title: Imaging of the porta hepatis: spectrum of disease.
abstract: A wide array of pathologic conditions can arise within the porta hepatis, which encompasses the portal triad (the main portal vein, common hepatic artery, and common bile ducts), lymphatics, nerves, and connective tissue. Major vascular diseases of the portal triad include thrombosis, stenosis, and aneurysm. Portal vein thrombosis can complicate liver cirrhosis and hepatocellular carcinoma and has important therapeutic implications. Hepatic artery thrombosis and stenosis require immediate attention to reduce graft loss in liver transplant recipients. Congenital (eg, choledochal cyst) and acquired (benign and malignant) diseases of the biliary system can manifest as mass lesions in the porta hepatis. Lymphadenopathy can arise from neoplastic and nonneoplastic entities. Uncommon causes of mass lesions arise from nerves (eg, neurofibroma, neurofibrosarcoma) and connective tissue (sarcomas) and are rare. The hepatoduodenal ligament is a peritoneal reflection at the porta hepatis and is an important route for the spread of pancreatic and gastrointestinal cancers. Imaging plays a major role in diagnosis and enables appropriate management. Ultrasonography accurately demonstrates anatomic variations and pathologic conditions and is the initial modality of choice for detection of vascular and biliary lesions. Multidetector computed tomography and magnetic resonance imaging allow characterization and differentiation of various masses in the porta hepatis. Imaging-guided interventions, including embolization and stent placement, also play a key role in disease management.
authors.affiliation: From the Department of Imaging, Dana Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.H.T.); Department of Radiology, University of Texas Health Sciences Center at San Antonio, San Antonio, Tex (A.K.P.S.); Department of Radiology, University of Texas M.D. Anderson Cancer Center, Houston, Tex (R.V., S.R.P.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.O.M.).
authors.forename: Sree Harsha
authors.initials: SH
authors.lastname: Tirumani
authors.forename: Alampady Krishna Prasad
authors.initials: AK
authors.lastname: Shanbhogue
authors.forename: Raghunandan
authors.initials: R
authors.lastname: Vikram
authors.forename: Srinivasa R
authors.initials: SR
authors.lastname: Prasad
authors.forename: Christine O
authors.initials: CO
authors.lastname: Menias
mesh_terms: D006801:Humans; D007089:Image Enhancement / Q000379:methods; D008099:Liver / Q000000981:diagnostic imaging* / Q000473:pathology*; D008107:Liver Diseases / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D061330:Multidetector Computed Tomography / Q000379:methods*; D014463:Ultrasonography / Q000379:methods*