Contrast-enhanced ultrasound for the characterization of portal vein thrombosis vs tumor-in-vein in HCC patients: a systematic review and meta-analysis

Abstract

Objectives Portal vein thrombosis (PVT) is a common complication of liver cirrhosis. However, differentiation of thrombosis and tumor-in-vein (TIV) may be challenging. Contrast-enhanced ultrasound (CEUS) is an excellent method for detection of vascularization and could help in the distinction. We performed a systematic review and meta-analysis for evaluating the diagnostic value of CEUS in differentiating between PVT and TIV in hepatocellular carcinoma (HCC) patients. Methods PubMed, Embase, Cochrane Library, and Web of Science were searched up to the 5th of May 2019. The study quality was assessed by QUADAS-2 tool. Pooled sensitivity and specificity were calculated by the bivariate random effect model and hierarchical summary receiver-operating characteristic (SROC) curve was plotted. Results Seven studies including 425 participants were analyzed after screening 986 articles searched from databases. The pooled sensitivity and specificity of CEUS in diagnosing TIV were 0.94 (95%CI, 0.89-0.97) and 0.99 (95%CI, 0.80-1.00), respectively. The area under the curve (AUC) of SROC curve was 0.97 (95%CI, 0.95-0.98). The pooled sensitivity and AUC were consistent across all the subgroups of different subject numbers, country, study design, CEUS contrast agents, and diagnostic criteria. Conclusions CEUS is highly efficient in differentiating TIV from PVT and is an alternative or a substitute for CT and/or MRI. Trial registration PROSPERO registration number: CRD42019138847 Key Points • Characterization of portal vein thrombosis (PVT) vs tumor-in-vein (TIV) is critical for HCC staging. • CEUS has an excellent safety profile, provides a real-time analysis without any loss in accuracy compared with CT and MRI. • This meta-analysis demonstrates that contrast-enhanced ultrasound (CEUS) is a suitable method for the detection of PVT and distinction with TIV.

Profiling hepatocellular carcinoma aggressiveness with contrast-enhanced ultrasound and gadoxetate disodium-enhanced MRI: An intra-individual comparative study based on the Liver Imaging Reporting and Data System

“…Interestingly, the LR-TIV and LR-M categories were the most frequent sources of discordant LI-RADS category assignments in our study. Using postoperative pathology as the reference standard, we found that CEUS was more specific than EOB-MRI for diagnosing tumor thrombus (96% vs. 89%, P =.02), which were in line with a recent metaanalysis [31]. This may reflect the higher spatial resolution of CEUS for depicting relatively small vessels as well as its higher temporal resolution for demonstrating the enhancement pattern of the tumor thrombus [32].…”

Contrast-enhanced ultrasound liver reporting and data system for hepatocellular carcinoma diagnosis

“…Tumor in a vein (LR-TIV) is categorized when the classic arterial hyperenhancement and late mild washout of HCC are seen in soft tissue mass within a vein. A review and subsequent meta-analysis of the diagnostic accuracy of CEUS for diagnosis of a tumor in vein support high sensitivity and specificity from several published studies [31,32] , with a pooled sensitivity of 94% and a pooled specificity of 99%. On the other hand, diagnosis using CT or MRI can be more challenging with a poorer reported performance for more widely available CT/MRI techniques.…”

Portal vein aneurysm combined with intrahepatic portosystemic venous shunt diagnosed by multimodal imaging techniques: A case report

“…In addition, contrast-enhanced ultrasound technology effectively identifies portal vein tumors. [ 13 ] Using this technology, the time of arrival of the contrast agent to the hepatic artery, portal vein, and hepatic vein (HVAT) were recorded. The time interval for the arrival of the contrast agent from the hepatic artery to the hepatic vein (HA-HVAT) and the transit time for the contrast agent to reach the hepatic vein from the portal vein (PV-HVTT) was calculated.…”