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The “streamline phenomenon” of the portal vein flow and its influence on liver involvement by gastrointestinal diseases: current concepts and imaging-based review

Abdominal Radiology volume 45, pages 403–415 (2020)Cite this article

Abstract

The streamline flow in the portal system is a phenomenon by which blood from superior mesenteric vein goes preferentially to the right hepatic lobe, while splenic and inferior mesenteric veins divert preferentially to the left lobe. Such a phenomenon results in different patterns of distribution of several liver diseases. The purpose of this article is to discuss the concepts behind the theory of streamline flow and to perform an imaging-based review of representative cases, demonstrating how it may influence the patterns of liver involvement in different gastrointestinal diseases.

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(Source: https://commons.wikimedia.org/wiki/File:Encontro_das_%C3%81guas_-_Manaus.jpg. Meeting (confluence) of the Waters, Manaus, Brazil. License: CC BY 3.0 BR)

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References

  1. Singh V. Portal Vein Blood Flow - An anatomical and physiological enigma. Journal of the Anatomical Society of India 2014;63:1-2.

    Article  Google Scholar 

  2. Copher GH, Dick BM. “Streamline” phenomena in the portal vein and selective distribution of portal blood in the liver. Arch Surg 1928;17:408-19.

    Article  Google Scholar 

  3. Desai A, Park C, Schilling JB. Streamline in the portal vein: its effect on the spread of metastases to the liver. Clin Nucl Med 1985; 10: 556–559.

    CAS  Article  Google Scholar 

  4. Hata Y, Kondoh M, Nakajima Y et al.Streamline phenomena in liver metastasis of gastrointestinal tumors - a clinical-study based upon 172 patients. Oncol Rep 1995; 2:593–595.

    CAS  PubMed  Google Scholar 

  5. Kuchler IL, Miekeley N, Fosberg BR. A contribution to the chemical characterization of rivers in the Rio Negro Basin, Brazil. J Braz Chem Soc 2000;11: 286-292.

    CAS  Article  Google Scholar 

  6. Couinaud C. Le foie : études anatomiques et chirurgicales. Paris, France: Masson; 1957.

    Google Scholar 

  7. Standring S. Gray’s Anatomy E-Book: The Anatomical Basis of Clinical Practice. S S, editor. Elsevier Heal Sci. 2010, Nov 7.

  8. Moore KL, Dalley AF. Clinically Oriented Anatomy. 5th ed. Lippincott Williams & Wilkins, Philadephia, 2006, 247-322.

    Google Scholar 

  9. German T, Favelier S. et al. Liver segmentation: Practical Tips. Gastrointestinal Imaging. 2014; 95: 1003-1016.

    Google Scholar 

  10. Vanneuville G, Viallet J, Garcier J. La veine porte. Anatomie clinique : le tronc. Paris: Springer Verlag. 1994: 455-70.

  11. Cheng Y, Huang T, Lee T, Chen T, Chen C. Variation of the intrahepatic portal vein; angiographic demonstration and application in living-related hepatic transplantation. Transplant Proc 1996; 28:1667-1668.

    CAS  PubMed  Google Scholar 

  12. Rosenthal SJ, Harrison LA, Baxter KG, Wetzel LH, Cox GG, Batnitzky S. Doppler US of helical flow in the portal vein. Radiographics 1995;15:1103-1111.

    CAS  Article  Google Scholar 

  13. Ambrosetti MC, Zamboni GA, Mucelli RP. Distribution of liver metastases based on the site of primary pancreatic carcinoma. Eur Radiol 2016; 26:306-10.

    Article  Google Scholar 

  14. Moore GE, Bridenbaugh RB. Roentgen demonstration of the venous circulation in the liver: portal venography. Radiology 1951; 57: 685–690.

    CAS  Article  Google Scholar 

  15. Guyton AC, Hall JE. Textbook of Medical Physiology. Basic Principles of Circulation Function. Saunders An Imprint of Elsevier, Inc; 2011:161.

  16. Cederbaum AI. Alcohol metabolism. Clinic Liver Disease 2012; 16(4): 667-685.

    Article  Google Scholar 

  17. Gallix BP, Reinhold C, Dauzat M, Bret PM. Streamlined flow in the portal vein: demonstration with MR angiography. J Magn Reson Imaging 2002;15:603-609.

    Article  Google Scholar 

  18. Ito K, Koike S, Jo C, Shimizu A, Kanazawa H, Miyazaki M, et al. Intraportal venous flow distribution: evaluation with single breath-hold ECG-triggered three-dimensional half-Fourier fast spin-echo MR imaging and a selective inversion-recovery tagging pulse. AJR Am J Roentgenol 2002;178:343-348.

    Article  Google Scholar 

  19. Tsukuda T, Ito K, Koike S, Sasaki K, Shimizu A, Fujita T, et al. Pre- and postprandial alterations of portal venous flow: evaluation with single breath-hold three-dimensional half-Fourier fast spin-echo MR imaging and a selective inversion recovery tagging pulse. J Magn Reson Imaging 2005; 22:527-533.

    Article  Google Scholar 

  20. Pathak S, Palkhi E, Dave R, White A, Pandanaboyana S, Prasad KR, et al. Relationship between primary colorectal tumour and location of colorectal liver metastases. ANZ J Surg 2016;86:408-410.

    Article  Google Scholar 

  21. Schulz W, Hagen C, Hort W. The distribution of liver metastases from colonic cancer. A quantitative postmortem study. Virchows Arch A Pathol Anat Histopathol 1985;406:279-284.

    CAS  Article  Google Scholar 

  22. Wigmore SJ, Madhavan K, Redhead DN, Currie EJ, Garden OJ. Distribution of colorectal liver metastases in patients referred for hepatic resection. Cancer 2000;89:285-287.

  23. Rhu J, Heo JS, Choi SH, Choi DW, Kim JM, Joh JW, et al. Streamline flow the portal vein affects the lobar distribution of colorectal liver metastasis and has a clinical impact on suviver. Ann Surg Trat and Res 2017; 92:348-354.

  24. Yang SY, Cho MS, Kim NK. Difference between right-sided and left-sided colorectal cancers: from embryology to molecular subtype. Expert Rev Anticancer Ther 2018;18:351-358.

    CAS  Article  Google Scholar 

  25. Lupinacci RM, Paye F, Coelho FF, Kruger JA, Herman P. Lymphatic drainage of the liver and its implications in the management of colorectal cancer liver metastases. Updates Surg 2014;66:239-245.

    Article  Google Scholar 

  26. Enweluzo C, Aziz F. Pancreatic Cancer and Gastroenterology: A Review. Gastroenterology Research 2013;6 :81-84.

    PubMed  PubMed Central  Google Scholar 

  27. Mourad N, Zhang J, Rath A. et al. The venous drainage of the pancreas. Surg Radiol Anat 1994; 16: 37-45.

    CAS  Article  Google Scholar 

  28. Stickel F, Datz C, Hampe J, Bataller R. Pathophysiology and Management of Alcoholic Liver Disease: Update 2016. Gut and Liver 2017; 11: 173-188.

    CAS  Article  Google Scholar 

  29. Okazaki H, Ito K, Fujita T, Koike S, Takano K, Matsunaga N. Discrimination of alcoholic from virus-induced cirrhosis on MR imaging. AJR Am J Roentgenol 2000;175:1677-1681.

    CAS  Article  Google Scholar 

  30. Indiran V, Jagannathan K. Right posterior hepatic notch sign. Abdom Radiol (NY) 2017;42:2780.

    Article  Google Scholar 

  31. Shreiner DP, Barlai-Kovach M. Diagnosis of alcoholic cirrhosis with the right-to-left hepatic lobe ratio: concise communication. J Nucl Med 1981; 22:116-120.

  32. Garcia JE, Atkins F. A low right-to-left hepatic lobe ratio. Is streamlining of ethanol to the right lobe of the liver the cause? Clin Nucl Med 1985; 10:807-809.

    CAS  Article  Google Scholar 

  33. Blomquist L, Wang Y, Kimiaei S, Jacobsson H. Change in size, shape and radiocolloid uptake of the alcoholic liver during alcohol withdrawal, as demonstrated by single photon emission computed tomography. J Hepatol 1994;21:417-423.

    CAS  Article  Google Scholar 

  34. Nishino M, Hayakawa K, Nakamura Y, Morimoto T, Mukaihara S. Effects of tamoxifen on hepatic fat content and the development of hepatic steatosis in patients with breast cancer: high frequency of involvement and rapid reversal after completion of tamoxifen therapy. AJR Am J Roentgenol 2003;180:129-134.

    Article  Google Scholar 

  35. Nomura F, Ohnishi K, Ochiai T, Okuda K. Obesity-related nonalcoholic fatty liver: CT features and follow-up studies after low-calorie diet. Radiology 1987;162:845-847.

    CAS  Article  Google Scholar 

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This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Hospital Beneficência Portuguesa, Sao Paulo, Brazil

    Eduardo Medeiros de Araujo, Douglas Jorge Racy & Lucas Rios Torres

  2. Grupo Fleury, Rua Cincinato Braga, 282, Bela Vista, São Paulo, SP, 01333-010, Brazil

    Ulysses S. Torres, Lucas Rios Torres & Giuseppe D’Ippolito

  3. A.C.Camargo Cancer Center Imaging Department, Sao Paulo, Brazil

    Rubens Chojniak

  4. Hospital Sao Paulo, Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, Brazil

    Giuseppe D’Ippolito

Authors
  1. Eduardo Medeiros de Araujo
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  2. Ulysses S. Torres
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  3. Douglas Jorge Racy
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  4. Lucas Rios Torres
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  5. Rubens Chojniak
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  6. Giuseppe D’Ippolito
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Correspondence to Ulysses S. Torres.

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de Araujo, E.M., Torres, U.S., Racy, D.J. et al. The “streamline phenomenon” of the portal vein flow and its influence on liver involvement by gastrointestinal diseases: current concepts and imaging-based review. Abdom Radiol 45, 403–415 (2020). https://doi.org/10.1007/s00261-019-02335-2

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  • DOI: https://doi.org/10.1007/s00261-019-02335-2

Keywords

  • Streamline
  • Liver
  • Portal vein
  • Hemodynamics
  • Vascular imaging