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Imaging Insights into EHPVO Induced Portal Biliopathy and its Grading: Retrospective Study Over A Decade at A Tertiary Care Hospital
Shalini Thapar Laroia1, Komal Yadav1, Senthil Kumar2, Guresh Kumar3, Ragini Kilambi2, Shridhar Vasantrao Sasturkar2, Tushar Kanti Chattopadhyay2, Shiv Kumar Sarin4
1Department of Radiology, 2Department of HPB Surgery and Liver Transplantation, 3Department of Research, 4Department Hepatology, Institute of Liver and Biliary sciences, New Delhi, India.

Corresponding Author
Dr Shalini T Laroia


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.