Role of Doppler Ultrasound and Triphasic CT in differentiation between benign and malignant portal vein thrombosis.

Sažetak

Background: Portal vein thrombosis is typically a consequence of cirrhosis that already exists, abdominal malignancy, hypercoagulable conditions, or abdominal inflammation. Imaging techniques are used to identify portal vein thrombosis. Once a thrombus has been identified using ultrasound, Doppler ultrasonography can be used to exclude malignancy activity. The following step is computed tomography or magnetic resonance angiograms if more information is needed. If these tests are insufficient, digital subtraction angiography should be carried out. Methods: The study included 40 patients diagnosed by B mode ultrasound to have PVT and referred to the radiology department of the National Hepatology and Tropical Medicine Research Institute to differentiate between benign and malignant PVT using color Doppler and Triphasic CT. Results: A total of 40 subjects were included in the final analysis report. The CT categorized 17 subjects as benign PVT and 23 subjects as malignant PVT. However, all of them had neovascularity and showed early arterial enhancement and delayed washout. Intra-thrombus pulsatile flow by color Doppler was detected in 19 patients with percentage of agreement 80%, sensitivity of 73.9% and specificity of 88.2%. Conclusions: Color Doppler US is considered an effective noninvasive tool to differentiate between benign and malignant PVT, but it is operator-dependent which need the expertise to detect the vascularity within the thrombus. But is an easy, low cost, available, no contraindications to be done and no exposure to radiation. Although absence of intra-thrombus vasculature doesn`t exclude the intra-vascular malignancy invasion, and here comes the role of Triphasic CT.