Year: 2026
Type: preprint
Study design: Observational Study
Abstract: Purpose Portal hypertension, a major complication of chronic liver disease, leads to significant morbidity and mortality. While portal vein diameter measured on imaging has long been proposed as a non-invasive marker of portal hypertension, normative CT-based reference values and population-level associations remain incompletely characterized. Here, we aim to define contemporary reference values for portal vein diameter on clinically obtained CT and evaluate its associations with demographic, clinical, and imaging factors, as well as its diagnostic performance for portal hypertension. Methods We conducted a retrospective analysis of 20,225 clinically obtained CT scans at a single academic medical center. The main portal vein was automatically segmented using Total Segmentator, and maximum diameter extracted using the Vascular Modeling Toolkit. Associations with demographic and imaging factors were evaluated using linear mixed-effects models; prevalent liver disease and portal hypertension using logistic regression; risk of incident ascites and esophageal varices among participants with liver disease using Cox regression; and invasive hepatic venous pressures using correlation analysis and linear regression. Results The mean portal vein diameter was 12.4 mm (95% CI, 12.37–12.45). Larger diameter was independently associated with male sex (+1.4 mm), higher BMI (+0.11 mm/kg/m 2 ), greater height (+0.04 mm/cm), and older age (+0.05 mm/10 years) (all p < 0.001), and was substantially larger on contrast-enhanced abdomen/pelvis CT (+2.4 mm, p < 0.001). Each 1-mm increase in portal vein diameter was associated with higher odds of prevalent liver disease (OR 1.06; 95% CI, 1.04–1.08) and portal hypertension (OR 1.18; 95% CI, 1.12–1.28). Among individuals with liver disease, greater diameter predicted higher risk of incident esophageal varices (baseline diameter HR 1.50; 95% CI, 1.14–2.08) and ascites (HR per mm increase in diameter 1.06; 95% CI, 1.003–1.12). However, portal vein diameter demonstrated weak to no association with invasively measured hepatic venous pressures. Conclusion In this large, EHR-linked imaging cohort, the mean portal vein diameter on CT was 12.4 mm and varied with demographic and imaging factors. Larger diameter was associated with liver disease, portal hypertension, and subsequent development of varices and ascites, supporting use of portal vein diameter as a pragmatic screening or enrichment tool within multimodal clinical frameworks. Key Results Mean portal vein diameter on routine clinical CT was 12.4 mm (95% CI, 12.37–12.45) and varied with sex, height, BMI, exam type, contrast use, and clinical setting. Each 1-mm increase in portal vein diameter was associated with higher odds of prevalent liver disease (OR 1.06) and portal hypertension (OR 1.18). Among individuals with liver disease, larger portal vein diameter predicted higher risk of incident esophageal varices and ascites, independent of demographic and imaging factors.
Source: medRxiv
Institutions: University of Pennsylvania, Philadelphia VA Medical Center
Language: English
Subfield: Hepatology
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funders: U.S. Department of Defense, University of Pennsylvania, Georgia Clinical and Translational Science Alliance, University of Pennsylvania Health System, National Institutes of Health, Perelman School of Medicine, University of Pennsylvania, National Center for Advancing Translational Sciences
Awards: G6104092673, G9000025887, Non-invasive imaging of reactive oxygen species in reperfusion injury myocardial infarction, Institutional Clinical and Translational Science Award, LONGITUDINAL ASSOCIATION OF POST-INFARCT LIPOMATOUS METAPLASIA AND MALIGNANT ARRHYTHMIA, Research Track Radiology Residency, Multimodality and Longitudinal Artificial Intelligence for Diagnosis and Prognosis in Hepatic Steatosis, Ethical Multimodal AI Development for Obesity, Diabetes and Digestive Disease
OpenAlex ID: W7128920034