Rational classification of portal vein thrombosis and its clinical significance.
Portal vein thrombosis (PVT) is commonly classified into acute (symptom duration <60 days and absence of portal carvernoma and portal hypertension) and chronic types. However, the rationality of this classification has received little attention. In this study, 60 patients (40 men and 20 women) with PVT were examined using contrast-enhanced computed tomography (CT). The percentage of vein occlusion, including portal vein (PV) and superior mesenteric vein (SMV), was measured on CT image. Of 60 patients, 17 (28.3%) met the criterion of acute PVT. Symptoms occurred more frequently in patients with superior mesenteric vein thrombosis (SMVT) compared to those without SMVT (p<0.001). However, there was no significant difference in PV occlusion between patients with and without symptoms. The frequency of cavernous transformation was significantly higher in patients with complete PVT than those with partial PVT (p<0.001). Complications of portal hypertension were significantly associated with cirrhosis (p<0.001) rather than with the severity of PVT and presence of cavernoma. These results suggest that the severity of PVT is only associated with the formation of portal cavernoma but unrelated to the onset of symptoms and the development of portal hypertension. We classified PVT into complete and partial types, and each was subclassified into with and without portal cavernoma. In conclusion, neither symptom duration nor cavernous transformation can clearly distinguish between acute and chronic PVT. The new classification system can determine the pathological alterations of PVT, patency of portal vein and outcome of treatment in a longitudinal study.
Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.
Jingqin
J
Ma
Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.
Zhiping
Z
Yan
Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.
Jianjun
J
Luo
Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.
Qingxin
Q
Liu
Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.
Jianhua
J
Wang
Bone and Mineral Research Laboratory, Henry Ford Hospital, Detroit, Michigan, United States of America.
Shijing
S
Qiu
D000293:Adolescent; D000328:Adult; D000368:Aged; D003287:Contrast Media / Q000737:chemistry; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications; D008297:Male; D008642:Mesenteric Veins / Q000000981:diagnostic imaging; D008875:Middle Aged; D011169:Portal Vein / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011857:Radiographic Image Interpretation, Computer-Assisted; D012189:Retrospective Studies; D013927:Thrombosis / Q000145:classification* / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed; D055815:Young Adult
D003287:Contrast Media