Background: Portal vein thrombosis (PVT) leads to portal hypertension (PH)
with its sequelae. Computed tomography spleno-mesenterico-portography (CT-SMPG)
combines sequential CT spleno-portography and CT mesenterico-portography. CT-SMPG
comprehensively illustrates the venous hemodynamic changes due to PH. Objective: To
assess the effects of PV confluence thrombosis (PVCT) and liver cirrhosis on venous blood
flow characteristics of patients with PVT. Method: CT-SMPG was performed in 21 patients
with chronic PVT. CT-SMPG was compared to standard contrast-enhanced CT (CECT) and
gastroscopy concerning the patency of splanchnic veins, varices and venous congestion.
Results: PVCT had a significant effect on perfusion patterns: in patients without PVCT,
esophageal varices (EV) and gastric varices were supplied by either the splenic vein (SV),
the superior mesenteric vein (SMV), or both. In patients with PVCT, EV and gastric
varices were mostly supplied by the SV (p = 0.021, p = 0.016). In patients without PVCT,
small bowel varices were fed by both systems or the SMV, while in patients with PVCT
they were fed by the SMV (p = 0.031). No statistically significant changes were detected
regarding gastropathy, colorectal varices and small bowel congestion. Liver cirrhosis had
no statistically relevant effect on hemodynamics. Conclusions: In CT-SMPG, patients with
PVCT showed different venous hemodynamics to patients without PVCT, and this can
serve as a basis for selecting therapy options.