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CT Signs of Hepatofugal Portal Venous Flow in Patients with Cirrhosis

Thomas J. Bryce1, Benjamin M. Yeh1, Aliya Qayyum1, Preeyacha Pacharn2, Nathan M. Bass3, Ying Lu1 and Fergus V. Coakley1

1 Department of Medicine and Department of Radiology, Abdominal Imaging Section, University of California at San Francisco, Box 0628, 505 Parnassus Ave., San Francisco, CA 94143-0628.
2 Department of Radiology, Mahidol University, 2 Prannok Rd., Bangkok, 10700 Thailand.
3 Department of Medicine, Division of Gastroenterology, University of California at San Francisco, Box 0538, 505 Parnassus Ave., San Francisco, CA 94143-0538.



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  		Fig. 1. —Diagram shows diameters of main portal vein in patients with hepatopetal flow versus hepatofugal flow. Note that main portal vein diameter of less than 1 cm is highly specific for hepatofugal flow.

 


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  		Fig. 2. —Diagram shows receiver operating characteristic (ROC) values achieved using small main portal vein diameter to predict hepatofugal flow in main portal vein in patients with cirrhosis. Operating points achieved by predicting hepatofugal flow when main portal vein diameter was less than 1 cm are shown for observer 1 (x) and observer 2 ({Delta}). Note that at appropriate operating points, this sign is highly specific for hepatofugal flow. Area under ROC curve (Az) was 0.83 for observer 1 and 0.74 for observer 2.

 


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  		Fig. 3A. —73-year-old woman with cirrhosis due to alcohol abuse. Axial CT scan obtained during portal venous phase shows small (8 mm in diameter) main portal vein (arrow); this finding strongly correlates with hepatofugal flow.

 


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  		Fig. 3B. —73-year-old woman with cirrhosis due to alcohol abuse. Sonogram shows hepatofugal flow in main portal vein.

 


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  		Fig. 4A. —49-year-old man with cirrhosis due to chronic hepatitis C infection. CT scan obtained during arterial phase shows contrast enhancement of portal vein. This sign is thought to indicate hepatofugal portal venous flow.

 


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  		Fig. 4B. —49-year-old man with cirrhosis due to chronic hepatitis C infection. Doppler sonogram obtained 1 day earlier than A, however, reveals hepatopetal flow.

 

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