Characterization of Portal Vein Thrombus With the Use of Contrast-Enhanced Sonography

Ueno, Norio; Kawamura, Harunobu; Takahashi, Hirokazu; Fujisawa, Nobutaka; Yoneda, Masato; Kohno, Hiroyuki; Sakaguchi, Takashi; Saito, Satoru; Togo, Shinji

doi:10.7863/jum.2006.25.9.1147

Cited by 27 publications

(29 citation statements)

References 26 publications

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“…, 3 , 4 HCC is the most common primary malignant cancer of the liver and more easily invades adjacent vasculature when compared to other liver tumours 5 . Lesions in the disease are hypervascular, demonstrating disorganised arterial flow, a characteristic demonstrated on imaging 2 …”

Section: Discussionmentioning

confidence: 99%

“…, 6 , 7 Tumour invasion into the portal vein is a sign of an advanced disease state 2 and can be shown on imaging, if characteristics similar to the malignant lesions are evident 2 5 , 6 , 8 Potential interventions for PVT include surgical resection, liver transplantation and percutaneous ablation 2 4 , 5 , 8 , 9 As tumour reoccurrence for malignant PVT is almost 100%, 9 it is important to differentiate between bland and malignant PVT as the presence of malignant PVT may be a contraindication for intervention 2 …”

Section: Discussionmentioning

confidence: 99%

“…, 5 , 6 , 8 Potential interventions for PVT include surgical resection, liver transplantation and percutaneous ablation 2 4 , 5 , 8 , 9 As tumour reoccurrence for malignant PVT is almost 100%, 9 it is important to differentiate between bland and malignant PVT as the presence of malignant PVT may be a contraindication for intervention 2 4 , 5 , 8 – 10 …”

Section: Discussionmentioning

confidence: 99%

“…For differentiating between bland and malignant PVT Power Doppler (PD) has shown to have a higher sensitivity and specificity than CD 2 5 Both these methods have also been compared with CEUS, which was found to be the superior method. In one study, CEUS was able to accurately differentiate between malignant and bland lesions in 55 patients 5 .…”

Section: Discussionmentioning

confidence: 99%

“…, 5 Both these methods have also been compared with CEUS, which was found to be the superior method. In one study, CEUS was able to accurately differentiate between malignant and bland lesions in 55 patients 5 . Another study of 54 patients reported a sensitivity of 88% and a specificity of 100% for CEUS in detecting malignant PVT 2 …”

Section: Discussionmentioning

confidence: 99%

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Portal vein thrombosis with contrast‐enhanced ultrasound in a patient with hepatocellular carcinoma: a case study

Salman

2012

Australas J Ultrason Med

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Portal vein thrombosis (PVT) is the presence of thrombus in the portal vein that causes partial or complete occlusion. It is prevalent in hepatocellular carcinoma (HCC), where it can be either bland or malignant depending on the presence of invasion. Recent studies have identified contrast‐enhanced ultrasound (CEUS) as the most reliable method of imaging to make this distinction. The arterial neovascularisation that is evident in a neoplastic thrombus can be visualised on CEUS with enhancement and pulsation, witnessed in real‐time. This case study describes the use of contrast‐enhanced ultrasound used as a non‐invasive method to define the bland and malignant components of portal vein thrombosis in a 76‐year‐old male with hepatocellular carcinoma and cirrhosis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Portal vein thrombosis with contrast‐enhanced ultrasound in a patient with hepatocellular carcinoma: a case study

Salman

2012

Australas J Ultrason Med

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Role of contrast‐enhanced ultrasound for differentiation of benign vs. malignant portal vein thrombosis in hepatocellular carcinoma – A systematic review a meta‐analysis

Giri,

Vaidya,

Agrawal

et al. 2023

Australas J Ultrason Med

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Introduction/PurposePatients with cirrhosis and hepatocellular carcinoma (HCC) can develop both benign and malignant portal vein thrombosis (PVT). Characterising the nature of PVT is important for planning an optimal therapeutic strategy. In the absence of typical findings or contraindications to computed tomography (CT) or magnetic resonance imaging (MRI), contrast‐enhanced ultrasound (CEUS) could help in this differentiation. The present meta‐analysis aimed to evaluate the performance of CEUS for characterising PVT in patients with HCC.MethodsElectronic databases of PubMed, Embase and Scopus were searched from inception to 31 December 2022 for studies analysing the role of CEUS in the differentiation of benign and malignant PVT in HCC. Using the bivariate random effect model, pooled sensitivity and specificity were calculated, and the summary receiver operating characteristic (sROC) curve was plotted.ResultsA total of 12 studies with data from 712 patients were included in the meta‐analysis. The pooled sensitivity and specificity of CEUS for the diagnosis of tumour in vein were 97.0% (95% CI: 93.0–98.7) and 96.8% (95% CI: 92.1–98.7), respectively, without significant heterogeneity. A sROC curve was plotted, and the area under the receiver operating characteristic was 0.99 (95% CI: 0.98–1.00). Despite the presence of publication bias, sensitivity analysis did not show any change in sensitivity and specificity.DiscussionOur meta‐analysis summarises the accuracy data from 12 studies, including >700 subjects. Contrast‐enhanced ultrasound had excellent diagnostic accuracy with pooled sensitivity and specificity of 97.5% (95% CI: 93.5–99.1) and 98.2% (95% CI: 91.5–99.6), respectively, without any significant heterogeneity. Additionally, the pooled positive LR, negative LR and DOR were 54.6 (95% CI: 11.1–25.6), 0.02 (0.01–0.07) and 2186.8 (318.3–15022.2), respectively. A positive result increases the pretest probability of malignant PVT from 50% to 98%, whereas a negative result decreases it from 50% to 2%. Most of the studies included in our meta‐analysis used identical techniques and 6–12‐month follow‐up scans to check for thrombus progression or regression. Our analysis showed no significant heterogeneity in the studies, and area under receiver operating characteristic curve (AUROC) with 95% CI was 1.00 (95% CI: 0.99–1.00). This critical meta‐analysis thus propels CEUS to the forefront for differentiating benign from tumoural PVT and suggests routinely using CEUS in patients presenting with HCC and evidence of thrombus on greyscale ultrasound.ConclusionContrast‐enhanced ultrasound is an effective diagnostic modality differentiation of benign and malignant PVT in patients with HCC and can be an alternative modality to CT or MRI. Further studies are required to study the role of CEUS as initial diagnostic modality for the characterisation of PVT in HCC.

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Clinical implications for imaging of vascular invasion in hepatocellular carcinoma

et al. 2016

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Hepatocellular carcinoma (HCC) is the second largest cause of cancer mortality in the world, with vascular invasion being one of the most important prognostic factors. HCC with tumor thrombus was traditionally considered to have very limited treatment options. However, multiple promising treatment strategies have emerged in recent years, with diagnostic and interventional radiologists playing a major role in patient management. We provide a comprehensive update on the diagnosis and management of HCC with vascular invasion and the role of the radiologist in this condition.

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Characterization of Portal Vein Thrombus With the Use of Contrast-Enhanced Sonography

Abstract: Contrast-enhanced sonography can be helpful in discriminating between benign and malignant portal vein thrombi.

Cited by 27 publications

References 26 publications

Portal vein thrombosis with contrast‐enhanced ultrasound in a patient with hepatocellular carcinoma: a case study

Portal vein thrombosis with contrast‐enhanced ultrasound in a patient with hepatocellular carcinoma: a case study

Role of contrast‐enhanced ultrasound for differentiation of benign vs. malignant portal vein thrombosis in hepatocellular carcinoma – A systematic review a meta‐analysis

Clinical implications for imaging of vascular invasion in hepatocellular carcinoma

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