Usefulness of Conventional MRI Sequences and Diffusion-Weighted Imaging in Differentiating Malignant From Benign Portal Vein Thrombus in Cirrhotic Patients

Sandrasegaran, Kumaresan; Tahir, Bilal; Nutakki, Kavitha; Akisik, Fatih; Bodanapally, Uttam K.; Tann, Mark; Chalasani, Naga

doi:10.2214/ajr.12.10171

Cited by 83 publications

(54 citation statements)

References 27 publications

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“…The high SI of the DVT on DWI was compatible with that of a cerebral vein thrombus 2 and over half of the portal vein thrombi. 3 These results suggest that the high SI of venous thrombi on DWI is a characteristic finding. However, the sensitivity and specificity of combined DWI/T 2 -weighted MR imaging were better than those of DWI alone as a screening tool for detecting abdominal malignancies.…”

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confidence: 78%

Diffusion-weighted MR Imaging of Deep Vein Thrombosis

et al. 2016

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Magnetic resonance (MR) imaging is not commonly used as a diagnostic tool for deep vein thrombosis (DVT). Technological advances in fat saturation pulse sequences and surface coils have enabled the application of diffusion-weighted imaging (DWI) to whole-body imaging, 1 and we applied this technique to detect DVT and evaluated its tissue contrast.To evaluate the extent of DVT in a 60-year-old woman with asymptomatic pulmonary thromboembolism, we performed noncontrast diffusion and T 1 -weighted MR imaging (T 1 WI) of her lower legs after obtaining her informed consent. She underwent MR imaging using a 1.5-tesla superconducting system combined with a 12-channel bodyphased array coil (Signa Excite HDxt; GE Medical Systems, WI, USA). DWI was performed in the transverse plane using single-shot echo planar imaging with fat suppression and short-tau inversion recovery (STIR) within 7 min (repetition time [TR]/echo time [TE]/IR, 10000/65.3/200 ms; field of view (FOV), 480 © 480 mm; matrix, 64 © 128; slice thickness, 7 mm with 1.4-mm overlap; 152 slices; band width, « 125 kHz; number of excitations, 2; phase FOV, 0.5; asset factor, 2; and b values of 1000 mm 2 /s). Coronal maximum intensity projection of DWI (Fig. 1A) showed a lesion with branching high signal intensity (SI) in the right lower limb. In addition, T 1 WI showed a lesion with high SI in the right posterior tibial and soleus veins, which indicated DVT. Axial-merged images showed colocalization of the high SI lesion on DWI and T 1 WI (Fig. 1B). The high SI of the DVT on DWI was compatible with that of a cerebral vein thrombus 2 and over half of the portal vein thrombi. 3 These results suggest that the high SI of venous thrombi on DWI is a characteristic finding. However, the sensitivity and specificity of combined DWI/T 2 -weighted MR imaging were better than those of DWI alone as a screening tool for detecting abdominal malignancies. The merged DWI and T 1 WI images added anatomical and qualitative information to the high SI lesion on DWI. In addition, a lesion of low SI in MR venography may support the diagnosis of DVT. Tumors, inflammatory lesions, and several normal structures in the lower limb (peripheral nerves, lymphatic system, and bone marrow) exhibit impeded diffusion.1 Therefore, careful evaluation of DWI findings along with other MR imaging sequences and clinical and laboratory findings is necessary to reduce false-positive diagnoses.

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confidence: 78%

Diffusion-weighted MR Imaging of Deep Vein Thrombosis

et al. 2016

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“…In one recent study, Sorrentino and colleagues (76) evaluated the diagnostic performance of arterial phase hyperenhancement of the thrombus at CT and found a sensitivity of 87%. As mentioned later, in retrospective studies, diffusion-weighted MR imaging has been shown by some investigators to aid in the differentiation of macrovascular invasion from bland venous thrombus (77), but other investigators have not found diffusion-weighted imaging to be helpful (78). Larger prospective studies are needed to evaluate diffusion-weighted imaging for this purpose.…”

Section: Feature Commentsmentioning

confidence: 99%

“…It should be emphasized, moreover, that ADC and diffusion-weighted signal-intensity ratios are technique, field strength, and scanner dependent; hence, diffusion-weightedbased prediction thresholds may not be generalizable. Additionally, some investigators have suggested that restricted diffusion may aid in the differentiation of macrovascular invasion from bland venous thrombus (77); however, other investigators have found that restricted diffusion does not aid in this differentiation due to substantial overlap in ADCs between bland thrombus and macrovascular invasion (78). Owing to these conflicting results, caution should be exercised in using diffusion-weighted images for differentiating bland from malignant thrombus.…”

Section: Ancillary Features That Favor the Diagnosis Of Malignancy Bumentioning

confidence: 99%

CT and MR Imaging Diagnosis and Staging of Hepatocellular Carcinoma: Part II. Extracellular Agents, Hepatobiliary Agents, and Ancillary Imaging Features

Choi¹,

Lee²,

Sirlin³

2014

Radiology

463

385

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Computed tomography (CT) and magnetic resonance (MR) imaging play critical roles in the diagnosis and staging of hepatocellular carcinoma (HCC). The second article of this two-part review discusses basic concepts of diagnosis and staging, reviews the diagnostic performance of CT and MR imaging with extracellular contrast agents and of MR imaging with hepatobiliary contrast agents, and examines in depth the major and ancillary imaging features used in the diagnosis and characterization of HCC.q RSNA, 2014

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“…8 Discrimination between a benign and malignant etiology for a thrombus may occasionally be difficult despite these differences and the use of modern imaging modalities. 17 Tumor thrombi commonly develop in patients with HCC and RCC, and the surgical approaches to management of such thrombi have been well documented. 5 , 6 , 8 Although less frequently reported, tumor thrombi are also common in patients with pNET.…”

Section: Discussionmentioning

confidence: 99%

Role and Operative Technique of Portal Venous Tumor Thrombectomy in Patients with Pancreatic Neuroendocrine Tumors

Prakash

Lee

Yao

et al. 2015

Journal of Gastrointestinal Surgery

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Usefulness of Conventional MRI Sequences and Diffusion-Weighted Imaging in Differentiating Malignant From Benign Portal Vein Thrombus in Cirrhotic Patients

Abstract: Signal-intensity characteristics on DWI and measured ADC values do not reliably differentiate benign PVT from malignant PVT. On the other hand, careful assessment of conventional MRI findings may allow this distinction, thus obviating biopsy.

Cited by 83 publications

References 27 publications

Diffusion-weighted MR Imaging of Deep Vein Thrombosis

Diffusion-weighted MR Imaging of Deep Vein Thrombosis

CT and MR Imaging Diagnosis and Staging of Hepatocellular Carcinoma: Part II. Extracellular Agents, Hepatobiliary Agents, and Ancillary Imaging Features

Role and Operative Technique of Portal Venous Tumor Thrombectomy in Patients with Pancreatic Neuroendocrine Tumors

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