Most Informative Projection for Portography: Quantitative Analysis of 47 Percutaneous Transhepatic Portograms

Abstract

The goal of this study was to determine which projection for percutaneous transhepatic portography best depicts the anatomy of the proximal portal vein. Portograms ( n = 47) obtained in the anteroposterior, right anterior oblique, and right anterior caudal oblique projections were analyzed retrospectively. Lengths of the right portal trunk, the transverse portion of the left portal vein, and the right anterior and posterior portal branches, as well as angles between the right portal trunk and the transverse portion of the left portal vein and between the right anterior and posterior portal branches were measured in the various projections. Differences were evaluated using analysis of variance with Scheffe's method. The transverse portion of the left portal vein and the right anterior and posterior portal branches appeared longer on the right anterior caudal oblique views than on the anteroposterior ( p < 0.0001, < 0.0001, < 0.0001) or right anterior oblique ( p < 0.0001, = 0.001, < 0.0001) views. The angle between the right portal trunk and the transverse portion of the left portal vein was wider on the right anterior oblique views than on the anteroposterior ( p < 0.0001) or right anterior caudal oblique ( p = 0.007) views. The angle between the right anterior and posterior portal branches was wider on the right anterior caudal oblique views than on the anteroposterior ( p < 0.0001) or right anterior oblique ( p = 0.030) views. The right anterior caudal oblique projection provides the best image of the proximal portal vein, and therefore should be obtained whenever possible in preoperative staging of hepatobiliary cancer.

Hepatectomy With Simultaneous Resection of the Portal Vein and Hepatic Artery for Advanced Perihilar Cholangiocarcinoma

“…26,27 After 2003, multidetector-row computed tomography (MDCT) was used for this purpose; multiplanar reformation and 3-dimensional volume-rendered (3DVR) images were generated from arterial and portal phase data and viewed from several angles as reported previously. 28 Presence or absence of vascular invasion was estimated using multiplanar reformation images, and vascular resection with reconstruction was planned using 3DVR images (Fig.…”

Portal Vein Embolization before Extended Hepatectomy for Biliary Cancer: Current Technique and Review of 494 Consecutive Embolizations

“…First, a clear portogram of at least 3 different projections was obtained, e.g. supine position, right anterior oblique projection, and right anterior oblique projection with caudally tilting 20°, to confirm the individual anatomy of the portal system [14] . The third projection often provided the best visualization of the root of the right anterior/posterior portal vein and the left portal vein.…”

Percutaneous Transhepatic Portal Vein Embolization: Rationale, Technique, and Outcomes

“…Therefore, embolization of the right portal vein extended to segment IV should be considered for all patients scheduled for an extended right hepatectomy. 25 Before performing this procedure, we obtain informed written consent. Patients receive a single dose of intravenous antibiotic (1 g ceftriaxone sodium; Roche, Basel, Switzerland) immediately before the procedure.…”

“…Selective left and right portal venography is also performed. Interestingly, Nishio et al 25 studied the different projections obtained during portography and determined that the most informative projection for PVE is in the right anterior caudal oblique position, with the image intensifier tilted 30 degrees to the patient's right and 20 degrees caudally. More recently, C-arm CT has been used to facilitate understanding of complex portal venous anatomy, especially when PVE is to be performed.…”