Abstract
ObjectivesPortal vein thrombosis (PVT) is a common complication of liver cirrhosis. However, differentiation of thrombosis and tumor-in-vein (TIV) may be challenging. Contrast-enhanced ultrasound (CEUS) is an excellent method for detection of vascularization and could help in the distinction. We performed a systematic review and meta-analysis for evaluating the diagnostic value of CEUS in differentiating between PVT and TIV in hepatocellular carcinoma (HCC) patients.MethodsPubMed, Embase, Cochrane Library, and Web of Science were searched up to the 5th of May 2019. The study quality was assessed by QUADAS-2 tool. Pooled sensitivity and specificity were calculated by the bivariate random effect model and hierarchical summary receiver-operating characteristic (SROC) curve was plotted.ResultsSeven studies including 425 participants were analyzed after screening 986 articles searched from databases. The pooled sensitivity and specificity of CEUS in diagnosing TIV were 0.94 (95%CI, 0.89–0.97) and 0.99 (95%CI, 0.80–1.00), respectively. The area under the curve (AUC) of SROC curve was 0.97 (95%CI, 0.95–0.98). The pooled sensitivity and AUC were consistent across all the subgroups of different subject numbers, country, study design, CEUS contrast agents, and diagnostic criteria.ConclusionsCEUS is highly efficient in differentiating TIV from PVT and is an alternative or a substitute for CT and/or MRI.Trial registrationPROSPERO registration number: CRD42019138847Key Points• Characterization of portal vein thrombosis (PVT) vs tumor-in-vein (TIV) is critical for HCC staging.• CEUS has an excellent safety profile, provides a real-time analysis without any loss in accuracy compared with CT and MRI.• This meta-analysis demonstrates that contrast-enhanced ultrasound (CEUS) is a suitable method for the detection of PVT and distinction with TIV.
Highlights
Portal vein thrombosis (PVT), which is the formation of a thrombus within the portal vein trunk and intrahepatic portal branches, is a common complication of liver cirrhosis [1–3]
According to the Oxford 2011 Levels of Evidence (OCEBM levels) [30], studies enrolled in our meta-analysis provided level 2 or level 3 evidence in evidence-based medicine [31]
As depicted in the results, with low to moderate risk of bias and low applicability concern, contrast-enhanced ultrasound (CEUS) embraces excellent diagnostic accuracy with pooled sensitivity and pooled specificity of 0.94 (95%confidence intervals (CIs), 0.89–0.97) and 0.99 (95%CI, 0.80–1.00), respectively. This demonstrated that CEUS is an ideal modality for portal vein evaluation in suspected or proved hepatocellular carcinoma (HCC) patients
Summary
Portal vein thrombosis (PVT), which is the formation of a thrombus within the portal vein trunk and intrahepatic portal branches, is a common complication of liver cirrhosis [1–3]. PVT prevalence in cirrhotic patients (≥ 26%) increases in advanced liver diseases, such as hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) [4]. Advanced HCC commonly invades the portal vein. In such cases, both PVT and tumor-in-vein (TIV) could be associated. In China, TIV incidence ranged from 44 to 62.2% in HCC patients concomitant with PVT [5]. HCC patients without TIV were defined as Barcelona-Clínic Liver Cancer (BCLC) 0/A/ B, considering related symptoms, liver function, tumor size, and number. HCC patients with TIV are not eligible for resection or liver transplantation. Median survival rate drops down from more than 60 months to less than 11 months [6–9]. They are candidates for sorafenib targeted therapy
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
