Diagnosis of benign and malignant portal vein thrombosis in cirrhotic patients with hepatocellular carcinoma: color Doppler US, contrast-enhanced US, and ... View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2006-07-24

AUTHORS

L. Tarantino, G. Francica, I. Sordelli, F. Esposito, A. Giorgio, P. Sorrentino, G. de Stefano, A. Di Sarno, G. Ferraioli, P. Sperlongano

ABSTRACT

BackgroundWe assessed the role of contrast-enhanced ultrasound (CEUS) in the differential diagnosis between benign and malignant portal vein thrombosis in patients who had cirrhosis with hepatocellular carcinoma (HCC).MethodsFifty-four consecutive patients who had cirrhosis, biopsy-proved HCC, and thrombosis of the main portal vein and/or left/right portal vein on US were prospectively studied with color Doppler US (CDUS) and CEUS. CEUS was performed at low mechanical index after intravenous administration of a second-generation contrast agent (SonoVue, Bracco, Milan, Italy). Presence or absence of CDUS signals or thrombus enhancement on CEUS were considered diagnostic for malignant or benign portal vein thrombosis. Twenty-eight patients also underwent percutaneous portal vein fine-needle biopsy (FNB) under US guidance. All patients were followed-up bimonthly by CDUS. Shrinkage of the thrombus and/or recanalization of the vessels on CDUS during follow-up were considered definitive evidence of the benign nature of the thrombosis, whereas enlargement of the thrombus, disruption of the vessel wall, and parenchymal infiltration over follow-up were considered consistent with malignancy. CDUS, CEUS, and FNB results were compared with those at follow-up.ResultsFollow-up (4 to 21 months) showed signs of malignant thrombosis in 34 of 54 patients. FNB produced a true-positive result for malignancy in 19 of 25 patients, a false-negative result in six of 25 patients, and a true-negative result in three of three patients. CDUS was positive in seven of 54 patients. CEUS showed enhancement of the thrombus in 30 of 54 patients. No false-positive result was observed at CDUS, CEUS, and FNB. Sensitivities of CDUS, CEUS, and FNB in detecting malignant thrombi were 20%, 88%, and 76% respectively. Three patients showed negative CDUS and CEUS and positive FNB results; follow-up confirmed malignant thrombosis in these patients. One patient showed negative CDUS, CEUS, and FNB findings. Howewer, follow-up of the thrombus showed US signs of malignancy. Another FNB confirmed HCC infiltration of the portal vein.ConclusionCEUS seems to be the most sensitive and specific test for diagnosing malignant portal vein thrombosis in patients with cirrhosis. More... »

PAGES

537-544

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00261-005-0150-x

DOI

http://dx.doi.org/10.1007/s00261-005-0150-x

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1042424236

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/16865315


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32 schema:description BackgroundWe assessed the role of contrast-enhanced ultrasound (CEUS) in the differential diagnosis between benign and malignant portal vein thrombosis in patients who had cirrhosis with hepatocellular carcinoma (HCC).MethodsFifty-four consecutive patients who had cirrhosis, biopsy-proved HCC, and thrombosis of the main portal vein and/or left/right portal vein on US were prospectively studied with color Doppler US (CDUS) and CEUS. CEUS was performed at low mechanical index after intravenous administration of a second-generation contrast agent (SonoVue, Bracco, Milan, Italy). Presence or absence of CDUS signals or thrombus enhancement on CEUS were considered diagnostic for malignant or benign portal vein thrombosis. Twenty-eight patients also underwent percutaneous portal vein fine-needle biopsy (FNB) under US guidance. All patients were followed-up bimonthly by CDUS. Shrinkage of the thrombus and/or recanalization of the vessels on CDUS during follow-up were considered definitive evidence of the benign nature of the thrombosis, whereas enlargement of the thrombus, disruption of the vessel wall, and parenchymal infiltration over follow-up were considered consistent with malignancy. CDUS, CEUS, and FNB results were compared with those at follow-up.ResultsFollow-up (4 to 21 months) showed signs of malignant thrombosis in 34 of 54 patients. FNB produced a true-positive result for malignancy in 19 of 25 patients, a false-negative result in six of 25 patients, and a true-negative result in three of three patients. CDUS was positive in seven of 54 patients. CEUS showed enhancement of the thrombus in 30 of 54 patients. No false-positive result was observed at CDUS, CEUS, and FNB. Sensitivities of CDUS, CEUS, and FNB in detecting malignant thrombi were 20%, 88%, and 76% respectively. Three patients showed negative CDUS and CEUS and positive FNB results; follow-up confirmed malignant thrombosis in these patients. One patient showed negative CDUS, CEUS, and FNB findings. Howewer, follow-up of the thrombus showed US signs of malignancy. Another FNB confirmed HCC infiltration of the portal vein.ConclusionCEUS seems to be the most sensitive and specific test for diagnosing malignant portal vein thrombosis in patients with cirrhosis.
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39 schema:keywords BackgroundWe
40 ConclusionCEUS
41 Doppler US
42 Howewer
43 MethodsFifty-four consecutive patients
44 ResultsFollow
45 US guidance
46 US signs
47 absence
48 administration
49 agents
50 benign nature
51 benign portal vein thrombosis
52 biopsy
53 biopsy-proven hepatocellular carcinoma
54 carcinoma
55 cirrhosis
56 cirrhotic patients
57 color Doppler US
58 consecutive patients
59 contrast agents
60 contrast-enhanced US
61 contrast-enhanced ultrasound
62 definitive evidence
63 diagnosis
64 differential diagnosis
65 disruption
66 enhancement
67 enlargement
68 evidence
69 false-negative results
70 false-positive results
71 findings
72 fine-needle biopsy
73 guidance
74 hepatocellular carcinoma
75 index
76 infiltration
77 intravenous administration
78 low mechanical index
79 main portal vein
80 malignancy
81 malignant portal vein thrombosis
82 malignant thrombosis
83 malignant thrombus
84 mechanical index
85 nature
86 parenchymal infiltration
87 patients
88 portal vein
89 portal vein thrombosis
90 presence
91 recanalization
92 results
93 right portal vein
94 role
95 second-generation contrast agent
96 sensitivity
97 shrinkage
98 signals
99 signs
100 specific tests
101 test
102 thrombosis
103 thrombus
104 thrombus enhancement
105 true-negative results
106 true-positive results
107 ultrasound
108 uses
109 vein
110 vein thrombosis
111 vessel wall
112 vessels
113 wall
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