ROLE OF COLOR DOPPLER ULTRASONOGRAPHY VERSUS TRIPHASIC CT WITH PORTOGRAPHY IN PORTAL VEIN THROMBOSIS

Abstract

Back ground: Although portal vein thrombosis is a rare event among general population, its prevalence in cirrhotic patients about 28 % (1). Generally liver cirrhosis is a widespread disease, the differentiation between bland and malignant thrombus is very essential as neoplastic portal vein thrombosis gravely affects the prognosis and the subsequent treatment options (1). Doppler ultrasonography usually the first noninvasive modality used to diagnose portal vein thrombosis, using color and spectral data analysis. Triphasic CT with portography is very helpful to differentiate bland from malignant thrombus and enable characterization of malignant portal vein thrombosis using maximum intensity projection (MIP) reconstruction allow better analysis of the thrombus (2).Aim of the work: To show the role of color Doppler ultrasonography (US) and Triphasic CT in diagnosis of portal vein thrombosis (PVT) and differentiation between bland and tumoral thrombus.Patient and Methods: This study included 32 cases presented with portal vein thrombosis clinically and radiologically.Results: Of the 32 subjects,21 had malignant PVT and 11 patients had benign PVT. Direct invasion of portal vein from adjacent focal lesion had the highest sensitivity 95.2 % was achieved, with a specificity of 100 %. The Positive predictive value (PPV) was 100 %, while the negative predictive value (NPV) was 91.7 %. Early arterial enhancement and rapid washout of contrast showed 76.2 % sensitivity and 100 % specificity, PPV 100 % and NPV 68.8 %. Pulsatile flow within the thrombus depicted 38.1 % sensitivity, 100 % specificity with PPV 100 % and NPV 45.8 %.Conclusion: Triphasic CT and color Doppler US have to be considered a useful tools in evaluating portal vein thrombosis provides helpful information for the detection and characterization of malignant and benign portal vein thrombi.