Portal Vein Flow Research Articles

Importance of Hepatic Flows in Liver Transplantation

Establishing appropriate dual blood supply in liver transplant is important to ensure optimal graft survival and post-operative outcomes. The hemodynamic changes in cirrhotic patients render the patients with hyperdynamic circulation and this environment raises the portal venous flow through the graft immediately after transplant. In deceased donor liver transplantation, lower hepatic flows are associated with detrimental outcomes. Lower measured hepatic artery flow has been associated with lower graft survival and higher rate of arterial complications. Lower portal venous flow of less than 1-1.3 L/min has been associated with lower graft survival. Lower hepatic artery flow is associated with increased rate of biliary complications after deceased donor transplantation. In live donor liver transplantation, portal hyperperfusion is implicated in small for size syndrome. Maneuvers to decrease portal venous flow such as splenic artery ligation, splenectomy or portacaval shunt have been associated with improved outcomes after live donor liver transplantation. It appears that relationship between higher portal flows and poor outcomes is not yet firmly established in that the live donor liver graft may tolerate higher PV flows when the outflow of the graft is well established and if the higher PV flow is not accompanied by portal hypertension. The importance of blood flow in liver transplantation is undeniable. Further studies are required to establish the relationship between the portal and hepatic arterial flows to biliary and arterial complications after liver transplantation.

Effects of selective double portazygous disconnection and devascularization on hemodynamics of the portal venous system

Aim: Selective double portazygous disconnection with preserving vagus (SDPDPV) is currently used for the therapy of portal hypertension. Doppler ultrasonography (DU) has been proposed for non-invasive evaluation of splanchnic hemodynamics, but the effect of SDPDPV on portal vein (PV) hemodynamics has not been analyzed with DU. This was the aim of the study. Material and methods: Two hundred and thirty six patients with cirrhotic portal hypertension who underwent either SDPDPV or pericardial devascularization with splenectomy (PDS) for variceal bleeding were enrolled. The hemodynamics parameter, operation-relevant information, change of lavatory examination data, postoperative complications, and clinical outcomes were analyzed. Results: The free portal pressure (FPP) in the SDPDPV group was significantly lower than the PDS group after operation (p<0.05). Velocities and blood flow of PV after SDPDPV decreased; however, when the hepatic artery (HA) and superior mesenteric vein (SMV) increased, the differences were significant (p<0.05). The correlation between the decreased FPP and changed blood flow of portal vein(PVF), hepatic artery (HAF) or superior mesenteric vein (SMVF) was significant (p<0.05) after SDPDPV. The difference between pre and postoperative values of portal congestion index (CI) in SDPDPV was significant (p<0.05). Occurrences or development of postoperative rebleeding showed a great difference between the two groups (p< 0.05). PVF and SMVF were significant independent indicators of postoperative rebleeding (p< 0.05). Conclusions: Compared with the PDS, the SDPDPV apparently decreased the blood velocity and blood flow of PV, and increased that of HA and SMV which has a beneficial effect on hepatic function and encourages the controlof the recurrent bleeding from varices. PVF and SMVF may be value indicators in predicting postoperative rebleeding.

Hepatic Hemodynamic Changes Following Stepwise Liver Resection

AimExtended liver resection has increased during the last decades. However, hepatic hemodynamic changes after resection and the consequent complications like post hepatectomy liver failure are still a challenging issue. The aim of this study was to systematically evaluate the role of stepwise liver resection on hepatic hemodynamic changes. MethodsTo evaluate this effect we performed 25, 50, and 75 % sequential liver resections in 10 pigs. Before and after each resection, the hepatic artery flow and portal vein flow in relation to the remnant liver volume (RLV) as well as hepatic vascular pressures were measured and compared between the groups. ResultsFollowing sequential liver resection, the hepatic artery flow /100 g decreases and the portal vein flow increases up to 17 and 167 % following extended liver resection (75 %), respectively. Also, during stepwise liver resection, the portal vein pressure increases gradually up to 33 % following extended hepatectomy (75 %). ConclusionSequential decrease in the RLV decreases the hepatic artery flow /100 g and increases the portal vein flow /100 g and portal vein pressure. As the consequence, the liver goes under more poor-oxygenated blood supply and higher pressure. This may be one of the most important mechanisms of the post hepatectomy liver failure in case of extended liver resection.

Small for Size and Flow (SFSF) syndrome: An alternative description for posthepatectomy liver failure

Small for Size Syndrome (SFSS) syndrome is a recognizable clinical syndrome occurring in the presence of a reduced mass of liver, which is insufficient to maintain normal liver function. A definition has yet to be fully clarified, but it is a common clinical syndrome following partial liver transplantation and extended hepatectomy, which is characterized by postoperative liver dysfunction with prolonged cholestasis and coagulopathy, portal hypertension, and ascites. So far, this syndrome has been discussed with focus on the remnant size of the liver after partial liver transplantation or extended hepatectomy. However, the current viewpoints believe that the excessive flow of portal vein for the volume of the liver parenchyma leads to over-pressure, sinusoidal endothelial damages and haemorrhage. The new hypothesis declares that in both extended hepatectomy and partial liver transplantation, progression of Small for Size Syndrome is not determined only by the "size" of the liver graft or remnant, but by the hemodynamic parameters of the hepatic circulation, especially portal vein flow. Therefore, we suggest the term "Small for Size and Flow (SFSF)" for this syndrome. We believe that it is important for liver surgeons to know the pathogenesis and manifestation of this syndrome to react early enough preventing non-reversible tissue damages.

Hepatic Arterial Buffer Response Maintains the Homeostasis of Graft Hemodynamics in Patient Receiving Living Donor Liver Transplantation.

In living donor liver transplantation (LDLT), the hepatic hemodynamics plays important roles in graft regeneration, and the hepatic blood inflows are associated with graft size. However, the data of interplay between the hepatic arterial buffer response (HABR) and graft-to-recipient weight ratio (GRWR) in clinical LDLT are lacking. To identify the effect of the HABR on the hepatic hemodynamics and recovery of graft function and to evaluate the safe lower limit of the GRWR in carefully selected recipients. Portal venous and hepatic arterial blood flow was measured in recipients with ultrasonography, and the graft functional recovery, various complications, and survive states after LDLT were compared. In total, 246 consecutive patients underwent LDLT with right lobe grafts. In total, 26 had a GRWR < 0.7 % (A), 29 had a GRWR between 0.7 and 0.8 % (B), and 181 had a GRWR > 0.8 % (C). For small-for-size syndrome, there was no significant difference (P = 0.176). Graft survival rates at 1, 3, and 5 year were not different (P = 0.710). The portal vein flow and portal vein flow per 100 g graft weight peaks were significantly higher in the A. Hepatic arterial velocity and hepatic arterial flow decreased in all the three groups on postoperative day 1; however, the hepatic arterial flow per 100 g graft weight was close to healthy controls. HABR played important roles not only in the homeostasis of hepatic afferent blood supply but also in maintaining enough hepatic perfusion to the graft.

The Correlation of Hepatic and Systemic Hemodynamics During Liver Transplantation: Quantification of Hepatic Resistance as an Actual Value.

The correlation between portal vein pressure (PVP) and flow (PVF) has not been established, and there is still lack of consensus about the optimal hemodynamics during liver transplantation (LT). We aimed to establish the correlation between systemic and hepatic hemodynamics during LT by applying the hepatokinetic power hypothesis, based on the law of energy conservation and hydrodynamics.A total of 103 adult liver transplant recipients were enrolled in this study from September 2012 to December 2014. Systemic and hepatic hemodynamics were assessed intraoperatively to calculate the hepatokinetic power status. Severe surgical complications (Clavien-Dindo grade ≥III) were recorded as the main outcome measure, and potential covariates were evaluated including recipient, donor, donor-recipient match, surgery-related factors, conventional hemodynamics, and the intraoperative hepatokinetic power profile.In multivariate analysis, hepatokinetic power gradient >4260 mL mmHg min100 g graft weight (P = 0.001), 2.2 < ratio of hepatokinetic power from the portal vein to the hepatic artery ≤8.7 (P = 0.012), and hepatic resistance of partial grafts ≤0.006 or >0.015 min mmHg mL (P = 0.012) were associated with a higher risk. None of the conventional hemodynamic parameters, such as PVP, PVF, and hepatic venous pressure gradient, entered into this regression model (c-statistic = 0.916) when competing with hepatokinetic power indexes.The hepatokinetic power hypothesis clarifies the correlation of systemic and hepatic hemodynamics in a simple, rational manner. The hepatic resistance, derived from the hepatokinetic power equation, can be quantified and has an effect on the incidence of severe surgical complications. This finding offers a new objective clinical approach to evaluate graft quality during transplantation.

Doppler flowmetry of the superior mesenteric artery and portal vein: impact for the early prediction of necrotizing enterocolitis in neonates.

Necrotizing enterocolitis (NEC) is a serious gastrointestinal disorder in newborns. Early diagnosis and rapid treatment is essential for seeking good outcome for neonates. The aim of our study was to evaluate intestinal blood flow in superior mesenteric artery (SMA) and portal vein (PV) in neonates with suspected or confirmed NEC and investigate the prognostic cut-off values to develop NEC. Doppler flowmetry of SMA and PV was performed for 62 newborns. Resistive (RI) and pulsatility (PI) indexes were measured in SMA as well as Volumetric blood flow (Vflow) in PV. ROC curves were applied to estimate sensitivity and specificity and to identify cut-off values. There were 93.5% preterm neonates. 29 patients (46.8%) were diagnosed with NEC and 33 (53.2%) formed a control group. 96.3% NEC patients had RI >0.75 with sensitivity of 96.3% and specificity of 90.9% (OR 260). 88.9% NEC patients had PI >1.85 with sensitivity of 88.9% and specificity of 78.8% (OR 29). Portal Vflow lower than 37 ml/min was present in 89.7% patients with NEC (OR 11.7). Intestinal blood flow Dopplerography can be a useful tool for diagnosing and predicting NEC.

Preserving low perfusion during surgical liver blood inflow control prevents hepatic microcirculatory dysfunction and irreversible hepatocyte injury in rats.

Hepatic ischaemia/reperfusion (I/R) injury is of primary concern during liver surgery. We propose a new approach for preserving low liver blood perfusion during hepatectomy either by occlusion of the portal vein (OPV) while preserving hepatic artery flow or occlusion of the hepatic artery while limiting portal vein (LPV) flow to reduce I/R injury. The effects of this approach on liver I/R injury were investigated. Rats were randomly assigned into 4 groups: sham operation, occlusion of the portal triad (OPT), OPV and LPV. The 7-day survival rate was significantly improved in the OPV and LPV groups compared with the OPT group. Microcirculatory liver blood flow recovered rapidly after reperfusion in the OPV and LPV groups but decreased further in the OPT group. The OPV and LPV groups also showed much lower ALT and AST levels, Suzuki scores, inflammatory gene expression levels, and parenchymal necrosis compared with the OPT group. An imbalance between the expression of vasoconstriction and vasodilation genes was observed in the OPT group but not in the OPV or LPV group. Therefore, preserving low liver blood perfusion by either the OPV or LPV methods during liver surgery is very effective for preventing hepatic microcirculatory dysfunction and hepatocyte injury.

The Role of MHC Class II in Interferon Gamma-Activated Mesenchymal Stem Cell-Macrophage Crosstalk

Khatibi, Katherine G.; Szilagyi, Erzsebet MD, PhD; Patil, Rachana; Choi, Kevin; Bartholomew, Amelia M. MD, FACS Author Information

Significance of Measured Intraoperative Portal Vein Flows after Thrombendvenectomy in Deceased Donor Liver Transplant Recipients with Portal Vein Thrombosis

Significance of Measured Intraoperative Portal Vein Flows after Thrombendvenectomy in Deceased Donor Liver Transplant Recipients with Portal Vein Thrombosis

Assessment of splanchnic hemodynamics in patients with cirrhosis after portocaval shunting in comparison with no-operated patients with the compensated and decompensated course of disease

Portocaval shunting is recommended for decrease of the portal pressure and regression of the varicose veins in patients with cirrhosis. But the shunting surgery at cirrhosis is limited by the high risk of development of hepatic encephalopathy and the hepatocellular insufficiency in post-surgical period. And the disorder of the hepatic and splanchnic hemodynamics that inevitably appears at different dates after surgery is considered as the main cause of these states.Aim of research. To assess an influence of the shunting surgical interventions on the character of changes of splanchnic hemodynamics in patients with cirrhosis in comparison with no-operated patients with compensated and decompensated course of disease.Material and methods. 190 patients with cirrhosis were examined: 133 had gastrointestinal bleeding, 57 – diuretic-resistant ascites. 18 patients underwent surgery – portocaval shunting. 84 patients died during observation (10 after surgery). The duration of observation was from 2-3 weeks to 2,5-3 years.All patients underwent the repeated ultrasound examination of abdominal cavity. There were defined the diameter of hepatic and splenic vessels; quantitative and qualitative characteristics of the blood flow in hepatic and splenic arteries, in portal and splenic veins. Results of research. At assessment of splanchnic hemodynamics we noticed the differences of parameters depending on time that passed after surgery. The changes of portal blood flow in first 3-6 month were characterized by the moderate widening of portal and splenic veins at little decrease of its mean linear and volume speed so an inflow of the portal blood still stable. Arterial blood flow in hepatic artery was forced at the expense of both widening of diameter and increase of the mean speed of blood flow. The splenic arterial blood flow practically was not changed. The reliable decrease of the volume blood flow in portal vein at the expense of decrease of its linear speed was observed in all patients at later dates. An unfavorable sign was an increase of an index of haemostasia in portal vein and of splenic and hepatic portal index in dynamics that took place in all operated patients and in no-operated ones at the stage of decompensation.Conclusions. The character of changes of splanchnic hemodynamics after portocaval shunting is analogous to the one in no-operated patients at transition from the compensated course of cirrhosis to decompensated one. The compensatory mechanism that preserves the volume of the portal inflow to liver is the widening of the portal vein and preservation of the splenic blood flow. The quality of life in post-surgical period is determined by the duration of compensation of hemodynamic disorders

Preoperative hepatic hemodynamics in the prediction of early portal vein thrombosis after liver transplantation in pediatric patients with biliary atresia

Portal vein thrombosis (PVT) is one of the main vascular complications after liver transplantation (LT), especially in pediatric patients with biliary atresia (BA). This study aimed to assess the preoperative hepatic hemodynamics in pediatric patients with BA using Doppler ultrasound and determine whether ultrasonographic parameters may predict early PVT after LT. One hundred and twenty-eight pediatric patients with BA younger than 3 years of age underwent Doppler ultrasound within seven days before LT, between October 2006 and June 2013. The preoperative hepatic hemodynamic parameters were then compared between patients with early PVT (within 1 month following LT) and those without PVT. Receiver operating characteristic analysis was performed to determine the optimal cutoff value for predicting early PVT. Of the 128 transplant recipients, 41 (32.03%) had a hypoplastic portal vein (PV), 52 (40.63%) had hepatofugal PV flow and 40 (31.25%) had a high hepatic artery resistance index (HARI) of ≥1. Nine cases (7.03%) experienced early PVT. A PV diameter ≤4 mm (sensitivity 88.89%, specificity 72.27%), and a hepatofugal PV flow (sensitivity 77.78%, specificity 62.18%) with a high HARI ≥1 (sensitivity 77.78%, specificity 72.27%) were hepatic hemodynamic risk factors for early PVT. Hepatic hemodynamic disturbances in pediatric recipients with BA were more common. Small PV diameter (≤4 mm) and hepatofugal PV flow combined with high HARI (≥1) are strong warning signs of early PVT after LT in pediatric patients with BA. Intense monitoring of vascular patency and prophylactic thrombolytic therapy should be considered in pediatric patients undergoing LT for BA.

Optimal Management of Portal Vein Thrombosis in Patients with Liver Cirrhosis: a Review

Portal vein thrombosis (PVT) is a fairly common complication of cirrhosis, especially in patients with advanced liver disease and reduced portal vein flow velocity. Prospective studies have shown that its occurrence parallels rather than causes the progression of liver disease and that spontaneous regression is a frequent finding. PVT occurrence is associated with an increased mortality after liver transplantation. Treatment options include anticoagulation and insertion of a transjugular intrahepatic portosystemic shunt. Anticoagulation with vitamin K antagonists or low-molecular-weight heparins achieves partial or complete portal vein recanalization in most patients. Anticoagulation does not seem to increase the bleeding risk when proper prophylaxis of variceal bleeding is applied. Monitoring of anticoagulation difficulties exist, inherent to the coagulopathy of chronic liver disease. Placement of a transjugular intrahepatic portosystemic shunt is an alternative in selected patients. Trials are underway to evaluate the potential benefit of PVT prophylaxis with low-molecular-weight heparins.

Assessment of splenic blood flow in patients with the compensated and decompensated course of cirrhosis

Splenomegaly, increased splenic blood flow are the specific characteristics of the natural course of cirrhosis. But an importance of these alienations is inadequately appreciated when choosing methods of correction the portal hypertensia syndrome.Aim of the study. To assess the splenic blood flow in patients with compensated and decompensated course of cirrhosis.Materials and methods.190 patients with cirrhosis were under surveillance: 123 had the gastrointestinal bleeding, 67 – the refractory ascites. 84 patients died during surveillance. The surveillance lasted from 2-3 weeks to 2,5 -3 years.All patients underwent reiterated ultrasound study of an abdominal cavity. The dimensions of spleen, diameter of hepatic and splenic vessels were assessed; the qualitative and quantitative characteristics of blood flow in hepatic and splenic arteries, portal and splenic veins were defined.Result of the study. All cirrhosis patients have the different degree of splenomegaly with increase of volumetric blood flow in splenic artery and vein in 1,3 and 3,2 times respectively. At the decompensation of disease on the background of decrease of the blood flow in portal vein, hepatic and splenic arteries, the blood flow in splenic vein practically didn’t change. The ratio between the volumetric blood flow in splenic vein and the portal one at decompensation of disease increased from 65,5±18,0 % to 99,1±27,0 %, while the norm is 43,2±15,0 % (р &lt; 0,01), that can be the one of prognostic indications of the complications development.Conclusions. The natural course of cirrhosis characterizes by increase of the splenic blood flow relative to the portal one when transition from the compensated state to the decompensated one, that can be one of the factors of increase of the portal pressure and hemodynamic causes of the complications development that must be taken into account choosing method of correction the syndrome of portal hypertensia

A central approach to splenorenal shunt in pediatric living donor liver transplantation

The management of LSRS is a crucial problem to ensure a sufficient PV flow during pediatric LT. Although several techniques have been indicated to solve this problem, a more appropriate approach to LSRS is still needed in pediatric LT. We herein present a modified surgical approach to the ligation of LSRS via the left side of the IVC for a nine-month-old boy with severe portal hypertension and a history of Kasai portoenterostomy. LSRS was identified and exposed through the left side of the IVC and the dorsal surface of the pancreas from the superior side of the body of the pancreas. The post-operative course was uneventful with an excellent PV flow. The central approach for the ligation of LSRS is worth considering as an alternative procedure for a patient with collateral vessels and a history of multiple laparotomies.

Non-invasive predictive model of esophageal varices in cirrhosis

To analyze the non-invasive indexes for predicting esophageal varices (EV) in liver cirrhosis, and to establish a model for predicting the degree of EV. A total of 294 patients with liver cirrhosis and portal hypertension were divided into the following groups according to EV grade as assessed by endoscopy: non-EV and grade I EV, grade II EV and grade III EV. The non-invasive EV predictive measures of liver stiffness (LS), platelet (PLT) count, spleen thickness (ST), PLT/ST ratio, portal vein diameter, portal vein flow velocity and Child-Pugh score (CPS) were assessed by univariate analysis and multivariate logistic regression analysis, and used to generate a predictive model. The t-test, chi-square test, logistic analysis and receiver operating characteristic (ROC) curve were used in statistical analyses. The area under the ROC for the new model was 0.990. The best cutoff value for the score was 0.898, as defined from the ROC. The sensitivity of the model was 96.5%, and the specificity was 99.2%. The model for predicting EV was composed of LS, PLT count, ST, PLT/ST and CPS, which was accurate and sensitive, and could be used to predict EV in clinic.

Optimal Central Venous Pressure During the Neohepatic Phase to Decrease Peak Portal Vein Flow Velocity for the Prevention of Portal Hyperperfusion in Patients Undergoing Living Donor Liver Transplantation

BackgroundThe association between intraoperative systemic hemodynamic status and preventing portal hyperperfusion, which induces shear stress on the sinusoidal endothelial cells of liver grafts, resulting in poor graft function in live-donor recipients, has not been identified. This study evaluates the effects of systemic hemodynamic parameters (SHPs) during the neohepatic phase on changes in hepatic hemodynamic parameters (HHPs) between the neohepatic phase and the 1st postoperative day. MethodsThirty-eight patients undergoing living donor liver transplantation (LDLT) were enrolled in this study. HHPs (flow velocities of portal vein and hepatic artery) were measured immediately after hepatic artery and bile duct reconstruction and on the first postoperative day. SHPs (mean arterial pressure, central venous pressure [CVP], cardiac index, stroke volume variation, stroke volume index, systemic vascular resistance index, and central venous oxygen saturation) were recorded and averaged for 5 minutes after the measurement of HHPs. The relationships between the SHPs and HHPs were assessed using linear or quadratic regression analysis. ResultsPeak portal vein flow velocity (PVV) decreased on the 1st postoperative day in 24 patients (63%). There was an inverted-U relationship between CVP and the percentage change in PVV (R2 = 0.241, P = .008). According to the quadratic regression model, the PVV maximally decreased at a CVP of 7.8 mm Hg. No significant correlations were found between the other SHPs and HHPs. ConclusionsMaintaining CVP (approximately 8 mm Hg) during the neohepatic phase was clinically beneficial in decreasing PVV to prevent portal hyperperfusion in the early postoperative period of LDLT.

De-novo portal vein thrombosis in liver cirrhosis: risk factors and correlation with the Model for End-stage Liver Disease scoring system.

Portal vein thrombosis (PVT) is a potential lethal complication in late liver cirrhosis. There is a lack of knowledge of the clinical features and risk factors of PVT. We aimed to investigate the clinical and radiological characteristics, and biochemical markers of cirrhotic patients to determine the high-risk individuals for PVT attending our center. Of 426 cirrhotic patients, only 120 consecutive patients were included. Clinical, biochemical, immunological, Model for End-stage Liver Disease (MELD) score, portal vein patency, and flow velocity were measured in all patients at baseline and every 6 months thereafter. Variables that could predict the development of PVT within 1 year were identified by multiple logistic regression. Only 95 patients completed the study; PVT was found in 17 (17.9%) patients. PVT was observed mainly in the portal trunk, superior mesenteric vein, and splenic vein. Univariate analysis showed that diabetes mellitus, lower levels of hemoglobin, platelet counts, and portal vein flow velocity as well as increased MELD scores, platelet indices, portal vein diameter, and splenic thickness were associated with PVT patients than in non-PVT patients (all P<0.01). The incidence of PVT was 17.9%. PVT occurred mainly in the portal vein trunk, superior mesenteric vein, and splenic vein. Diabetes mellitus, lower levels of hemoglobin, platelet count and portal vein flow velocity as well as increased MELD score, platelet indices, portal vein diameter, and splenic thickening were associated with PVT. Splenic thickening, marked reduced of mean portal flow velocity, and diabetes mellitus may be risk factors for PVT.

Severe Vascular Complications Due to Liver Hydatid Cyst Relapse: A Case Report and Review of the Literature

Vascular complications of liver hydatidosis are infrequent but severe. We present a case with severe vascular problems due to a recurrence of a liver hydatid cyst. A 39 year-old male consulted the Emergency Department after frank hematemesis due to esophagealvarices. He had undergone surgery at the age of seven in his native country for liver and lung hydatid cysts. Abdominal CT showed a 20 cm multivesicular cyst, occupying segments IV, V and VIII of the liver, displacing and partially compressing a dilated portal vein and causing portal hypertension and obstruction of the inferior cava vein. A subtotal cystectomy was performed. After surgery, portal vein flow was normal and esophagealvarices disappeared, but caval obstruction remained. We review the vascular complications due to liver hydatidosis, focusing on therapeutic management. performed a subtotal cystectomy and left a lar ge drain in the cyst cavity. Postoperatively, the patient presented low output biliary fistula that did not require any treatment. The microbiological study of the liquid of the cyst confirmed Echinococcusgranulosus infestation.

Liver computed tomographic perfusion in the assessment of microvascular invasion in patients with small hepatocellular carcinoma.

Detecting microvascular invasion (mVI) in patients with hepatocellular carcinoma is a diagnostic challenge. The present study aimed to acquire a series of quantitative perfusion parameters from liver computed tomography (CT) with a 320-slice scanner in patients with small hepatocellular carcinoma (sHCC) and study its efficacy in identifying mVI. Fifty-six patients who underwent hepatic resection for sHCC (≤3 cm) were preoperatively examined with a 320-detector row CT scanner. Histopathological analyses of liver biopsies confirmed that 18 patients had sHCC with mVI and that 38 patients had sHCC without mVI. Hepatic artery flow, portal vein flow (PVF), and perfusion index were measured in both tumor and normal liver tissues. Nonparametric receiver operating characteristic curve analysis was performed to quantify the accuracy of the perfusion CT parameters. The tumor PVF (PVFtumor), difference in PVF between tumor and liver tissue (ΔPVF), and the ΔPVF/liver PVF ratio (rPVF) were significantly higher in sHCC with mVI than in sHCC without mVI (P = 0.0094, P = 0.0018, and P = 0.0007, respectively; Wilcoxon signed rank test). The PVFtumor, ΔPVF, and rPVF correctly predicted mVI in 73.2% (sensitivity, 66.7%; specificity, 76.3%; cutoff, 103.8 mL per 100 mL/min), 76.8% (sensitivity, 66.7%; specificity, 81.6%; cutoff, -53.65 mL per 100 mL/min), and 83.9% (sensitivity, 77.8%; specificity, 86.8%; cutoff, -0.38) of a total of 56 patients with sHCC, respectively. Other parameters were not significantly different between the groups. Liver CT perfusion provides a noninvasive, quantitative method that can predict mVI in patients with sHCC through measurement of 3 perfusion parameters: PVFtumor, ΔPVF, and rPVF.