How to Best Detect Portal Vein Tumor Thrombosis in Patients with Hepatocellular Carcinoma Meeting the Milan Criteria: Gadoxetic Acid-Enhanced MRI versus Contrast-Enhanced CT

Abstract

Introduction: The detection of portal vein tumor thrombosis (PVTT) in patients with hepatocellular carcinoma (HCC) meeting the Milan criteria is of critical importance as PVTT is known to be a contraindication to transplantation and an indicator of a dismal prognosis. Objective: To determine which modality may best detect PVTT, we compared the diagnostic performance of gadoxetic acid-enhanced MRI (GA-MRI) and contrast-enhanced CT (CECT) in HCC patients meeting the Milan criteria. Methods: We retrospectively enrolled 310 patients with HCCs meeting the Milan criteria who underwent both GA-MRI and CECT between June 2007 and May 2017. Among them, 44 patients were demonstrated to have PVTT while 266 patients had no PVTT. Two radiologists then assessed GA-MRI and CECT images for the presence of PVTT on a 5-point scale as well as vessel expansion, continuity with tumors, and enhancement on both modalities, as well as T2 hyperintensity and diffusion restriction on GA-MRI. The McNemar test was used to compare sensitivity and specificity of GA-MRI and CECT for the detection of PVTT, and Fisher's exact test was used to compare their imaging features.

Surveillance, Diagnosis, and Treatment Outcomes of Hepatocellular Carcinoma in Japan: 2021 Update

“…Portal vein invasion was also less common in Japan than in other countries, but its incidence was higher than expected, occurring in 2,523 of 19,167 patients (13.2%) examined at the time of initial detection. This higher-than-expected incidence could be explained by recent advances in CT and MRI [51,52] and abdominal contrast-enhanced ultrasound [53], which have made minor vascular invasion graded as Vp1 or Vp2 clinically discernable from the time of initial detection for small HCCs.…”

Improvement of image quality and assessment of respiratory motion for hepatocellular carcinoma with portal vein tumor thrombosis using contrast-enhanced four-dimensional dual-energy computed tomography

“…For the detection of PVTT using the GA-MRI, Bae et al . reported that the additional information of diffusion- and T2-weighted imaging, which are not available with CECT, could contribute better depiction of common imaging findings, such as continuity with the tumor in the adjacent liver parenchyma than CE-CT [ 19 ], The study by Kim et al . demonstrated that the PVTT showed the increased T2 signal intensity and diffusion restriction, and the characteristic imaging features improved diagnostic capability [ 18 ].…”

Real-world outcome of immune checkpoint inhibitors for advanced hepatocellular carcinoma with macrovascular tumor thrombosis

“…The presence and extent of vascular invasion were diagnosed by characteristic findings using multiphase dynamic computed tomography (CT) or magnetic resonance imaging (MRI) [ 16 , 17 ]. Malignant tumor thrombus was defined as thrombus enhancement after the administration of contrast media compared to pre-contrast images (≥ 20 HU on CT and ≥ 15% on MRI), thrombus expansion within the involved vessel, and continuity of thrombus within the tumor [ 18 ].…”