Background: In contrast to an acute occlusion of the visceral arteries, which is the most important differential diagnosis for an occlusion of the portal venous system and which poses a highly dangerous situation ending in gangrene of the bowel wall, the symptoms of an acute occlusion of the portal venous system are quite unspecific. To rule out an acute arterial occlusion, diagnostic evaluation has to be carried out quickly in order to decide on the necessity of therapeutic steps concerning a recanalization of the occluded vessels. Only few therapeutic options are available to recanalize and remodel the portal venous system, depending on the underlying disease, the age of the occlusion, its extension, and the effect on the bowel wall, stomach, spleen, and abdominal wall. Moreover, the efficacy of recanalization procedures mainly depends on the formation and number of collateral venous blood supply, its degree, and the anatomic structure. Possible complications of portal hypertension like varices, gastrointestinal vasculopathy, ascites, and splenomegaly also influence the success of recanalization procedures. Only in cases of acute thrombotic occlusion systemic lytic therapy promises to be successful. Therefore, other options such as transjugular intrahepatic recanalization, e.g. by means of the TIPS (transjugular intrahepatic portosystemic shunt) procedure, have to be evaluated. Methods: Review of the literature. Results: Noninvasive methods such as ultrasound (US), computed tomography, and especially magnetic resonance imaging (MRI) allow the evaluation of therapeutic options as well as their success, the feasibility of technical procedures, the detection of possible risks, and a calculation of risks and benefits. Conclusion: In order to arrive at the correct therapeutic decision, a combination of MRI and US methods combined with color Doppler guarantee the most efficient diagnostic results in cases with acute or chronic occlusions of the portal venous system.

Keywords:
Portal vein occlusion, Diagnostic methods
1.
Gore RM, Levine MS (eds): Textbook of Gastrointestinal Radiology, ed 3. Philadelphia, Saunders, 2007.
2.
Romano S, Niola R, Maglione F, Romano L: Small bowel vascular disorders from arterial etiology and impaired venous drainage. Radiol Clin North Am 2008;46:891-908.
3.
Cenedese A, Monneuse O, Gruner L, et al: Initial management of extensive mesenteric venous thrombosis: retrospective study of nine cases. World J Surg 2009;33:2203-2208.
4.
Wong YC, Wu CH, Wang LJ, et al: Mesenteric vascular occlusion: comparison of ancillary CT findings between arterial and venous occlusion and independent CT findings suggesting life-threatening events. Korean J Radiol 2013;14:38-44.
5.
Tessler FN, Gehring BJ, Gomes AS, et al: Diagnosis of portal vein thrombosis: value of color Doppler imaging. AJR Am J Roentgenol 1991;157:293-296.
6.
Parvey HR, Eisenberg RL, Giyanani V, Krebs CA: Duplex sonography of the portal venous system: pitfalls and limitations. AJR Am J Roentgenol 1989;152:765-770.
7.
Miller VE, Berland LL: Pulsed Doppler duplex sonography and CT of portal vein thrombosis. AJR Am J Roentgenol 1985;145:73-76.
8.
Marshall MM, Beese RC, Muiesan P, et al: Assessment of portal venous system patency in the liver transplant candidate: a prospective study comparing ultrasound, microbubble-enhanced colour Doppler ultrasound, with arteriography and surgery. Clin Radiol 2002;57:377-383.
9.
Ricci P, Cantisani V, Biancari F: Contrast-enhanced color Doppler US in malignant portal vein thrombosis. Acta Radiol 2000;41:470-473.
10.
Ali Raza J, Miller M, Dieter RS, et al: Diagnosis and non-surgical management of mesenteric ischemia. Vasc Dis Manag 2006;3. www.vasculardiseasemanagement.com/article/5495.
11.
Rhee RY, Gloviczki P: Mesenteric venous thrombosis. Surg Clin North Am 1997;77:327-338.
12.
Bradbury MS, Kavanagh PV, Bechtold RE, et al: Mesenteric venous thrombosis: diagnosis and noninvasive imaging. Radiographics 2002;22:527-541.
13.
Bartnicke BJ, Balfe DM: CT appearance of intestinal ischemia and intramural hemorrhage. Radiol Clin North Am 1994;32:845-860.
14.
Rha SE, Ha HK, Lee SH, et al: CT and MR imaging findings of bowel ischemia from various primary causes. Radiographics 2000;20:29-42.
15.
Li C, Hu A, Haacke M, et al: Direct portal vein thrombosis visualization with T2*-weighted magnetic resonance imaging. Int J Med Sci 2013;10:1570-1574.
16.
Catalano OA, Choy G, Zhu A, et al: Differentiation of malignant thrombus from bland thrombus of the portal vein in patients with hepatocellular carcinoma: application of diffusion-weighted MR imaging. Radiology 2010;254:154-162.
17.
Sandrasegaran K, Tahir B, Nutakki K, et al: Usefulness of conventional MRI sequences and diffusion-weighted imaging in differentiating malignant from benign portal vein thrombus in cirrhotic patients. AJR Am J Roentgenol 2013;201:1211-1219.
18.
Shimada K, Isoda H, Okada T, et al: Non-contrast-enhanced MR portography with time-spatial labeling inversion pulses: comparison of imaging with three-dimensional half-fourier fast spin-echo and true steady-state free-precession sequences. J Magn Reson Imaging 2009;29:1140-1146.
19.
Kreft B, Strunk H, Flacke S, et al: Detection of thrombosis in the portal venous system: comparison of contrast enhanced MR angiography with intraarterial digital subtraction angiography. Radiology 2000;216:86-92.
20.
Cakmak O, Elmas N, Tamsel S, et al: Role of contrast-enhanced 3D magnetic resonance portography in evaluating portal venous system compared with color Doppler ultrasonography. Abdom Imaging 2008;33:65-71.
21.
Shah TU, Semelka RC, Voultsinos V, et al: Accuracy of magnetic resonance imaging for preoperative detection of portal vein thrombosis in liver transplant candidates. Liver Transp 2006;12:1682-1688.
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2014
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