Maruyama Hitoshi, Ishibashi Hiroyuki, Takahashi Masanori, Shimada Taro, Kamesaki Hidehiro, Yokosuka Osamu
Department of Medicine and Clinical Oncology, Chiba University Graduate School of Medicine, Inohana, Chuou-ku, Japan.
Abdom Imaging. 2012 Jun;37(3):431-8. doi: 10.1007/s00261-011-9795-9.
To examine whether intra-thrombus enhancement on contrast-enhanced sonograms can predict the recanalization by anticoagulation for recent portal thrombosis.
This prospective study included 10 patients with a recent portal thrombosis and 20 controls (10 cirrhosis patients and 10 healthy subjects, all without thrombosis). The diagnosis of thrombosis was based on clinical and ultrasound findings. Pre-anticoagulation intra-thrombus enhancement on the contrast-enhanced sonogram was examined with respect to the post-anticoagulation results or portal enhancement in controls.
Complete recanalization was obtained in 4 patients with positive intra-thrombus enhancement. However, in 4 other patients who had a thrombosis showing positive enhancement concurrent with one showing negative enhancement, anticoagulation recanalized the former and failed to recanalize the latter. Mean onset time of contrast enhancement measured from the beginning of hepatic arterial enhancement was significantly longer in the thrombus (6.6 ± 4.3 s, 3-16 s) than in the portal vein of controls (cirrhosis, 4.3 ± 1.4 s, 2-8 s, P = 0.0035; healthy subjects, 2.4 ± 0.6 s, 1-3 s, P < 0.0001). Anticoagulation failed to achieve recanalization in 2 patients with negative intra-thrombus enhancement. Sensitivity and specificity of contrast enhancement for the prediction of post-treatment recanalization was 100%.
Intra-thrombus positive enhancement demonstrated on contrast-enhanced sonograms has promise as a successful predictor of recanalization for the recent portal thrombosis.
探讨对比增强超声检查中血栓内强化情况能否预测近期门静脉血栓形成经抗凝治疗后的再通情况。
本前瞻性研究纳入10例近期发生门静脉血栓形成的患者及20例对照者（10例肝硬化患者和10例健康受试者，均无血栓形成）。血栓形成的诊断基于临床及超声检查结果。根据抗凝治疗后的结果或对照者门静脉强化情况，对对比增强超声检查中抗凝治疗前门静脉血栓内强化情况进行评估。
4例血栓内强化呈阳性的患者实现了完全再通。然而，在另外4例血栓形成患者中，1例强化呈阳性，1例强化呈阴性，抗凝治疗使前者实现了再通，而后者未实现再通。从肝动脉强化开始测量的对比剂增强平均起始时间，血栓组（6.6±4.3秒，3 - 16秒）显著长于肝硬化对照者门静脉（4.3±1.4秒，2 - 8秒，P = 0.0035）及健康受试者门静脉（2.4±0.6秒，1 - 3秒，P < 0.0001）。2例血栓内强化呈阴性的患者抗凝治疗未能实现再通。对比剂增强预测治疗后再通的敏感性和特异性均为100%。
对比增强超声检查显示的血栓内阳性强化有望成为近期门静脉血栓形成再通成功的预测指标。
