A systematic review and meta-analysis of portal vein morphometry in pediatric and adult populations: Drawing the line between normal and abnormal findings

Abstract

PurposeThe morphometry of the hepatic portal vein is of clinical importance, particularly in pre-operative assessments, surgical management, and diagnoses of liver conditions. This systematic review and meta-analysis aimed to characterize the morphometry of the normal portal vein in both pediatric and adult patients. MethodsThe study, conducted using the PRISMA guidelines and registered with PROSPERO, utilized the MEDLINE, EMBASE, SCOPUS and Web of Science databases up to May 2020, and updated to May 2023. All studies reporting extractable data on diameter, length, and cross-sectional area (CSA) of the main, left, and right portal veins (PV, LPV, RPV, respectively) were included. The AQUA Tool was used to assess the quality of the included studies. Data analysis included subgroup analyses based on geographical location, sex, age, and imaging modality. ResultsA total of 122 studies with 11,637 subjects were eligible for inclusion. Overall, the pooled mean diameter of the PV (PVD) was 10.09 mm (95% CI: 9.56–10.62). Significant differences in diameter were found between pediatric (6.60 mm; 95% CI: 5.38–7.82) and adult (10.72 mm; 95% CI: 10.25–11.19) subjects. Additionally, there was a significantly larger PVD measurement from computed tomography (CT) than other imaging modalities: CT, 13.28 mm (95% CI: 11.71–14.84); magnetic resonance imaging (MRI), 10.50 mm (95% CI: 9.35–11.66) and ultrasound (US), 9.81 mm (95% CI: 9.47–10.16). The mean diameters of the LPV and RPV were 8.27 mm (95% CI: 6.78–9.77) and 8.33 mm (95% CI: 6.70–9.95), respectively. Mean PV length in adults is 48.63 mm (95% CI: 35.63–61.64). Mean CSA of the PV was 1.09 cm2. ConclusionsThe study obtained aim to improve the understanding of portal vein anatomy, especially with relevance to surgical interventions of the liver in both pediatric and adult patients. Measurements from ultrasound imaging closely approximates the generated pooled PVD mean for pediatric and adult patients. CT imaging, however, significantly exceeded the established 13 mm threshold for adults. For pediatric patients, a threshold of 8 mm is proposed as a diagnostic upper limit for a normal PVD. Although not significant, the PVD decreased from the portal confluence towards its bifurcation.