Imagerie des thromboses portales

Abstract

A variety of hepatic or pancreatic diseases may have an impact on the status of the portal venous system so that a functional and morphological evaluation of the portal venous system is needed in such conditions. Accurate evaluation of the portal venous system is critical in the evaluation and the follow-up of candidates to hepatic transplantation or transhepatic intrahepatic portosystemic shunt placement. A specific imaging technique should be adequately chosen as adapted to the current indication. Ultrasonography coupled with duplex Doppler is the first-line investigation carried out for the diagnosis and follow-up of portal thrombosis. Multidetector helicoid computed tomography allows morphological and functional approach of the portal venous system. In case of portal thrombosis, this technique may show the extent, potential consequences and possible causes of the portal thrombosis. Magnetic resonance imaging presents similar performances for the visualization of the portal system; furthermore, this technique has a higher efficacy in characterizing liver and pancreas complicated by a portal thrombosis. This technique is useful for the detection of venous complications after hepatic transplantation. More invasive procedures such as transhepatic percutaneous portography, and transjugular portography are limited to some specific indications.