Diagnosis of portal vein thrombosis in patients with hepatocellular carcinoma: efficacy of color Doppler sonography compared with angiography.

Tanaka, Katsuaki; Numata, Kazushi; Okazaki, H; Nakamura, Shigeto; Inoue, Soichiroh; Takamura, Yutaro

doi:10.2214/ajr.160.6.8388620

Cited by 58 publications

(29 citation statements)

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“…Tanaka et al demonstrated that the presence of pulsatile flow in a portal thrombus is specific for malignant thrombosis [20]. Using detection of pulsatile flow within the thrombus as a criteria for malignant PVT diagnosis, the sensitivity and specificity of color Doppler sonography were 92% and 100% respectively, with 95% accuracy in the study of Lencioli et al [22].…”

Section: Gray-scale (B-mode Imaging) and Doppler Us In The Diagnosis mentioning

confidence: 99%

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Portal vein thrombosis in liver cirrhosis – the added value of contrast enhanced ultrasonography.

et al. 2016

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Portal vein thrombosis (PVT) is a frequent complication of liver cirrhosis and its prevalence increases with the severity of liver disease. Patients with liver cirrhosis and hepatocellular carcinoma may have either malignant or blunt (benign) PVT. In these patients, the diagnosis and characterization of PVT is important for the prognosis and further treatment.Ultrasound (US) is the modality of choice for the diagnosis of PVT. The features of PVT on B-mode (gray-scale) US include: dilatation of the portal vein, visualization of the thrombus and, in chronic PVT-cavernous transformation. Sensitivity of US in the diagnosis of PVT is improved by the use of Doppler US and of ultrasound contrast agents. In the latter years, contrast enhanced ultrasound (CEUS) showed high sensitivity in the differential diagnosis between benign and malignant PVT and could be the diagnostic method of choice for the characterization of PVT. Blunt thrombi are avascular and will not enhance during CEUS examination, while a hyperenhancement pattern of the portal thrombus in the arterial phase, with "wash out" in the portal or late phase is typical for malignant PVT.

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Section: Gray-scale (B-mode Imaging) and Doppler Us In The Diagnosis mentioning

confidence: 99%

“…Color signals within the thrombus (due to tumoral neovascularity) and detection of pulsatile flow in a portal vein thrombus using power Doppler US are criteria for malignant PVT [20].…”

Section: Gray-scale (B-mode Imaging) and Doppler Us In The Diagnosis mentioning

confidence: 99%

Portal vein thrombosis in liver cirrhosis – the added value of contrast enhanced ultrasonography.

et al. 2016

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“…The combination of Doppler with US can be useful for the identification of portal thrombosis in patients with HCC, with 89 to 92% sensitivity and 100% specificity in the identification of tumor thrombosis (13). The presence of a hepatofugal pulsatile flow inside the thrombus is suggestive of vascular invasion (14).…”

Section: Ultrasoundmentioning

confidence: 99%

“…The presence of a hepatofugal pulsatile flow inside the thrombus is suggestive of vascular invasion (14). Hepatic arteriography for the identification of portal thrombosis can be avoided when US-Doppler reveals permeability of the portal system (13). In patients with tumors submitted to alcoholization, chemical thrombosis can be differentiated from tumoral thrombosis by means of USDoppler based on the presence of blood flow in the thrombus.…”

Section: Ultrasoundmentioning

confidence: 99%

Diagnosis, staging and treatment of hepatocellular carcinoma

França

Elías

Lima

et al. 2004

Braz J Med Biol Res

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Hepatocellular carcinomas are aggressive tumors with a high dissemination power. An early diagnosis of these tumors is of great importance in order to offer the possibility of curative treatment. For an early diagnosis, abdominal ultrasound and serum alpha-fetoprotein determinations at 6-month intervals are suggested for all patients with cirrhosis of the liver, since this disease is considered to be the main risk factor for the development of the neoplasia. Helicoidal computed tomography, magnetic resonance and/or hepatic arteriography are suggested for diagnostic confirmation and tumor staging. The need to obtain a fragment of the focal lesion for cytology and/or histology for a diagnosis of hepatocellular carcinoma depends on the inability of imaging methods to diagnose the lesion. Several classifications are currently available for tumor staging in order to determine patient prognosis. All take into consideration not only the stage of the tumor but also the degree of hepatocellular dysfunction, which is known to be the main factor related to patient survival. Classifications, however, fail to correlate treatment with prognosis and cannot suggest the ideal treatment for each tumor stage. The Barcelona Classification (BCLC) attempts to correlate tumor stage with treatment but requires prospective studies for validation. For single tumors smaller than 5 cm or up to three nodules smaller than 3 cm, surgical resection, liver transplantation and percutaneous treatment may offer good anti-tumoral results, as well as improved patient survival. Embolization or chemoembolization are therapeutic alternatives for patients who do not benefit from curative therapies. Correspondence

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“…However, with the exception of haemangiomas with APS and hepatocellular carcinomas, the peritumoural hepatofugal portal flow on CDS is an uncommon finding among various hypervascular tumours, to the best of our knowledge. Hepatofugal portal flow associated with hepatocellular carcinoma is usually seen in cases with tumoural thrombus in the portal vein lumen [14,15]. Therefore, the presence of peritumoural hepatofugal portal flow on CDS in the absence of portal vein thrombus may be an important sign that enhances the suspicion of hepatic haemangioma with APS.…”

Section: Discussionmentioning

confidence: 99%

Colour Doppler sonography of hepatic haemangiomas with arterioportal shunts

Lim

Kim²,

Jeong³

et al. 2012

BJR

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Objectives: To determine the frequency of intratumoural flow and peritumoural hepatofugal portal flow using colour Doppler sonography (CDS) on hepatic haemangiomas with arterioportal shunt (APS), and to investigate possible factors that may affect the capability of CDS to depict such findings. Methods: The study included 45 patients (35 men, 10 women; mean age, 56 years) with hepatic haemangiomas with APS on CT or MRI. Locating the tumour on greyscale sonography, the depth, size and echogenicity of the tumour were evaluated. CT or MR images were evaluated for fatty liver. CDS was performed to determine the presence of intratumoural flow and peritumoural hepatofugal portal flow. Differences in frequency of intratumoural flow and peritumoural hepatofugal portal flow according to the depth, size, echogenicity and fatty liver were evaluated by Student's t-test and Fisher's exact test. Results: On CDS, intratumoural flow and peritumoural hepatofugal portal flow were found in 66.7% and 60%, respectively. The tumour depth was the significant variable that affected the capability of CDS to depict such findings. The frequencies of intratumoural flow and peritumoural hepatofugal portal flow were as high as 88% and 80% for shallow (#30 mm) lesions, and they were 40% and 35% for deep (.30 mm) lesions (p50.0012; p50.0051). Conclusion: CDS can commonly depict intratumoural flow and peritumoural hepatofugal portal flow in patients with hepatic haemangiomas with APS. Therefore, CDS should be routinely performed when an incidental mass is encountered during the screening sonography, especially when the lesion is shallow. Hepatic haemangiomas are frequently found incidentally on screening sonography; therefore, it is important to characterise their sonographic appearances.The value of colour Doppler sonography (CDS) for the evaluation of hepatic haemangioma has been generally underestimated, presumably because most typical haemangiomas have slow intratumoural flow below the sensitivity limits of CDS [1,2]. However, the blood flow pattern of haemangioma differs from tumour to tumour depending on the internal architecture or collective size of the vascular spaces [3], and high-flow haemangiomas, usually (83-89%) accompanying arterioportal shunt (APS), constitute approximately 29-35% of hepatic haemangiomas [4,5]. In contrast to the dissatisfying results in typical slow-flow haemangiomas, it has been reported that, in six cases of angiographically proven haemangiomas with APS, CDS could demonstrate large penetrating arteries, multiple intratumoural flow signals, reversed portal flow within the tumours and hepatofugal portal flow around the tumours [6]. However, the small sample size may have limited the value of this study, and we assume that the capability of CDS to depict the intratumoural flow and peritumoural hepatofugal portal flow in haemangiomas with APS may have depended on various factors.Thus, the purposes of our study were to determine the frequency of intratumoural flow and peritumoural hepatofugal portal flow on CDS of ...

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Diagnosis of portal vein thrombosis in patients with hepatocellular carcinoma: efficacy of color Doppler sonography compared with angiography.

Cited by 58 publications

References 0 publications

Portal vein thrombosis in liver cirrhosis – the added value of contrast enhanced ultrasonography.

Portal vein thrombosis in liver cirrhosis – the added value of contrast enhanced ultrasonography.

Diagnosis, staging and treatment of hepatocellular carcinoma

Colour Doppler sonography of hepatic haemangiomas with arterioportal shunts

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