Contrast-enhanced color Doppler US in malignant portal vein thrombosis.
OBJECTIVE
To assess the role of contrast-enhanced color Doppler US in the differential diagnosis of benign and malignant portal vein thrombosis.


METHODS
Fifty-six patients with portal vein thrombosis underwent color and power Doppler US examination before and after i.v. injection of galactose-palmitic acid suspension. The criterion for diagnosing the presence and extension of thrombosis was the lack of visualization of portal vein flow in a segment of the portal vein. The criterion for diagnosing malignant portal vein thrombosis was the detection of pulsatile arterial flow, either hepatopetal or hepatofugal, in the thrombus. The US data were correlated with the types of portal vein thrombosis.


RESULTS
Among the 56 patients, there were 40 benign and 16 malignant portal thromboses. Unenhanced Doppler US detected continuous blood flow in 24 benign thromboses and pulsatile in 3 malignant thromboses. No flow, either continuous or pulsatile, was detected in 16 cases with benign thrombosis and in 13 cases with malignant thrombosis. Contrast-enhanced Doppler US allowed to assess pulsatile flow in 15 cases with malignant thrombosis (94%). The use of pulsatile flow as diagnostic criterion of malignant thrombosis yielded a sensitivity of 57% and a specificity of 95% with conventional Doppler US, whereas contrast-enhanced US achieved a sensitivity of 94% and a specificity of 100%.


CONCLUSIONS
Contrast-enhanced Doppler US is a reliable diagnostic tool for assessing malignant portal vein thrombosis.
Ricci
P
P
Department of Radiology, University La Sapienza, Rome, Italy.
Cantisani
V
V
Biancari
F
F
Drud
F M
FM
Coniglio
M
M
Di Filippo
A
A
Fasoli
F
F
Passariello
R
R
D000368:Aged; D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D005690:Galactose; D006503:Hepatic Veins / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009360:Neoplastic Cells, Circulating; D019308:Palmitic Acid; D011134:Polysaccharides; D011169:Portal Vein / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011673:Pulsatile Flow / Q000502:physiology; D012039:Regional Blood Flow / Q000502:physiology; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D018615:Ultrasonography, Doppler, Color; D014655:Vascular Resistance / Q000502:physiology; D020246:Venous Thrombosis / Q000000981:diagnostic imaging* / Q000503:physiopathology
D003287:Contrast Media; D011134:Polysaccharides; C059891:SHU 508; D019308:Palmitic Acid; D005690:Galactose