Tarantino L, Francica G, Sordelli I, Esposito F, Giorgio A, Sorrentino P, de Stefano G, Di Sarno A, Ferraioli G, Sperlongano P
Hepatology and Interventional Ultrasound Unit, S. Giovanni di Dio Hospital, ASL NA3, Frattaminore, Naples, Italy.
Abdom Imaging. 2006 Sep-Oct;31(5):537-44. doi: 10.1007/s00261-005-0150-x.
We assessed the role of contrast-enhanced ultrasound (CEUS) in the differential diagnosis between benign and malignant portal vein thrombosis in patients who had cirrhosis with hepatocellular carcinoma (HCC).
Fifty-four consecutive patients who had cirrhosis, biopsy-proved HCC, and thrombosis of the main portal vein and/or left/right portal vein on US were prospectively studied with color Doppler US (CDUS) and CEUS. CEUS was performed at low mechanical index after intravenous administration of a second-generation contrast agent (SonoVue, Bracco, Milan, Italy). Presence or absence of CDUS signals or thrombus enhancement on CEUS were considered diagnostic for malignant or benign portal vein thrombosis. Twenty-eight patients also underwent percutaneous portal vein fine-needle biopsy (FNB) under US guidance. All patients were followed-up bimonthly by CDUS. Shrinkage of the thrombus and/or recanalization of the vessels on CDUS during follow-up were considered definitive evidence of the benign nature of the thrombosis, whereas enlargement of the thrombus, disruption of the vessel wall, and parenchymal infiltration over follow-up were considered consistent with malignancy. CDUS, CEUS, and FNB results were compared with those at follow-up.
Follow-up (4 to 21 months) showed signs of malignant thrombosis in 34 of 54 patients. FNB produced a true-positive result for malignancy in 19 of 25 patients, a false-negative result in six of 25 patients, and a true-negative result in three of three patients. CDUS was positive in seven of 54 patients. CEUS showed enhancement of the thrombus in 30 of 54 patients. No false-positive result was observed at CDUS, CEUS, and FNB. Sensitivities of CDUS, CEUS, and FNB in detecting malignant thrombi were 20%, 88%, and 76% respectively. Three patients showed negative CDUS and CEUS and positive FNB results; follow-up confirmed malignant thrombosis in these patients. One patient showed negative CDUS, CEUS, and FNB findings. However, follow-up of the thrombus showed US signs of malignancy. Another FNB confirmed HCC infiltration of the portal vein.
CEUS seems to be the most sensitive and specific test for diagnosing malignant portal vein thrombosis in patients with cirrhosis.
我们评估了超声造影（CEUS）在肝硬化合并肝细胞癌（HCC）患者门静脉良性与恶性血栓形成鉴别诊断中的作用。
对54例连续的肝硬化、经活检证实为HCC且超声显示门静脉主干和/或左/右门静脉血栓形成的患者进行前瞻性彩色多普勒超声（CDUS）和CEUS研究。静脉注射第二代造影剂（声诺维，意大利布雷西亚的博莱科公司）后，以低机械指数进行CEUS检查。根据CEUS上CDUS信号的有无或血栓增强情况诊断门静脉血栓的良恶性。28例患者还在超声引导下接受了经皮门静脉细针穿刺活检（FNB）。所有患者每两个月接受一次CDUS随访。随访期间CDUS上血栓缩小和/或血管再通被视为血栓为良性的明确证据，而随访期间血栓增大、血管壁破坏及实质浸润则被视为与恶性肿瘤相符。将CDUS、CEUS和FNB结果与随访结果进行比较。
随访（4至21个月）显示54例患者中有34例存在恶性血栓形成迹象。FNB在25例患者中有19例得出恶性肿瘤的真阳性结果，25例中有6例为假阴性结果，3例中有3例为真阴性结果。CDUS在54例患者中有7例呈阳性。CEUS显示54例患者中有30例血栓增强。CDUS、CEUS和FNB均未观察到假阳性结果。CDUS、CEUS和FNB检测恶性血栓的敏感性分别为20%、88%和76%。3例患者CDUS和CEUS均为阴性而FNB为阳性；随访证实这些患者存在恶性血栓形成。1例患者CDUS、CEUS和FNB结果均为阴性。然而，对该血栓的随访显示出超声恶性肿瘤迹象。再次FNB证实门静脉有HCC浸润。
CEUS似乎是诊断肝硬化患者门静脉恶性血栓形成最敏感和特异的检查方法。
