Contrast-enhanced ultrasound beats CT in diagnosis of portal vein thrombosis in liver cancer

Contrast-enhanced ultrasound detected portal vein thrombosis far better than CT in cases complicating hepatocellular carcinoma. While CT found only 68% of thrombi, contrast-enhanced ultrasound identified every one in the study. It also did a far better job of helping determine if they were malignant.

Dr. Sandro Rossi and colleagues at the IRCCS Policlinico "S. Matteo" in Golgi, Italy, and Sunnybrook Health Science Centre in Toronto studied 50 patients diagnosed with hepatocellular carcinoma complicated by portal vein thrombosis. They published their study in European Radiology, which made it available online March 28.

In 37 cases, the thrombi involved segmental branches. The other 13 cases involved the main portal trunk. Each diagnosis was confirmed with biopsy, which also showed that 44 of the 50 thrombi were malignant.

Researchers performed CT scans and contrast-enhanced ultrasound exams the same week as the corresponding biopsies. Experienced readers under blinded conditions checked each exam for the presence of portal vein thrombosis and rated findings as either malignant or benign.

The researchers then compared these ratings with the biopsy results to determine accuracy. CT exams detected only 34 of the 50, or 68% of thrombi. Readers correctly characterized the malignancy of only 23 of these 34, or 68%.

Contrast-enhanced ultrasound detected all 50, or 100%, of thrombi. Readers correctly characterized the malignancy of 49 of the 50, or 98%.

The researchers concluded that contrast-enhanced ultrasound is significantly superior to CT when used in detecting and characterizing portal vein thrombosis as a complication of hepatocellular carcinoma. They recommend its use in the staging of these tumors.