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Alterations in Hepatic Perfusion Resulting from Splanchnic Venous Luminal Compromise Caused by Pancreatic Carcinoma

¹ All authors: Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA 02215.

OBJECTIVE. We determined whether alterations in hepatic enhancement exist on dual phase helical CT of the liver in patients with splanchnic venous luminal compromise resulting from pancreatic adenocarcinoma.

SUBJECTS AND METHODS. We examined the extent of hepatic enhancement on dual phase helical CT in 22 patients with pancreatic adenocarcinoma. Eleven patients had splanchnic venous luminal narrowing (flattening along at least 120° of the circumference) of the superior mesenteric vein with (n = 3) or without (n = 8) portal vein involvement caused by tumor. In the remaining patients, splanchnic vasculature appeared normal. An additional 16 patients without pancreatic or hepatic abnormality who underwent dual phase helical CT served as control subjects. We compared the extent of arterial phase and portal venous phase enhancement among the three groups.

RESULTS. The group of patients with splanchnic venous luminal compromise had significantly higher hepatic enhancement during the arterial phase (p < 0.01) and lower enhancement during the portal venous phase (p < 0.05) compared with the other two groups of patients. No significant difference in hepatic enhancement during either phase was noted between the control subjects and the patients with normal vasculature.

CONCLUSION. Because hepatic enhancement correlates with perfusion, splanchnic venous luminal compromise resulting from pancreatic adenocarcinoma likely causes decreased portal venous flow and compensatory increased hepatic arterial flow. This finding supports other evidence of a homeostatic mechanism that maintains hepatic perfusion.

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