title: Differentiation of neoplastic from bland macroscopic portal vein thrombi using dual-energy spectral CT imaging: a pilot study.
abstract: OBJECTIVE
  To assess the feasibility and value of dual-energy spectral computed tomography (DESCT) imaging for differentiating neoplastic from bland macroscopic portal vein (PV) thrombi.
  
  
  METHODS
  Computed tomography (CT) images of 44 patients with macroscopic PV thrombus (bland group, n = 16; neoplastic group, n = 28) were reviewed. Iodine-based material decomposition images in the portal venous phase were reconstructed to compare the iodine indices between groups, including thrombus iodine density (I                            (T)), thrombus-aorta iodine density ratio (I                            (T)/I                            (A)), and thrombus-PV iodine density ratio (I                            (T)/I                            (P)). Differential diagnostic performances of DESCT were calculated in the subgroup of 21 patients with histopathological evidence (bland group, n = 12; neoplastic group, n = 9).
  
  
  RESULTS
  The iodine indices of the neoplastic group were significantly higher than those in the bland group (P < 0.001). A threshold I                            (T) of 1.14 mg/mL, I                            (T)/I                            (A) of 0.17, and I                            (T)/I                            (P) of 0.17 in the portal venous phase yielded 100 %, 88.9 %, and 100 % sensitivity, and 91.7 %, 91.7 %, and 83.3 % specificity, respectively, in differentiating neoplastic from bland PV thrombi.
  
  
  CONCLUSIONS
  DESCT imaging with quantification of thrombus iodine density in the portal venous phase appears to be a promising new method for distinguishing neoplastic from bland macroscopic PV thrombi.
  
  
  CONCLUSIONS
  •                            Differentiating the nature of portal vein thrombus is of great clinical significance.                                                                              •                            Iodine-based material decomposition imaging reflects iodine distribution after contrast media administration.                                                                              •                            Dual-energy CT with iodine quantification can distinguish bland from neoplastic PV thrombi.
authors.affiliation: Department of Radiology, Renji Hospital, Shanghai Jiaotong University School of Medicine, No. 1630 Dongfang Rd. Pudong, Shanghai, 200127, People's Republic of China.
authors.forename: Li Jun
authors.initials: LJ
authors.lastname: Qian
authors.forename: Jiong
authors.initials: J
authors.lastname: Zhu
authors.forename: Zhi Guo
authors.initials: ZG
authors.lastname: Zhuang
authors.forename: Qiang
authors.initials: Q
authors.lastname: Xia
authors.forename: Yu Fan
authors.initials: YF
authors.lastname: Cheng
authors.forename: Jian Ying
authors.initials: JY
authors.lastname: Li
authors.forename: Jian Rong
authors.initials: JR
authors.lastname: Xu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009360:Neoplastic Cells, Circulating; D010865:Pilot Projects; D011169:Portal Vein; D013927:Thrombosis / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000379:methods; D055815:Young Adult