Division of Gastroenterology and Hepatology, University of California, San Francisco, CA.
Radiology and Biomedical Imaging, University of California, San Francisco, CA.
Liver Transpl. 2019 Feb;25(2):207-216. doi: 10.1002/lt.25345.
Differentiating tumor versus bland portal vein thrombosis (PVT) is essential in determining liver transplantation (LT) candidacy for patients with hepatocellular carcinoma (HCC). We aimed to evaluate radiographic and clinical features that could noninvasively distinguish tumor PVT from bland PVT in HCC patients. Of 467 patients with HCC listed for LT from 2004 to 2011, 59 (12.6%) had PVT and 12 of 59 (20.3%) were deemed malignant. When comparing tumor versus bland PVT, thrombus enhancement was seen in 100% versus 8.5%; venous expansion was seen in 91.7% versus 10.6%; neovascularity was seen in 58.3% versus 2.1%; and being adjacent to HCC or prior treatment site was seen in 100% versus 21.3% (all P < 0.001). Combining these 4 imaging characteristics with alpha-fetoprotein (AFP) >1000 ng/dL, the presence of ≥3 criteria best characterized tumor PVT with 100% sensitivity, 93.6% specificity, 80% positive predictive value, and 100% negative predictive value. No LT recipients with presumed bland PVT had macrovascular invasion on explant. There were no differences in post-LT survival or HCC recurrence with bland PVT versus no PVT. In conclusion, we proposed noninvasive criteria that could accurately differentiate tumor PVT from bland PVT called A-VENA, which is based on the presence of ≥3 of the following: AFP >1000 ng/dL; venous expansion; thrombus enhancement; neovascularity; and adjacent to HCC. Use of the A-VENA criteria can assist in standardizing the evaluation of PVT in patients with HCC being considered for LT.
区分肿瘤性门静脉血栓形成（PVT）与非肿瘤性门静脉血栓形成（PVT）对于确定肝细胞癌（HCC）患者的肝移植（LT）候选资格至关重要。我们旨在评估放射影像学和临床特征，以便能够无创地区分 HCC 患者的肿瘤性 PVT 与非肿瘤性 PVT。2004 年至 2011 年期间，共有 467 例 HCC 患者被列入 LT 名单，其中 59 例（12.6%）发生 PVT，59 例中的 12 例（20.3%）被认为是恶性的。在比较肿瘤性 PVT 与非肿瘤性 PVT 时，100%的血栓增强，8.5%的静脉扩张；58.3%的新生血管形成，2.1%的非肿瘤性 PVT；100%与 HCC 相邻或既往治疗部位，21.3%的非肿瘤性 PVT（均 P < 0.001）。将这 4 种影像学特征与甲胎蛋白（AFP）>1000ng/dL 相结合，当存在≥3 个标准时，最好能将肿瘤性 PVT 特征化，其敏感性为 100%，特异性为 93.6%，阳性预测值为 80%，阴性预测值为 100%。在肝移植标本中，没有被认为是单纯性 PVT 的 LT 受者有大血管侵犯。与无 PVT 相比，单纯性 PVT 与 LT 后生存或 HCC 复发无差异。总之，我们提出了一种可以准确区分肿瘤性 PVT 与非肿瘤性 PVT 的无创标准，称为 A-VENA，该标准基于以下≥3 项标准的存在：AFP>1000ng/dL；静脉扩张；血栓增强；新生血管形成；以及与 HCC 相邻。A-VENA 标准的使用可以帮助标准化评估 HCC 患者 LT 前的 PVT。
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