ANATOMICAL VARIATIONS OF THE PORTAL VENOUS SYSTEM AND THEIR ASSOCIATION WITH FIBROSIS SEVERITY IN PATIENTS WITH METABOLIC DYSFUNCTION-ASSOCIATED STEATOTIC LIVER DISEASE

Abstract

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a leading cause of chronic liver disease, and the level of fibrosis is a significant factor in the liver's outcome. The portal venous system varies in its anatomy, and there is limited understanding of the relationship between portal venous system anatomy and fibrosis in MASLD. Objective: To determine the frequency of portal venous anatomical variations and assess their association with fibrosis severity in patients with MASLD. Methods: This was an analytical cross-sectional study of 107 adults who received a diagnosis of MASLD at Prime Teaching Hospital from September 2025 to February 2026. Contrast-enhanced abdominal imaging was used to assess portal venous anatomy, and non-invasive fibrosis assessment was used to determine the severity of fibrosis. Data were examined by appropriate parametric and non-parametric tests, chi-square/Fisher's exact tests, and logistic regression. Results: In 22 (20.6%) patients, portal vein anatomical variations were found, the most frequent of which was portal vein trifurcation (8.4%). Clinically significant fibrosis (F2-F4) was present in 61 (57.0%) patients. There was a higher prevalence of anatomical variations in F2-F4 compared to F0-F1 fibrosis (26.2% vs. 13.0%), but the difference was not statistically significant (p=0.082). Patients with anatomical variations had higher liver stiffness (p=0.041). Diabetes was an independent predictor of clinically significant fibrosis (p=0.032). Conclusions: Portal venous variations were present in a significant proportion of subjects with MASLD and were linked to increased liver stiffness, but did not appear to be independently associated with clinically significant fibrosis.