Contrast-enhanced ultrasonography and spiral computed tomography in the detection and characterization of portal vein thrombosis complicating hepatocellular carcinoma

Abstract

The aim was to compare the performances of contrast-enhanced (CE) ultrasonography (US) and spiral computed tomography (CT) in the detection and characterization of portal vein thrombosis complicating hepatocellular carcinoma (HCC). We studied 50 patients with HCC who had biopsy-proven portal vein thrombi that had been detected with US and color Doppler US. Thirteen of the thrombi involved the main portal trunk and 37 the segmental branches. CEUS and CT were performed within a week of thrombus biopsies. For each imaging technique, diagnoses of thrombosis (present/absent) and thrombus nature (malignancy/benignancy) were made by experienced readers under blinded conditions and compared with pathological findings to determine accuracy rates for thrombus detection and characterization. Forty-four of the 50 thrombi were pathologically diagnosed as malignant and the remaining six were benign. CEUS detected 50/50 (100%) thrombi and correctly characterized 49/50 (98%). CT detected 34/50 (68%) thrombi and correctly characterized 23 of these 34 (68%). CEUS outperformed CT in terms of both thrombus detection (P < 0.0001) and characterization (P = 0.0001). CEUS appears to be significantly superior to CT for detection and characterization of portal vein thrombosis complicating HCC, and it should be considered in the staging of these tumors.

Portal vein thrombosis in liver cirrhosis – the added value of contrast enhanced ultrasonography.

“…Macrovascular invasion such as PVT in HCC is a contraindication for curative treatments. Helical CT was less sensitive than CEUS for the characterization of PVT (98 vs. 67.6%) in the Rossi et al study [29], but CT and MRI also provide information regarding the thrombus extension, such as SMV involvement. Also CT and MRI offer a simultaneous diagnosis of PVT and its possible underlying cause such as HCC.…”

Portal Vein Thrombosis

“…183 In a study CEUS detected tumor invasion in 100% and correctly characterized it in 98% of patients, while CT detected tumor invasion in 68% and correctly characterized it in 68% of them, CEUS may thus be helpful in staging HCC. 184 Patients with small HCC and PV obstruction can be safely treated with RFA. 185 Similarly Yttrium À90 glass microspheres (Theraspheres) appear to be safe and well tolerated in patients with portal vein obstruction without cavernous transformation.…”

The role of dynamic and diffusion weighted magnetic resonance imaging in differentiating malignant and benign portal vein thrombosis

“…The sensitivity of CEUS is higher than MDCT (67%). The sensitivity of CEUS is reported particularly increased in non-occlusive PVT cases (14,15). However, it is quite expensive to use in routine diagnosis.…”