Differentiation of Malignant Thrombus from Bland Thrombus of the Portal Vein in Patients with Hepatocellular Carcinoma: Application of Diffusion-weighted MR Imaging

Catalano, Onofrio A.; Choy, Garry; Hahn, Peter F.; Sahani, Dushyant V.

doi:10.1148/radiol.09090304

Cited by 185 publications

(126 citation statements)

References 41 publications

Supporting

Mentioning

110

Contrasting

Unclassified

Order By: Relevance

“…First, restricted diffusion (high signal intensity on diffusion weighted images and decreased ADC values) noted in the splenic and portal veins implied malignant tumor thrombi (6). Second, high signal intensity of tumor thrombus on T1 weighted image was helpful for narrowing the differential diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Metastatic Melanoma to the Pancreas Forming Portal Vein Tumor Thrombosis: A Case Report

Kim

Choi

et al. 2016

Iran J Radiol

View full text Add to dashboard Cite

Pancreatic metastasis of malignant melanoma is rare and porto-splenic tumor thrombus associated with malignant melanoma is even less frequent. We report a case of metastatic malignant melanoma involving the pancreas, portal vein, splenic vein and superior mesenteric vein. A 60-year-old man showed an elevated amylase level. He had a history of sigmoid colon adenocarcinoma and malignant melanoma. Computed tomography (CT) and magnetic resonance imaging (MRI) showed extensive thrombosis involving the intra-and extrahepatic portal veins extending into the superior/inferior mesenteric vein and splenic vein. On T1 weighted images, tumor thrombi demonstrated diffusely high signal intensity, which is a characteristic finding in malignant melanoma. Also, thrombus showed prominent diffusion restriction on diffusion weighted images and intense uptake of 18F-fluorodeoxyglucose (18F-FDG) on positron emission tomography (PET). Ultrasound-guided biopsy confirmed the metastatic, malignant melanoma involving the pancreas and the veins. We report an unusual manifestation of metastatic, malignant melanoma to the pancreas with extensive tumor thrombi. Specific MR features including high signal intensity on T1 weighted images and diffusion restriction on diffusion weighted images were helpful in reaching a conclusion.

show abstract

Section: Discussionmentioning

confidence: 99%

Metastatic Melanoma to the Pancreas Forming Portal Vein Tumor Thrombosis: A Case Report

Kim

Choi

et al. 2016

Iran J Radiol

View full text Add to dashboard Cite

show abstract

“…Visualization of PV hemodynamics with 4D flow MRI in a patient with suspected PV thrombosis shows not only a lack of flow in the PV, but also abnormal flow ways in other vessels (15,16). The tumor thrombus may also be differentiated from bland thrombus using diffusion-weighted imaging (DWI); ratio of apparent diffusion coefficient (ADC) of the thrombus to ADC of the primary tumor lower than 2 and similar signal intensity of the thrombus as the primary tumor suggest a tumor thrombus (17). Since DWI does not require contrast use, it can be particularly useful in patients with contraindications to contrast agent.…”

Section: Portal Vein Thrombosismentioning

confidence: 99%

Cross-sectional imaging of congenital and acquired abnormalities of the portal venous system

Ozbayrak

Tatlı²

2016

Diagn Interv Radiol

View full text Add to dashboard Cite

A wide range of congenital and acquired abnormalities may affect the portal venous system. They are sometimes encountered incidentally because of the widespread use of cross-sectional imaging modalities. Awareness of the presence of these abnormalities is important for adequate planning of surgical and percutaneous interventional procedures. The article reviews the normal anatomy, variations, and acquired pathologies involving the portal venous system as showed on computed tomography (CT) and magnetic resonance imaging (MRI). AnatomyThe portal venous system refers to the veins draining the gastrointestinal tract and spleen to the liver, excluding the inferior rectum and anal canal. The superior mesenteric vein (SMV) and splenic vein (SV) behind the neck of the pancreas form the main portal vein (PV) (Fig. 1). The inferior mesenteric vein (IMV) may drain into either the SV or into the confluence directly. The PV divides into the right and left PV. The right PV divides into anterior and posterior branches that supply the right liver lobe. The left PV courses horizontally and branches out to supply the lateral and medial segments of the left lobe (1,2). Congenital abnormalities Variations of the portal veinAnatomic variants of the branching pattern of the intrahepatic PV are present in approximately 20% of the population (1). The most common variant is trifurcation of the PV; the right PV does not exist and the PV divides into the right anterior, right posterior, and left branches (Fig. 2). Right anterior segmental branch arising from the left PV is another common variant (Fig. 3). Less common PV variations have been reported but their incidence has not been found to be higher than 2% (2). Awareness of these variants is crucial for planning surgery; for example, in a patient with right anterior segmental branch arising from the left PV, ligation of the left PV during left hepatectomy may lead to unexpected infarction of the anterior segment of the right liver lobe. Congenital agenesis of the portal veinCongenital agenesis of the PV is a rare malformation characterized by the absence of the PV and anomalous drainage of SMV and SV into the systemic circulation (Fig. 4). The PV is normally formed in 4-10 weeks of embryonic development via involution of the periintestinal vitelline venous loop. Atypical involution may cause a prebiliary, preduodenal, or duplicated PV, and excessive involution may result in the absence of the PV (3). Liver morphology is generally preserved. Congenital agenesis of the major branches of the PV is ABSTRACTKnowing the normal anatomy, variations, congenital and acquired pathologies of the portal venous system are important, especially when planning liver surgery and percutaneous interventional procedures. The portal venous system pathologies can be congenital such as agenesis of portal vein (PV) or can be involved by other hepatic disorders such as cirrhosis and malignancies. In this article, we present normal anatomy, variations, and acquired pathologies involving the portal venous system ...

show abstract

“…Portal vein involvement precludes most curative options [33] , but its diagnosis may be hampered by the presence of a non-neoplastic thrombus in a cirrhotic liver. Few and controversial papers have been published regarding the ability of DWI in distinguishing malignant from non-malignant thrombi: Catalano et al [34] reported that most neoplastic thrombi were isointense to the primary tumor on DWI, whereas all bland thrombi were hypointense; it must be noted that blood degradation products present variable T2 signal prolongation and water diffusivity, therefore false-positives may be encountered at DWI [35] . Satellite nodules are important determinants of patients' prognosis and influence the therapeutic approach.…”

Section: Pancreatic Tumorsmentioning

confidence: 99%

Prognostication and response assessment in liver and pancreatic tumors: The new imaging

Robertis¹,

Martini²,

Demozzi³

et al. 2015

WJG

View full text Add to dashboard Cite

Diffusion-weighted imaging (DWI), dynamic contrastenhanced magnetic resonance imaging (DCE-MRI) and perfusion computed tomography (CT) are technical improvements of morphologic imaging that can evaluate functional properties of hepato-bilio-pancreatic tumors during conventional MRI or CT examinations. Nevertheless, the term "functional imaging" is commonly used to describe molecular imaging techniques, as positron emission tomography (PET) CT/MRI, which still represent the most widely used methods for the evaluation of functional properties of solid neoplasms; unlike PET or single photon emission computed tomography, functional imaging techniques applied to conventional MRI/CT examinations do not require the administration of radiolabeled drugs or specific equipments. Moreover, DWI and DCE-MRI can be performed during the same session, thus providing a comprehensive "one-step" morphological and functional evaluation of hepato-bilio-pancreatic tumors. Literature data reveal that functional imaging techniques could be proposed for the evaluation of these tumors before treatment, given that they may improve staging and predict prognosis or clinical outcome. Microscopic changes within neoplastic tissues induced by treatments can be detected and quantified with functional imaging, therefore these techniques could be used also for posttreatment assessment, even at an early stage. or altered cellular membranes will present diffusion restriction, which is depicted as signal hyperintensity areas on high b-value DW images and hypointensity on the apparent diffusion coefficient (ADC) maps; ADC measurement can also quantify water molecules' diffusion. As dedifferentiation or therapies may induce microscopic changes in neoplastic tissues that could modify water molecules' diffusion, DWI can distinguish between different degrees of malignancy and can be also proposed for post-treatment monitoring. Moreover, DWI can be performed in a single session with DCE-MRI, thus providing a comprehensive "one-step" morphological and functional evaluation of hepatobilio-pancreatic tumors.Perfusion imaging techniques evaluate changes in signal intensity (DCE-MRI) or density (pCT) after contrast medium injection, being therefore able to assess microvascularization through the evaluation of the dynamics of contrast medium distribution from vessels to the neoplastic tissue. Perfusion parameters are therefore theoretically good candidates for the evaluation of microscopic vascular differences between lesions with different pathological grade and for the assessment of treatment response, especially after chemoembolization or during treatments with antiangiogenic drugs.This editorial analyzes up-to-date literature data regarding the application of functional imaging techniques, apart from molecular imaging, to hepatic and pancreatic tumors, with particular emphasis on correlations to pathological features, prognostic stratification and therapeutic response assessment. FUNCTIONAL IMAGING TECHNIQUES: TECHNICAL BASESIn 1965 Stejskal and Tanne...

show abstract

Differentiation of Malignant Thrombus from Bland Thrombus of the Portal Vein in Patients with Hepatocellular Carcinoma: Application of Diffusion-weighted MR Imaging

Abstract: DW imaging enables discrimination between bland and neoplastic portal vein thrombi when the ratio of the ADC of the thrombus to the ADC of HCC was lower than 2 and when the thrombi showed similar SI as the primary HCC when qualitative analysis was performed.

Cited by 185 publications

References 41 publications

Metastatic Melanoma to the Pancreas Forming Portal Vein Tumor Thrombosis: A Case Report

Metastatic Melanoma to the Pancreas Forming Portal Vein Tumor Thrombosis: A Case Report

Cross-sectional imaging of congenital and acquired abnormalities of the portal venous system

Prognostication and response assessment in liver and pancreatic tumors: The new imaging

Contact Info

Product

Resources

About