الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
The complex anatomic architecture of the porta hepatis makes it a diagnostic challenge. A wide spectrum of benign and neoplastic pathologic conditions can occur in the structures that form the porta hepatis. Improved spatial resolution of current imaging techniques have enabled greater accuracy in diagnosing these conditions.
The aim of this work was to identify the value of different imaging modalities in the evaluation of the various lesions involving the porta hepatis.
This study was conducted on 56 patients referred to the radiology departments. It included 38 males and 18 females with ages ranged from 15 - 80 years old, (mean age of 53.98 years old ± 13.63). All patients were subjected to complete history taking and clinical assessment, different available diagnostic imaging modalities including U/S, CT, MRI, MRCP and PET/CT.
In the current study, different vascular and non-vascular lesions located at the porta hepatis region were assessed with the different imaging modalities namely ultrasonography, MDCT, MRI, MRCP and PET/CT. And each lesion was presented with the appropriate imaging modality which best show the lesion’s anatomy, extension and relations.
In the 56 studied patients there were different porta hepatis lesions. Lesions were further arranged in descending order based on the number of patients /frequency of cases presented with each lesion. i.e. Choledocolithiasis (10 cases), lymphadenopathy (10 cases), PVT (7 cases), CHA encasement (6 cases), HCC with PVT (4 cases), Cholangiocarcinoma (4 cases), free air (7 cases); [4 with aerobilia, 2 with free pneumopritoneum and one with PV gas], Post-cholecystectomy sequelae (2 cases), and solitary case in each of the following cholangiocarcinoma+PVT, portal biliopathy, free collection, CBD tumoral extension, Choledocal cyst and CHA aneurysm.
Multi-modality imaging were conducted on 15 patients. Three patients had ultrasound and consequently CECT (Two patients with PVT and one was diagnosed as PH lymphadenopathy). Four patients had MRCP with ultrasound (2 patients) and limited MRI study (axial T1WI & T2WI) for choledocholithiasis. Two patients had CECT preceding MRCP and complimentary ultrasound, (In one patient small 4 mm distal CBD stone was seen on MRCP and was not visible on U/S or CT. The other patient showed tumor extension into the CBD on CECT and MRCP). Both post-operative NCCT and MRCP were done in one patient (showing EHBD, CBD stent, pneumobilia and absence of biliary stone on MRCP). Five had FAST sonography and NCCT.
The remaining 41 patients had single imaging modality technique that was tailored upon their clinical complaints and their referring physician requests. CT only was performed in 23 patients. One patient had NCCT showing aerobilia, while 22 patients had CECT which showed different lesions namely; PVT (bland & malignant) in seven patients, CHA encasement in six patients, lymphadenopathy in 5 patients, CHA aneurysm in one patient, CBD dilatation in one patient and choledocal cyst in another one patient. MRCP was done in 12 Twelve patients associated with complimentary ultrasound in three patients and limited MRI (axial T1 and T2) in nine patients. MRCP imaging showed CBD stones in nine patients, cholangiocarcinoma in three patients, and biloma in one patient. While only three patients had complete parametric MRI imaging studies performed as a single modality and it showed Hilar cholangiocarcinoma in all three patients. PET/CT was conducted in three patients as a follow up study in the process of their treatment protocol. This imaging modality contained both NCCT and whole body PET scan. It showed active PH lymphadenopathies secondary to metastatic (one case) and lymphoma (two cases).