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Hepatic portal vein

The hepatic portal vein (HPV) is the major venous channel of the portal system, formed by the union of the superior mesenteric vein (SMV) and splenic vein behind the pancreas at L2. It ascends within the hepatoduodenal ligament posterior to the common bile duct and hepatic artery proper, then divides at the porta hepatis into right and left portal veins, which branch into segmental vessels supplying the liver.

It carries nutrient-rich, deoxygenated blood from the GI tract, pancreas, spleen, and gallbladder to the liver for metabolism and detoxification. Its tributaries include the SMV, splenic vein, gastric veins, cystic vein, and pancreaticoduodenal veins.

Clinically, the portal vein is critical in cirrhosis, portal hypertension, hepatocellular carcinoma (HCC), and portosystemic shunts (TIPS).

Synonyms

  • Portal vein

  • Vena portae hepatis

  • Portal venous trunk

Function

  • Transports nutrient-rich venous blood to the liver

  • Contributes ~75% of hepatic blood supply

  • Essential for drug metabolism, glycogen storage, detoxification, and hormone regulation

  • Central vessel in portal hypertension and variceal formation

Tributaries

  • Superior mesenteric vein (SMV)

  • Splenic vein

  • Left and right gastric veins

  • Cystic vein

  • Pancreaticoduodenal veins

MRI Appearance
T1-weighted images: Lumen appears as a signal void due to venous flow, vessel walls hypointense against surrounding liver.
T2-weighted images: Normal portal vein shows flow void; slow flow or thrombosis appears intermediate to high signal; periportal edema is hyperintense.
STIR: Suppresses fat, highlights periportal edema or inflammation.
T1 Post-Gadolinium (Dynamic Contrast MRI – Triple Phase):

  1. Arterial Phase (20–30 sec): Portal vein may be partially opacified; hepatic artery differentiation from portal system.

  2. Portal Venous Phase (60–70 sec): Portal vein enhances brightly and homogeneously; optimal phase for thrombosis, tumor thrombus, and branching.

  3. Delayed Phase (3–5 min): Enhancement washes out; persistent filling defects indicate thrombus, cavernoma, or tumor extension.
    MRA: Contrast-enhanced MR angiography shows origin, branching, and anomalies. Useful for pre-transplant evaluation, TIPS planning, and portal hypertension.

CT Appearance
CT Triple-Phase (Liver Protocol):

  1. Arterial Phase (20–30 sec): Portal vein partially filled; useful for distinguishing arterial versus venous tumor supply.

  2. Portal Venous Phase (60–70 sec): Portal vein fully opacified; best for detecting thrombosis, stenosis, and mapping intrahepatic branches.

  3. Delayed Phase (3–5 min): Persistent non-opacified regions distinguish bland thrombus from tumor thrombus; essential in HCC staging and cirrhosis.
    CT Post-Contrast (Portal Venography): Shows portal vein origin, confluence, branches, and variants. Multiplanar/3D reconstructions provide excellent mapping for surgery, TIPS, or transplantation.

CT images

Hepatic portal vein anatomy CT axial image -img-00000-00000

CT images

Hepatic portal vein MRI AXIAL IMAGE 1

CT images

Hepatic portal vein MRI AXIAL IMAGE

MRI images

Hepatic portal vein anatomy MRI axial image -img-00000-00000

MRI images

Hepatic portal vein anatomy MRI CORONAL image -img-00000-00000

CT image

Hepatic portal vein CORONAL CT IMAGE

MRI images

Hepatic portal vein CT axial image-img-00000-00000