Diagnosis of benign and malignant portal vein thrombosis in cirrhotic patients with hepatocellular carcinoma: color Doppler US, contrast-enhanced US, and fine-needle biopsy

Tarantino, L.; Francica, Giampiero; Sordelli, I.; Esposito, Francesco; Giorgio, Antonio; Sorrentino, Paolo; Stefano, G. de; Sarno, Antonella Di; Ferraioli, Giovanna; Sperlongano, Pasquale

doi:10.1007/s00261-005-0150-x

Cited by 161 publications

(129 citation statements)

References 48 publications

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“…Doppler ultrasound is accurate for diagnosing thrombosis of the main portal vein and its intrahepatic branches, but false negative results may occur in cases with limited occlusion [199][200][201]. Multiphasic helical CT or MRI are recommended to confirm the finding and evaluate patency of the superior mesenteric vein (SMV), splenic veins, or the occurrence of portosystemic shunts.…”

Section: Portal Vein Thrombosis In Cirrhosismentioning

confidence: 99%

Hemostatic balance in patients with liver cirrhosis: Report of a consensus conference

Andriulli

Tripodi

Angeli

et al. 2016

Digestive and Liver Disease

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a b s t r a c tPatients with cirrhosis present with hemostatic alterations secondary to reduced availability of procoagulant and anti-coagulant factors. The net effect of these changes is a rebalanced hemostatic system. The Italian Association of the Study of the Liver (AISF) and the Italian Society of Internal Medicine (SIMI) promoted a consensus conference on the hemostatic balance in patients with cirrhosis. The consensus process started with the review of the literature by a scientific board of experts and ended with a formal consensus meeting in Rome in December 2014. The statements were graded according to quality of evidence and strength of recommendations, and approved by an independent jury. The statements presented here highlight strengths and weaknesses of current laboratory tests to assess bleeding and thrombotic risk in cirrhotic patients, the pathophysiology of hemostatic perturbations in this condition, and outline the optimal management of bleeding and thrombosis in patients with liver cirrhosis.

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Section: Portal Vein Thrombosis In Cirrhosismentioning

confidence: 99%

Hemostatic balance in patients with liver cirrhosis: Report of a consensus conference

Andriulli

Tripodi

Angeli

et al. 2016

Digestive and Liver Disease

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“…Lesions in the disease are hypervascular, demonstrating disorganised arterial flow, a characteristic demonstrated on imaging 2 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 …”

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%

“…can be administered at any time 5 11 The greatest advantage of CEUS is that it allows for real‐time observation 2 8 , 9 , 11 This is a limitation of CT and MRI; enhancement can be missed if arterial phase scans are not optimally timed, 2 or if there is poorly controlled patient respiration.…”

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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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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Diagnosis of benign and malignant portal vein thrombosis in cirrhotic patients with hepatocellular carcinoma: color Doppler US, contrast-enhanced US, and fine-needle biopsy

Abstract: CEUS seems to be the most sensitive and specific test for diagnosing malignant portal vein thrombosis in patients with cirrhosis.

Cited by 161 publications

References 48 publications

Hemostatic balance in patients with liver cirrhosis: Report of a consensus conference

Hemostatic balance in patients with liver cirrhosis: Report of a consensus conference

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

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