Multidetector-Row Computed Tomography and Colour Doppler Imaging in the Evaluation of Patients with Extrahepatic Portal Hypertension: A Prospective Study

Background and aims: Evaluating patients of extrahepatic portal hypertension with Colour Doppler and MDCT to study the morphology of splenoportal axis, determining the site of obstruction, the anatomy of portosystemic collaterals, any associated vascular aneurysms, and features of portal biliopathy.
Materials and methods: We studied 45 patients (aged 6-55 years) with clinical features of portal hypertension with no identifiable hepatic cause or extrahepatic portal venous occlusion on sonography. All cases underwent Doppler ultrasound and MDCT. The data was compiled and analyzed. A comparative evaluation of Doppler imaging and MDCT was performed with the help of Cohen's kappa test to assess the agreement between the two modalities.
Results: MDCT provides better details about the morphology of the splenoportal axis, the site, and cause of block, as well as the extent and distribution of collateral groups. Colour Doppler has an advantage over MDCT in determining the direction and pattern of blood flow within the splenoportal axis, various collaterals, and spontaneous shunts, along with a better depiction of features of portal biliopathy. Colour Doppler is inadequate in the visualization of gastroesophageal and retroperitoneal varices. Identification of spontaneous spleno-adreno-renal and gastrorenal shunts is achieved with the high agreement between Colour Doppler and MDCT.

Conclusion: MDCT should be preferred for preoperative evaluation of patients being contemplated for shunt surgery. Colour Doppler imaging of portal biliopathy is sufficiently characteristic to avoid other invasive modalities. The two modalities provide complementary information in the evaluation of patients with extrahepatic portal hypertension.