Portal hypertension of diverse origins: special features of hepatic haemodynamics based on perfusion computed tomography assessment.

Purpose: The objective of this study is to analyse the characteristics of hepatic haemodynamics disturbances identified through perfusion computed tomography (PCT) in patients with portal hypertension of various aetiologies. Material and methods: The study included 110 individuals aged 18 to 67 years, divided into 4 groups based on the degree of portal circulation impairment: 63 patients with intrahepatic postsinusoidal occlusion associated with liver cirrhosis; 10 patients with intrahepatic presinusoidal occlusion associated with liver fibrosis (LF); 13 patients with intrahepatic occlusion in extrahepatic portal hypertension (EPH); and a control group of 24 healthy volunteers. The average age of the participants was 38.6 ± 1.1 years. Results: PCT of the liver is a valuable diagnostic tool for assessing the arterial fraction (AF), portal fraction (PF), and portal index (PI), providing insights into haemodynamic changes in portal hypertension. In presinusoidal obstruction (as in LF), the PF increases, while in cirrhosis with post-sinusoidal obstruction, it decreases with a compensatory rise in arterial perfusion and PI. The most significant changes occur in infrahepatic obstruction, marked by reduced or absent portal flow and a sharply elevated PI. Conclusions: In LF, preserved PF with slight AF and moderate PI increases suggests early vascular remodeling with limited arterial compensation. Cirrhosis showed reduced PF and elevated AF and PI, reflecting increased sinusoidal resistance. In EPH, PF was markedly decreased with pronounced AF and PI elevations, indicating strong arterial compensation. In congenital cavernous transformation, AF exceeded cirrhotic levels, pointing to early and dominant arterial substitution.