Color Doppler US and tri-phasic CT in differentiating benign from malignant portal vein thrombosis (PVT)

Abstract

Objective: To evaluate the efficacy of color Doppler US and tri-phasic CT in discriminating benign from malignant PVT. Patients and methods: This study included 30 patients presented ultrasonically with PVT and referred for color Doppler US and Tri-phasic CT examination for discriminating the benign from malignant PVT. The color Doppler US and tri-phasic CT results were compared and correlated with available histopathological results in the patients who had FNAC. Results: Those 30 patients were classified according to US, Tri-phasic CT, lab., findings into two groups: G.(A) included 16 patients with malignant PVT and G.(B) included 14 patients with benign PVT. Intrathrombus pulsatile flow was depicted in 12 patients with malignant PVT (12/16) (75%), while non-depicted in 14 patients with benign PVT with 100% specificity. On tri-phasic CT, neovascularity and an early arterial enhancement of PVT were depicted in 14 cases with malignant PVT with 87.5% sensitivity and non-depicted in 14 benign cases with PVT with 100% specificity. Conclusion: Distinguishing benign from malignant PVT in patients with HCC is required to determine the management plan. The color Doppler study of PVT should be an essential step in evaluation of patients with HCC. The combination of Color Doppler US and tri-phasic CT is common and essential for more accurate evaluation and differentiation of benign from malignant PVT.