From the Department of Imaging, Dana Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.H.T.); Department of Radiology, University of Texas Health Sciences Center at San Antonio, San Antonio, Tex (A.K.P.S.); Department of Radiology, University of Texas M.D. Anderson Cancer Center, Houston, Tex (R.V., S.R.P.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.O.M.).
Radiographics. 2014 Jan-Feb;34(1):73-92. doi: 10.1148/rg.341125190.
A wide array of pathologic conditions can arise within the porta hepatis, which encompasses the portal triad (the main portal vein, common hepatic artery, and common bile ducts), lymphatics, nerves, and connective tissue. Major vascular diseases of the portal triad include thrombosis, stenosis, and aneurysm. Portal vein thrombosis can complicate liver cirrhosis and hepatocellular carcinoma and has important therapeutic implications. Hepatic artery thrombosis and stenosis require immediate attention to reduce graft loss in liver transplant recipients. Congenital (eg, choledochal cyst) and acquired (benign and malignant) diseases of the biliary system can manifest as mass lesions in the porta hepatis. Lymphadenopathy can arise from neoplastic and nonneoplastic entities. Uncommon causes of mass lesions arise from nerves (eg, neurofibroma, neurofibrosarcoma) and connective tissue (sarcomas) and are rare. The hepatoduodenal ligament is a peritoneal reflection at the porta hepatis and is an important route for the spread of pancreatic and gastrointestinal cancers. Imaging plays a major role in diagnosis and enables appropriate management. Ultrasonography accurately demonstrates anatomic variations and pathologic conditions and is the initial modality of choice for detection of vascular and biliary lesions. Multidetector computed tomography and magnetic resonance imaging allow characterization and differentiation of various masses in the porta hepatis. Imaging-guided interventions, including embolization and stent placement, also play a key role in disease management.
广泛的病理状况可能发生在肝门，包括门三联（主门静脉、肝总动脉和胆总管）、淋巴管、神经和结缔组织。门三联的主要血管疾病包括血栓形成、狭窄和动脉瘤。门静脉血栓形成可使肝硬化和肝细胞癌复杂化，并具有重要的治疗意义。肝动脉血栓形成和狭窄需要立即关注，以减少肝移植受者的移植物丢失。先天性（例如，胆总管囊肿）和获得性（良性和恶性）胆道系统疾病可表现为肝门处的肿块病变。淋巴结病可由肿瘤和非肿瘤实体引起。神经（例如，神经纤维瘤、神经纤维肉瘤）和结缔组织（肉瘤）引起的罕见肿块的原因很少见。肝十二指肠韧带是肝门处的腹膜反射，是胰腺和胃肠道癌症扩散的重要途径。影像学在诊断中起着重要作用，并能进行适当的管理。超声准确地显示解剖变异和病理状况，是检测血管和胆道病变的首选初始方式。多排 CT 和磁共振成像允许对肝门内的各种肿块进行特征描述和区分。影像学引导的介入治疗，包括栓塞和支架置入，也在疾病管理中发挥着关键作用。
