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Hepatofugal Flow in the Portal Venous System: Pathophysiology, Imaging Findings, and Diagnostic Pitfalls¹

¹ From the Department of Radiology, University of Medicine and Dentistry of New Jersey–New Jersey Medical School, Newark. Presented as an education exhibit at the 2000 RSNA scientific assembly. Received March 30, 2001; revision requested May 29 and received October 19; accepted October 19. Address correspondence to R.H.W., Department of Radiology, University Hospital, 150 Bergen St, Rm C-320, Newark, NJ 07103-2406 (e-mail: wachsbrh@umdnj.edu).

Hepatofugal flow (ie, flow directed away from the liver) is abnormal in any segment of the portal venous system and is more common than previously believed. Hepatofugal flow can be demonstrated at angiography, Doppler ultrasonography (US), magnetic resonance imaging, and computed tomography (CT). The current understanding of hepatofugal flow recognizes the role of the hepatic artery and the complementary phenomena of arterioportal and portosystemic venovenous shunting. Detection of hepatofugal flow is clinically important for diagnosis of portal hypertension, for determination of portosystemic shunt patency and overall prognosis in patients with cirrhosis, as a potential pitfall at invasive arteriography performed to evaluate the patency of the portal vein, and as a contraindication to specialized imaging procedures (ie, transarterial hepatic chemoembolization and CT during arterial portography). Hepatofugal flow is generally diagnosed at Doppler US without much difficulty, but radiologists should beware of pitfalls that can impede correct determination of flow direction in the portal venous system.

© RSNA, 2002

Index Terms: Hypertension, portal, 957.711 • Liver, blood supply, 761.91 • Portal vein, flow dynamics, 957.453 • Shunts, arterioportal, 957.759 Shunts, portosystemic, 957.453

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