Abdom Imaging 27:720-727 (2002).
Sheth S, Horton KM, Fishman EK.
Vascular complications are a major source of morbidity and mortality in patients with hepatic cirrhosis. The most devastating clinical manifestations of end-stage liver disease, upper gastrointestinal bleeding, ascites, and hepatic encephalopathy are direct consequences of portal hypertension and the resulting development of portosystemic collaterals.
Dual-phase helical computed tomography (CT) of the liver is commonly used to detect complications, particularly the development of hepatocellular carcinoma, in patients with cirrhosis. Assessment of the main portal vein and diagnosis of portal hypertension are essential parts of the examination. Whereas axial images acquired in the portal venous phase are sufficient for the diagnosis of portal hypertension, three-dimensional (3D) CT angiography provides precise delineation of the distribution and extent of portosystemic collaterals with an accuracy comparable to conventional angiographic portography [1]. This information is critical to the hepatologist to help predict which patients are at risk for life-threatening variceal bleeding and the interventional radiologist for planning transhepatic shunt procedures and balloon-occluded retrograde transvenous obliteration of gastric varices. The anatomic layout of the portal venous system and its tributary is displayed in a format most hepatic and transplant surgeons are accustomed to and understand more readily than axial images [2]. This allows optimal surgical planning, thereby minimizing the risk of intraoperative hemorrhage and decreasing dissection time [3].
This pictorial essay reviews the vascular complications encountered in hepatic cirrhosis at CT, with an emphasis on the role of 3D CT angiography.