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. 2024 Aug;46(8):1177-1184.
doi: 10.1007/s00276-024-03427-5. Epub 2024 Jul 4.

Classification of variant portal vein anatomy based on three-dimensional CT: surgical implications

Zheyu Liu  1 , Tianni Shen  1 , Kexin Xia  1 , Junye He  2 , Tianhao Rui  2 , Wei Chen  3
Affiliations

Classification of variant portal vein anatomy based on three-dimensional CT: surgical implications

Zheyu Liu et al. Surg Radiol Anat. 2024 Aug.

Abstract

Purposes: The purpose of this study was to develop a new and more comprehensive classification system for portal vein (PV) variations using three-dimensional visualization and evaluation (3DVE) and to discuss the prevalence rates and clinical implications of the variants.

Methods: The anatomies of PVs were tracked and analyzed by using three-dimensional visualization of CT images acquired between 2013 and 2022. Scans from 200 adults were evaluated and a total of 178 patients (N = 178) were included in the study. The new classification system, named BLB classification, was developed based on the level of the absent PV branch in each variant anatomy.

Results: Using the BLB classification system, PVs were divided into thirteen subtypes. Only 82.6-84.8% of the portal veins of the 178 patients were depicted in Atri's, Cheng's or Covey's classification, compared with 100% identified by the BLB classification. The BLB classification was validated against external data sets from previous studies, with 97.0-98.9% of patients classified by the BLB system.

Conclusion: Variant PV anatomies are more commonly seen based on 3DVE than in previous reports. The BLB classification covers almost all portal vein variants and may be used for planning liver surgery.

Keywords: Anatomic variation; Clinical practice; Portal vein; Three-dimensional imaging.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Schematic diagram of BLB classification system (Type I-Type IV). MPV, main portal vein; LPV, left portal vein; RPV, right portal vein; RAPV, right anterior portal vein; RPPV, right posterior portal vein; P8, segmental VIII branch; P5, segmental V branch; P7, segmental VII branch; P6, segmental VI branch
Fig. 2
Fig. 2
IQQA three-dimensional images showing all Type I-Type IV anatomies in BLB classification system. LPV, left portal vein; RPV, right portal vein; RAPV, right anterior portal vein; RPPV, right posterior portal vein; P8, segmental VIII branch; P5, segmental V branch; P7, segmental VII branch; P6, segmental VI branch
See this image and copyright information in PMC

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