Benign and malignant portal venous thrombosis: Multi-modality imaging evaluation

Objective: To evaluate the value of color Doppler, tri-phasic CT and Diffusion weighted magnetic resonance imaging in differentiating benign from malignant portal vein thrombosis. Patients and methods: This study included 50 patients presented ultrasonically with PVT referred for discriminating the benign from malignant PVT. The color Doppler US, tri-phasic CT and MR DWI results were compared and correlated with available histopathological results. Results: Those 50 patients were classified on the bases of imaging criteria and histopathology into two groups: G.(I) included 17 patients with benign PVT and G.(II) included 33 patients with malignant PVT. Intrathrombus pulsatile flow was depicted in 25 patients with malignant PVT (25/33). On tri-phasic CT, neovascularity and early arterial enhancement of PVT were depicted in 28/33 and 29/33 of malignant cases and non-depicted in benign cases with 100% specificity. ADC values for group I was mean + SD (1.1 +/- 0.1), median (1.2), and the ADC values for group II was mean + SD (0.7 +/- 0.1), median (0.8) with significant P value (0.001). ROC curve revealed cutoff value (61), sensitivity (100%), specificity (82.5%). Conclusion: Distinguishing benign from malignant PVT is required to determine the management plane. The combination of color Doppler US, tri-phasic CT and MR DWI is essential for more accurate evaluation and can obviate FNAC. (C) 2016 The Egyptian Society of Radiology and Nuclear Medicine. Production and hosting by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).