Published in:
01-10-2012 | Hepatobiliary-Pancreas
Differentiation of neoplastic from bland macroscopic portal vein thrombi using dual-energy spectral CT imaging: a pilot study
Published in: European Radiology | Issue 10/2012
Login to get accessAbstract
Objectives
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.
Key Points
•
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.