Background and Aim: There is limited data on imaging features of extra hepatic portal venous obstruction (EHPVO) induced portal biliopathy. We describe a decade long experience of imaging spectrum of EHPVO induced portal biliopathy using MR/CT in a referral centre for liver diseases.
Methods: Retrospective data of patients with primary EHPVO on contrast magnetic resonance imaging MRI/ computed tomography (CT) (n=120) and portal biliopathy (PB) on subsequent magnetic resonance cholangiopancreatography (MRCP) (n=80/120) between June 2009 - 2019 was collected. Categorisation of portal biliopathy was as per the Sarin classification and the corresponding, relevant imaging parameters were studied and analysed.
Results: Sarin Type 1 biliopathy was present in 16.3 %, Type 2 in 13.8%, Type 3a in 8.8% and Type 3b in 61.3%patients. The median total serum bilirubin was 1.6 (0.9-3.4) mg/dl with a mean CBD diameter of 6.7 ± 2.9 mm. Bilobar and unilobar IHBRD were observed in 87.5% and 6.3% patients respectively. The mean CBD angle was 138.9 ± 18.8º. CBD showed smooth wall contours (10%), extrinsic indentations (83.8%) and smooth strictures (6.3%). The median CBD stricture length was 26 mm (1.25- 45 mm). Pre-stenotic dilatation was observed in 66.3% with stricture length >16 mm (sensitivity 81.1 % specificity 78%) predisposing to it. Statistically significant associations were tabulated according to the classification of PB.
Conclusion: This study provides the decade long experience of imaging findings in EHPVO induced portal biliopathy according to its classification and its clinical implications.