title: Rex shunt preoperative imaging: diagnostic capability of imaging modalities.
abstract: The purpose of this study was to evaluate the diagnostic capability of imaging modalities used for preoperative mesenteric-left portal bypass ("Rex shunt") planning. Twenty patients with extrahepatic portal vein thrombosis underwent 57 preoperative planning abdominal imaging studies. Two readers retrospectively reviewed these studies for an ability to confidently determine left portal vein (PV) patency, superior mesenteric vein (SMV) patency, and intrahepatic left and right PV contiguity. In this study, computed tomographic arterial portography allowed for confident characterization of left PV patency, SMV patency and left and right PV continuity in 100% of the examinations. Single phase contrast-enhanced CT, multi-phase contrast-enhanced CT, multiphase contrast-enhanced MRI, and transarterial portography answered all key diagnostic questions in 33%, 30%, 0% and 8% of the examinations, respectively. In conclusion, of the variety of imaging modalities that have been employed for Rex shunt preoperative planning, computed tomographic arterial portography most reliably allows for assessment of left PV patency, SMV patency, and left and right PV contiguity in a single study.
authors.affiliation: Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, United States of America.
authors.forename: Sharon W
authors.initials: SW
authors.lastname: Kwan
authors.forename: Nicholas
authors.initials: N
authors.lastname: Fidelman
authors.forename: Jeremy C
authors.initials: JC
authors.lastname: Durack
authors.forename: John P
authors.initials: JP
authors.lastname: Roberts
authors.forename: Robert K
authors.initials: RK
authors.lastname: Kerlan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003952:Diagnostic Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods*; D058017:Vascular Grafting / Q000379:methods*; D055815:Young Adult