mei JH, Zhu YF. Insight into congenital absence of the portal vein: is it rare? WJG. 2008;14(39):5969-79.

Kim TS, Noh YN, Lee S, Song SH, Shin M, Kim JM, et al. Anatomic similarity of the hepatic artery and portal vein according to the donor-recipient relationship. Transplant Proc. 2012;44(2):463-65. doi: 10.1016/j.transproceed.2012.01.062

Munguti J, Awori K, Odula P, Ogeng'o J. Conventional and variant termination of the portal vein in a black Kenyan population. Folia Morphol (Warsz). 2013;72(1):57-62.

Vauthey JN, Yamashita S. Perfecting a challenging procedure: The Nagoya portal vein guide to left trisectionectomy. Surgery. 2017;161(2):355-6. doi: 10.1016/j.surg.2016.07.030

Fishman EK. From the RSNA refresher courses: CT angiography: clinical applications in the abdomen. Radiographics. 2001;21:3-16. doi: 10.1148/radiographics.21.suppl_1.g01oc23s3

Iqbal S, Iqbal R, Iqbal F. Surgical Implications of Portal Vein Variations and Liver Segmentations: A Recent Update. J Clin Diagn Res. 2017;11(2):AE01-AE05. doi: 10.7860/JCDR/2017/25028.9453

Madoff DC, Hicks ME, Vauthey JN, Charnsangavej C, Morello FA, Ahrar K, et all. Transhepatic portal vein embolization: anatomy, indications, and technical considerations. Radiographics. 2002;22(5):1063-76. doi: 10.1148/radiographics.22.5.g02se161063

Pang G, Shao G, Zhao F, Liu C, Zhong H, Guo W. CT virtual endoscopy for analyzing variations in the hepatic portal vein. Surg Radiol Anat. 2015;37(5):457-62. doi: 10.1007/s00276-015-1463-2

Akgul E, Inal M, Soyupak S, Binokay F, Aksungur E, Oguz M. Portal Venoz Variation. Prevalance with contrast-enhanced helical CT. Acta Radiolagica. 2002;43:315-9.

Baba Y, Hokotate H, Nishi H, Inoue H, Nakajo M. Intrahepatic portal venous variations: demonstration by helical CT during arterial portography. J Comput Assist Tomogr. 2000;24(5):802-8.

Koc Z, Oguzkurt L, Ulusan S. Portal vein variations: clinical implications and frequencies in routine abdominal multidetector CT. Diagn Interv Radiol. 2007;13(2):75-80.

Sureka B, Patidar Y, Bansal K, Rajesh S, Agrawal N, Arora A. Portal vein variations in 1000 patients: surgical and radiological importance. Br J Radiol. 2015;8820150326. doi: 10.1259/bjr.20150326

Takeishi K, Shirabe K, Yoshida Y, Tsutsui Y, Kurihara T, Kimura K, et all. Correlation Between Portal Vein Anatomy and Bile Duct Variation in 407 Living Liver Donors. Am J Transplant. 2015;15(1):155-60.

Covey AM, Brody LA, Getrajdman GI, Sofocleous CT, Brown KT. Incidence, patterns, and clinical relevance of variant portal vein anatomy. AJR Am J Roentgenol. 2004;183(4):1055-64. doi: 10.2214/ajr.183.4.1831055

Schmidt S, Demartines N, Soler L, Schnyder P, Denys A. Portal vein normal anatomy and variants: implication for liver surgery and portal vein embolization. Semin Intervent Radiol. 2008;25(2):86-91. doi: 10.1055/s-2008-1076688

Gallego C, Velasco M, Marcuello P, Tejedor D, Campo LD, Friera A. Congenital and Acquired Anomalies of the Portal Venous System. Radiographics. 2002;22:141-59.

Cheng YF, Huang TL, Chen CL, Sheen-Chen SM, Lui CC, Chen TY, et al. Anatomic Dissociation between the Intrahepatic Bile Duct and Portal Vein: Risk Factors for Left Hepatectomy. World J Surg. 1997;21:297-300.