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Clinical and imaging predictors of the natural course of bland portal vein thrombus in cirrhotic patients

  • Hepatobiliary
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Background

Portal vein thrombus (PVT) in cirrhotic patients is associated with worsening portal hypertension, leads to increased complexity of necessary interventions such as transjugular liver portosystemic shunt or liver transplantation, and is associated with worse outcomes after liver transplantation. Additionally, there are no established consensus guidelines for management of bland PVT in cirrhotic patients, which currently exists on a spectrum and is patient and provider dependent.

Purpose

The aim of this study was to determine whether there are associations between key clinical and imaging variables and bland PVT burden over time.

Material and Methods

This exploratory, retrospective, single-center study included patients who underwent two or more multiphase CT or MRI examinations between 1/1/2013 and 12/31/2019 and had a diagnosis of PVT. Three readers independently evaluated all index and follow-up examinations for PVT burden using a proposed 8-point scale and the established Yerdel score. Key clinical factors were collected from the electronic medical record. The PVT burden over time and the association of this burden with key clinical and imaging variables were assessed using logistic regression models.

Results

138 patients with cirrhosis and bland PVT were included in the analyses. Median age was 60 years (interquartile range 55–67; 90 men) and median follow-up time was 19.6 months. At baseline, the mean score was 2.31 (± 1.44) and at the final follow-up examination, the mean score was 2.52 (± 1.99). Baseline occlusion level was the only statistically significant association with worsening PVT burden in all four vascular territories (p-value < 0.0001). Anticoagulation status did not have a statistically significant association with change in thrombus burden in any vascular territory or cumulative thrombus burden across all territories (p-value 0.11–0.43).

Conclusion

In conclusion, our study shows that in cirrhotic patients with bland PVT, the thrombus burden did not change significantly over time and baseline thrombus burden is the only clinical factor significantly associated with increasing burden over time.

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Abbreviations

PVT:

Portal vein thrombus

TIPS:

Transjugular intrahepatic portosystemic shunt

CT:

Computed tomography

MRI:

Magnetic resonance imaging

OR:

Odds ratio

SD:

Standard deviation

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Authors and Affiliations

  1. Department of Radiology, Duke University Medical Center, Durham, NC, 27710, USA

    Meghana Konanur, Celia Reynolds, Erin Shropshire, Benjamin Wildman-Tobriner, Brian Allen, Tracy Jaffe & Mustafa Bashir

  2. Department of Biostatistics and Bioinformatics (B&B), Duke University School of Medicine, Durham, NC, 27710, USA

    Reginald Lerebours & Alaattin Erkanli

  3. Center for Advanced Magnetic Resonance in Medicine, Duke University Medical Center, Durham, NC, 27705, USA

    Mustafa Bashir

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  1. Meghana Konanur
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  2. Celia Reynolds
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Correspondence to Mustafa Bashir.

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Konanur, M., Reynolds, C., Shropshire, E. et al. Clinical and imaging predictors of the natural course of bland portal vein thrombus in cirrhotic patients. Abdom Radiol 47, 3724–3732 (2022). https://doi.org/10.1007/s00261-022-03626-x

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