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Published online before print August 14, 2006, 10.1148/radiol.2411051102
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(Radiology 2006;241:149-155.)
© RSNA, 2006

Gastrointestinal Imaging

Atrophy-Hypertrophy Complex in Patients with Cavernous Transformation of the Portal Vein: CT Evaluation1

Valérie Vilgrain, MD, Bertrand Condat, MD, Christophe Bureau, MD, Antoine Hakimé, MD, Aurélie Plessier, MD, Dominique Cazals-Hatem, MD and Dominique C. Valla, MD

1 From the Departments of Radiology and INSERM Unité 773 CRB3 (V.V., A.H.), Hepatology and INSERM Unité 773 CRB3 (B.C., A.P., D.C.V.), and Anatomic Radiology (D.C.), Assistance Publique des Hôpitaux de Paris (APHP), Hôpital Beaujon, 100 bld Général Leclerc, 92110 Clichy, France; and Department of Hepatogastroenterology, Fédération Digestive, CHU Purpan, Toulouse, France (C.B.). Received July 2, 2005; revision requested September 2; revision received September 12; accepted October 14; final version accepted January 9, 2006. Address correspondence to V.V. (e-mail: valerie.vilgrain{at}bjn.ap-hop-paris.fr).

Purpose: To retrospectively evaluate the morphologic changes in the liver associated with cavernous transformation of the portal vein.

Materials and Methods: This study was institutional review board approved. Informed patient consent was not required. The computed tomographic (CT) results for 22 patients (14 male, eight female; mean age, 54 years) with cavernous transformation of the portal vein and no evidence of chronic liver disease at liver biopsy were retrospectively reviewed and compared with the CT results for 36 control subjects. Various morphologic changes in the hepatic lobes were qualitatively and quantitatively assessed by using the Student t test for unpaired data.

Results: Qualitative analysis revealed the atrophy-hypertrophy complex in most (n = 20, 91%) of the patients with cavernous transformation and in no control subjects. Atrophy of the left lateral segment and right liver lobe was seen in 16 (73%) and seven (32%) patients, respectively. Hypertrophy of the caudate lobe and liver segment IV was identified in 19 (86%) and 11 (50%) patients, respectively. All mean caudate lobe volume index values and mean caudate lobe–to–right lobe ratio values were significantly greater (P < .05) in the cavernous transformation group than in the control group. The mean segment IV diameter was significantly greater (41.6 vs 28.1 mm, P < .001) in the patients with cavernous transformation. Hepatic nodules and hepatic contour nodularity were not seen in the patients with cavernous transformation.

Conclusion: The atrophy-hypertrophy complex is frequently observed in patients with cavernous transformation of the portal vein. Some findings, such as hypertrophy of the caudate lobe, mimic chronic liver disease or signs of portal hypertension, but left lateral segment atrophy and a normal or enlarged segment IV are distinctive findings of cavernous transformation.

© RSNA, 2006




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