Zusammenfassung
Ziel: Analyse von portoportalen Kollateralen und von sekundären Veränderungen der Gallenwege bei Patienten mit kavernöser Pfortadertransformation mit MRT. Material und Methode: Auswertung von 34 Patienten mit angiographisch bzw. MR-angiographisch nachgewiesener kavernöser Transformation. Beurteilt wurden das Verteilungsmuster der portoportalen Kollateralen sowie Wandverdickungen, Stenosen, Erweiterungen und Wandunregelmäßigkeiten der extra- und intrahepatischen Gallenwege. Ergebnisse: Von 34 Patienten mit kavernöser Transformation konnten bei 23 (67,6 %) paracholedochale portoportale Kollateralen nachgewiesen werden, 22 (64,7 %) hiervon mit abgrenzbaren Gefäßlumina. Epicholedochale Kollateralen waren bei insgesamt 8 (23,5 %) Patienten vorhanden. 24 von 34 (70,5 %) Patienten zeigten durch portoportale Kollateralen verursachte sekundäre Gallengangsveränderungen, bei 8 (23,5 %) Patienten führten sie zu Stenosen mit Erweiterung der vorgeschalteten Gallenwege. Wandunregelmäßigkeiten wurden bei weiteren 7 (20,5 %), Wandverdickungen der Gallenwege bei 11 (32,3 %) und der Gallenblase bei 4 (12,9 %) Patienten registriert. Schlussfolgerungen: Mittels MRT können bei Patienten mit kavernöser Transformation portoportale Kollateralen identifiziert werden, die häufig zu sekundären Gallengangsveränderungen führen und differenzialdiagnostisch berücksichtigt werden müssen.
Abstract
Purpose: Evaluation of portoportal collateral vessels and associated biliary abnormalities in patients with cavernous transformation of the portal vein by MRI. Material and Methods: Review of 34 MRI examinations performed on patients with angiographically or MR-angiographically proven cavernous transformation. The analysis included the pattern of the portoportal collateral circulation and the abnormalities of the biliary system, such as wall thickening, stenosis, dilations and irregularities of the extra-and intrahepatic bile ducts. Results: 23 (67.6%) of 34 patients with cavernous transformation had paracholedochal portoportal collateral vessels, with 22 (64.7%) showing visible luminal channels. Epicholedochal venous collaterals could be observed in 8 (23.5%) patients. 24 (70.5%) of 34 patients demonstrated biliary abnormalities due to portoportal collaterals, leading to stenosis with dilatation of the proximal bile ducts in 8 (23.5%) patients. The ductal walls were irregular in 7 (20.5%) patients, and thickened in 11 (32.3%). The gallbladder wall was thickened in 4 (12.9%) patients. Conclusion: Portoportal collaterals in patients with cavernous transformation of the portal vein can be identified by MRI. These collaterals frequently alter the biliary system, which must be considered in differential diagnosis of biliary abnormalities observed in the presence of portoportal collaterals.
Schlüsselwörter
Kavernöse Pfortadertransformation - portoportale Kollateralen - sekundäre Gallengangsveränderungen - MRT
Key words
Portal cavernous transformation - portoportal collaterals - MRI - biliary abnormalities
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Dr. Rolf Schaible
Radiologische Klinik, Universität Bonn
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