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© 2006 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 25:1147-1152 • 0278-4297

Characterization of Portal Vein Thrombus With the Use of Contrast-Enhanced Sonography

Norio Ueno, MD, Harunobu Kawamura, MD, Hirokazu Takahashi, MD, Nobutaka Fujisawa, MD, Masato Yoneda, MD, Hiroyuki Kirikoshi, MD, Takashi Sakaguchi, MD, Satoru Saito, MD and Shinji Togo, MD

Division of Endoscopy, Yokohama City University Hospital, Yokohama, Japan (N.U.); and Third Department of Internal Medicine (H.Ka., H.T., N.F., M.Y., H.Ki., T.S., S.S.) and Second Department of Surgery (S.T.), Yokohama City University, School of Medicine, Yokohama, Japan.

Address correspondence to Norio Ueno, MD, Division of Endoscopy, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan. E-mail: nu-1952{at}io.ocn.ne.jp

Objectives. To select an appropriate treatment regimen, it is essential to accurately characterize the nature of a thrombus. This study prospectively assessed the ability of contrast-enhanced sonography to differentiate between benign and malignant portal vein thrombosis in a population of high-risk patients. Methods. Fifty-five patients (43 men and 12 women; mean age, 66 years; range, 55–83 years) with thrombi of the portal venous system were examined by power Doppler sonography and contrast-enhanced sonography with the intravenous contrast agent SH U 508A (Levovist; Schering AG, Berlin, Germany). Of the thrombi, 40 were characterized as malignant and 15 as benign. Pulsatile flow in the thrombus on power Doppler sonography and positive enhancement of the thrombus on contrast-enhanced sonography were judged as indications of a malignant thrombus. The sensitivity and specificity of both methods in differentiating the nature of the thrombus were evaluated. Results. The detection of pulsatile flow in a portal vein thrombus as the criterion for diagnosing malignant portal vein thrombus yielded overall sensitivity of 82.5% and specificity of 100%, whereas positive enhancement of the portal vein thrombus itself as a criterion for diagnosing malignancy yielded overall sensitivity and specificity of 100% for each. Conclusions. Contrast-enhanced sonography can be helpful in discriminating between benign and malignant portal vein thrombi.

Key Words: abdominal imaging • characterization • contrast media • dynamic sonography • portal vein thrombus

Abbreviations: CT, computed tomography • HCC, hepatocellular carcinoma

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