Sorrentino Paolo, D'Angelo Salvatore, Tarantino Luciano, Ferbo Umberto, Bracigliano Alessandra, Vecchione Raffaela
Liver Unit, Clinical and Experimental Hepatology, Department of Internal Medicine, S.G. Moscati Hospital, Via Pennini, 83100 Avellino, Italy.
World J Gastroenterol. 2009 May 14;15(18):2245-51. doi: 10.3748/wjg.15.2245.
To clarify which method has accuracy: 2nd generation contrast-enhanced ultrasound or biopsy of portal vein thrombus in the differential diagnosis of portal vein thrombosis.
One hundred and eighty-six patients with hepatocellular carcinoma and portal vein thrombosis underwent in blinded fashion a 2nd generation contrast-enhanced ultrasound and biopsy of portal vein thrombus; both results were examined on the basis of the follow-up of patients compared to reference-standard.
One hundred and eight patients completed the study. Benign thrombosis on 2nd generation contrast-enhanced ultrasound was characterised by progressive hypoenhancing of the thrombus; in malignant portal vein thrombosis there was a precocious homogeneous enhancement of the thrombus. On follow-up there were 50 of 108 patients with benign thrombosis: all were correctly diagnosed by both methods. There were 58 of 108 patients with malignant thrombosis: amongst these, 52 were correctly diagnosed by both methods, the remainder did not present malignant cells on portal vein thrombus biopsy and showed on 2nd generation contrast-enhanced ultrasound an inhomogeneous enhancement pattern. A new biopsy during the follow-up, guided to the area of thrombus that showed up on 2nd generation contrast-enhanced ultrasound, demonstrated an enhancing pattern indicating malignant cells.
In patients with hepatocellular carcinoma complicated by portal vein thrombosis, 2nd generation contrast-enhanced ultrasound of portal vein thrombus is very useful in assessing the benign or malignant nature of the thrombus. Puncture biopsy of thrombus is usually accurate but presents some sampling errors, so, when pathological results are required, 2nd generation contrast-enhanced ultrasound could guide the sampling needle to the correct area of the thrombus.
明确在门静脉血栓形成的鉴别诊断中，第二代超声造影或门静脉血栓活检哪种方法具有更高的准确性。
186例肝细胞癌合并门静脉血栓形成的患者以盲法接受了第二代超声造影检查及门静脉血栓活检；将两种检查结果与参考标准进行比较，并对患者进行随访。
108例患者完成了研究。第二代超声造影显示的良性血栓的特征为血栓逐渐低增强；恶性门静脉血栓则表现为血栓早期均匀增强。随访发现，108例良性血栓患者中有50例：两种方法均正确诊断。108例恶性血栓患者中有58例：其中52例两种方法均正确诊断，其余患者门静脉血栓活检未发现恶性细胞，第二代超声造影显示不均匀增强模式。随访期间，在第二代超声造影显示的血栓区域进行引导下再次活检，结果显示增强模式提示存在恶性细胞。
在肝细胞癌合并门静脉血栓形成的患者中，第二代门静脉血栓超声造影对于评估血栓的良恶性非常有用。血栓穿刺活检通常准确，但存在一些抽样误差，因此，当需要病理结果时，第二代超声造影可引导采样针至血栓的正确区域。
