Nuray HALİLOĞLU, Esra ÖZKAVUKCU, Ayșe ERDEN

Sirozu Olan ve Olmayan Hastalarda Portal Ven Trombozunda İntrapankreatik Kollaterallerin Manyetik Rezonans Görüntülemesi

Amaç: Sirotik ve sirotik olmayan gruplarda portal vende kavernöz transformasyonu olan hastalarda intrapankreatik kollaterallerin sıklığını araștırmaktır. Materyal ve Metod: Portal vende kavernöz transformasyonu olan 41 hastanın MR anjiyografi görüntüleri değerlendirildi. Bu hastaların 21’inde siroz vardı (Grup I) ve 20 hastada portal ven trombozunun (PVT) diğer nedenleri mevcuttu (Grup II). MR incelemeleri Eylül 2006- Șubat 2010 tarihleri arasında 1-T MRG cihazında yapıldı. MR görüntüleri, intrapankreatik kollaterallerin varlığı ve PVT’nin yaygınlığı açısından iki radyolog tarafından değerlendirildi. Bulgular: İntrapankreatik kollateraller 41 hastanın 25’inde (%61) mevcuttu (Grup I’de 11 hasta, Grup II’de 14 hasta). İstatistiksel olarak iki grup arasında anlamlı bir fark yoktu (p>0,05). Hastalarımızın hiçbirinde intrapankreatik kollaterallere ikincil kitle etkisi saptanmadı. İntrapankreatik kollateralleri olan 25 hastanın 22’sinde (%88) PVT superior mezenterik vene ve/veya splenik vene uzanıyordu. Sonuç: Portal vende kavernöz transformasyonu olan hastalarda intrapankreatik kolateraller sık görülür. Siroz intrapankreatik kollaterallerin sıklığını etkilememektedir. İntrapankreatik kollaterallerin gelișiminde ana etken PVT’nin yayılımıdır.

Anahtar Kelimeler:

Pankreas, Portal ven, Manyetik Rezonans Anjiyografi, Siroz

Magnetic Resonans Imaging Of Intrapancreatic Collaterals in Portal Vein Thrombosis With And Without Cirrhosis

Aim: To evaluate the frequency of intrapancreatic collaterals in patients with cavernous transformation of the portal vein, in cirrhotic and non-cirrhotic groups. Materials and Methods: We evaluated MR angiography images of 41 patients with cavernous transformation of the portal vein. Twenty-one of these patients had cirrhosis (Group I), and 20 patients had other causes of portal vein thrombosis (PVT) (Group II). MR studies were performed between September 2006-February 2010 using 1-T MRI system. MR images were reviewed by two radiologists, for the presence of intrapancreatic collaterals and the extension of the PVT. Results: Intrapancreatic collaterals were present in 25 of 41 (61%) patients (11 patients in Group I, 14 patients in Group II). Statistically there was no significant difference between the two groups (p>0.05). Mass effect caused by the intrapancreatic collaterals was not detected in any of our patients. The PVT was extending to the superior mesenteric vein and/or splenic vein in 22 of the 25 patients (88%) with intrapancretic collaterals. Conclusion: Intrapancreatic collaterals are common in patients with cavernous transformation of the portal vein. Cirrhosis does not seem to affect the frequency of intrapancreatic collaterals. The extension of PVT plays the major role in the formation of intrapancreatic collaterals

Keywords:

Pancreas; Portal vein; Magnetic Resonance Angiography; Cirrhosis,

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Marn CS, Francis IR. CT of portal venous occlusion. Am J Roentgenol 1992;159:717-726.
Levy HM, Newhouse JH. MR imaging of portal vein thrombosis. Am J Roentgenol 1988;151:283-286.
Mathieu D, Vasile N, Grenier P. Portal thrombosis: Dynamic CT features and course. Radiology 1985; 154: 737-741.
Vilgrain V, Condat B, O’Toole D, et al. Pancreatic portal cavernoma in patients with cavernous transformation of the portal vein: MR findings. Eur Radiol 2009;19:2608– 2613.
Ozcinar B, Ozden I, Bilge O, et al. Pancreatic portal cavernoma. J Pancreas 2005;6:40-41.
Ragozzino A, De Ritis R, Guardascione MA, Amitrano L. A portal vein cavernoma mimicking a pancreatic mass. J Hepatol 2003;38:372.
Mourad N, Zhang J, Rath AM, 10. Amitrano L, Guardascione MA, Chevrel JP. The venous drainage of the pancreas. Surg Radiol Anat 1994;16:37- 45.
Yamada Y, Mori H, Kiyosue H, et al. CT assessment of the inferior 11. Hoekstra J, Janssen HLA. Vascular peripancreatic veins: clinical significance. Am J Roentgenol 2000;174:677-684.
Tateishi A, Mitsui H, Oki T, et al. Extensive mesenteric vein and portal vein thrombosis successfully treated by thrombolysis and anticoagulation. J Gastroenterol Hepatol 2001;16:1429- 1433.
Chandra R, Kapoor D, Tharakan A, Chaudhary A, Sarin SK. Portal biliopathy. J Gastroenterol Hepatol 2001;16:1086–1092.
Shin SM, Kim S, Lee JW, Kim CW, et al. Biliary abnormalities associated with portal biliopathy: evaluation on MR cholangiography. Am J Roentgenol 2007; 188:W341–W347.