Published online May 7, 2026. doi: 10.3748/wjg.v32.i17.117479
Revised: January 7, 2026
Accepted: February 6, 2026
Published online: May 7, 2026
Processing time: 137 Days and 2.1 Hours
Complete portal vein thrombosis (PVT) is a severe form of PVT that carries a high risk of portal hypertension-related complications and poses major therapeutic challenges. Although contrast-enhanced computed tomography (CT) is widely used for diagnosis and treatment planning, current classifications in both international and domestic practice are largely time-based (acute vs chronic). However, clinical onset frequently fails to align with true histopathological maturity, parti
To analyze the radiological signs on contrast-enhanced CT images of the livers of patients with complete PVT, propose a new classification scheme, and establish the clinical significance of the scheme.
We retrospectively analyzed 171 patients who were diagnosed with complete PVT treated at one of three Beijing centers from January 2018 to December 2023. Among patients without contraindications to anticoagulation who underwent interventional or surgical treatment combined with or followed by anticoagulation therapy, thrombus samples were obtained from 102 cases for pathological examination. Treatment outcomes were compared among groups based on the newly proposed imaging feature-based thrombus classifications.
Acute PVT (26.9%) was characterized by very low-density thrombus shadows in the blood vessel with uniform density, absent or minimal collateral blood vessel formation and no vascular wall thickening. Chronic PVT accounted for 34.5% of the patients, characterized by somewhat low-density thrombus shadows in the blood vessel, potentially with uneven density, increased collateral blood vessel formation, and thickening of the blood vessel wall. Cavernous transformation, which was observed in 12.9% of patients, involved the complete replacement of normal vascular anatomy with collateral vessels, whereas mixed PVT (25.7%) displayed heterogeneous features. Pathological examination revealed that different compositions correlated with distinct thrombus types. The posttreatment portal pressure gradient significantly decreased across all groups (P < 0.001), indicating favorable therapeutic efficacy.
Complete PVT has distinct properties and imaging manifestations. The proposed new thrombosis classification includes four types with distinct properties. Thrombosis with acute or chronic properties can be treated locally or with thrombolysis with good results.
Core Tip: This study aimed to analyze contrast-enhanced computed tomography imaging features of complete portal vein thrombosis and establish a novel imaging-based classification system with clinical relevance. In a retrospective multicenter analysis of 171 patients, thrombus samples from 102 cases were examined pathologically. Four distinct thrombus types were identified: Acute (26.9%), chronic (34.5%), cavernous transformation (12.9%), and mixed (25.7%), each characterized by specific radiological and pathological profiles. Treatment resulted in a significant reduction in portal pressure gradient across all groups (P < 0.001), supporting the clinical utility of the proposed classification in guiding therapeutic strategy.