Portal hypertension: Imaging of portosystemic collateral pathways and associated image-guided therapy

Bandali, Murad; Mirakhur, Anirudh; Lee, Edward W.; Ferris, Mollie; Sadler, D.J.; Gray, Robin; Wong, Jason

doi:10.3748/wjg.v23.i10.1735

Cited by 72 publications

(45 citation statements)

References 52 publications

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“…Because magnetic resonance and computed tomography represent the gold standard techniques for focal liver lesions identification, particularly in cancer staging and surveillance, their use is still pivotal in post-HSCT VOD/SOS (42,54,55). However, the potential role of these imaging techniques can be further increased in all types of VOD/SOS (56).…”

Section: Clinical Presentation and Diagnosismentioning

confidence: 99%

Diagnosis and Treatment of VOD/SOS After Allogeneic Hematopoietic Stem Cell Transplantation

et al. 2020

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Hepatic veno-occlusive disease (VOD) or sinusoidal obstruction syndrome (SOS) is a rare complication characterized by hepatomegaly, right-upper quadrant pain, jaundice, and ascites, occurring after high-dose chemotherapy, hematopoietic stem cell transplantation (HSCT) and, less commonly, other conditions. We review pathogenesis, clinical appearance and diagnostic criteria, risk factors, prophylaxis, and treatment of the VOD occurring post-HSCT. The injury of the sinusoidal endothelial cells with loss of wall integrity and sinusoidal obstruction is the basis of development of postsinusoidal portal hypertension responsible for clinical syndrome. Risk factors associated with the onset of VOD and diagnostic tools have been recently updated both in the pediatric and adult settings and here are reported. Treatment includes supportive care, intensive management, and specific drug therapy with defibrotide. Because of its severity, particularly in VOD with associated multiorgan disease, prophylaxis approaches are under investigation. During the last years, decreased mortality associated to VOD/SOS has been reported being it attributable to a better intensive and multidisciplinary approach.

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Section: Clinical Presentation and Diagnosismentioning

confidence: 99%

Diagnosis and Treatment of VOD/SOS After Allogeneic Hematopoietic Stem Cell Transplantation

et al. 2020

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“…In the group of recipients with higher MELD scores (MELD >23), the image quality score for the PHA and IVC was significantly lower than for the group with lower MELD scores (Table ). There was 1 patient with PV occlusion and 10 patients with portosystemic collaterals, which included 9 patients with coronary vein enlargement (measuring 5.4‐18.3 mm) and 1 patient with gastrorenal shunt identified by IFIR MRA imaging and confirmed by intraoperative findings.…”

Section: Resultsmentioning

confidence: 99%

“…The presence of portosystemic collaterals may change the surgical procedure in LDLT by affecting decisions regarding whether or not to ligate the collateral vessel. In the case of adult LDLT recipients with portosystemic collaterals, portal inflow steal may occur after LDLT, which can result in inadequate portal flow for graft regeneration . It is well accepted that collaterals in the LDLT setting should be ligated when they are hemodynamically significant .…”

Section: Discussionmentioning

confidence: 99%

Noncontrast Magnetic Resonance Angiography Clinical Application in Pre–Liver Transplant Recipients With Impaired Renal Function

Huang¹,

Liao²,

Chen³

et al. 2020

Liver Transpl

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Image evaluation of the vascular architecture is essential before living donor liver transplantation (LDLT). However, the use of contrast-enhanced study in recipients with impaired renal function is limited due to the risk of acute kidney injury and nephrogenic systemic fibrosis. Therefore, a contrast medium-free method is both valuable and necessary for preoperative vascular evaluation. Recent literature reported inflow-sensitive inversion recovery (IFIR) magnetic resonance angiography (MRA) without the use of a contrast medium to be a reproducible and noninvasive tool to assess hepatic vasculature with adequate-to-good image quality. The purpose of this study is to clinically apply IFIR MRA preoperatively in LDLT recipients. We retrospectively reviewed 31 LDLT recipients with renal function impairment from March 2013 to August 2018 who received IFIR MRA as a pretransplant vascular architecture evaluation and who underwent a subsequent LDLT. The image findings were assessed for subjective image quality and were compared with intraoperative findings. Our results showed that the pretransplant vascular anatomy was well correlated with intraoperative findings in all recipients. Successful ratings with image quality scores ≥2 for proper hepatic arteries (PHAs), portal veins, and inferior vena cavas (IVCs) were 100.0%, 96.8%, and 93.5%, respectively. Readable ratings with imaging quality score ≥1 for left and right hepatic arteries and gastroepiploic arteries were 83.9%, 96.7%, and 22.6%, respectively. We also found that recipients with higher Model for End-Stage Liver Disease scores (>23) had lower image quality scores for PHAs (P = 0.003) and IVCs (P = 0.046). However, images were still satisfactory for pre-liver transplantation (LT) vascular evaluation. In conclusion, in pre-LT recipients with impaired renal function, IFIR MRA is a feasible and reproducible image modality.Liver Transplantation 26 196-202 2020 AASLD.

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“…Increased resistance to portal blood flow, the primary etiology in the portal hypertension pathophysiology, is in part due to morphological alternations occurring in long term liver diseases. This leads to the rerouting of blood flow away from the liver via collateral pathways to low-pressure systemic veins [11] .…”

Section: Zagazig University Medical Journalsmentioning

confidence: 99%

Assessment of Different Non-Invasive Score Modalities in Prediction of Esophageal Varices in Patients With Liver Cirrhosis

Ahmed¹,

Mohammed²,

Alaa³

et al. 2019

Zagazig University Medical Journal

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Background: Varices are a serious consequence of portal hypertension, and variceal bleeding is a life-threatening complication occurring in up to 30% of patients with cirrhosis. Despite the great improvement in diagnosis and the available therapeutic modalities, mortality from acute variceal bleeding may still reach up to 20%. Therefore, our aim was to assess the role of noninvasive score modalities in the prediction of the presence of EVs & to predict EVs severity. Methods: This Comparative cross-sectional study was conducted on a cohort of 90 cirrhotic patients. All patients were subjected to investigations include complete blood count, liver and kidney function tests, bleeding profile, random blood sugar, and serum sodium. The following scores were estimated: Child-Pugh score, MELD -Na + score, AAR, APRI, FIB-4, and King's score. Upper GI endoscopy was done for evaluation of presence or absence of EVs. Results: Our results revealed that Kings Score is the most sensitive and specific score in predicting the presence of EVs, followed by APRI score while AAR score has the least sensitivity and specificity.FIB-4 score is the most sensitive scoring system in predicting severe EVs, followed by APRI, Kings, and AAR scores. Regarding specificity, King's Score is the most specific one followed by FIB-4, APRI and AAR. Conclusions: King's score has the highest sensitivity and specificity in EVs prediction followed by APRI. Regarding severe EVs, FIB-4 score is the most sensitive scoring system in the prediction of severe EVs. However, King's score is the most specific one.

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Portal hypertension: Imaging of portosystemic collateral pathways and associated image-guided therapy

Cited by 72 publications

References 52 publications

Diagnosis and Treatment of VOD/SOS After Allogeneic Hematopoietic Stem Cell Transplantation

Diagnosis and Treatment of VOD/SOS After Allogeneic Hematopoietic Stem Cell Transplantation

Noncontrast Magnetic Resonance Angiography Clinical Application in Pre–Liver Transplant Recipients With Impaired Renal Function

Assessment of Different Non-Invasive Score Modalities in Prediction of Esophageal Varices in Patients With Liver Cirrhosis

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