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Portal vein thrombosis in patients with chronic liver diseases: From conventional to quantitative imaging
C Sofia1, A Cattafi1, S Silipigni1
1Department of Biomedical Sciences and Morphologic and Functional Imaging, Policlinico Universitario G.Martino, University of Messina, Messina, Italy.
Insights
Portal vein thrombosis, a liver disease complication, is often found incidentally. Advanced imaging techniques offer improved detection and characterization of this condition.
Area of Science:
- Radiology
- Hepatology
- Vascular Imaging
Background:
- Portal vein thrombosis (PVT) involves the occlusion of the portal vein and its intrahepatic branches, frequently linked to chronic liver diseases.
- PVT is often asymptomatic, discovered incidentally during chronic hepatopathy monitoring.
- Accurate imaging is crucial for detecting and characterizing PVT, especially in hepatocellular carcinoma patients.
Purpose of the Study:
- To provide a comprehensive overview of the primary imaging features of portal vein thrombosis.
- To highlight the role of various imaging modalities in PVT diagnosis and management.
Main Methods:
- Review of current imaging techniques for portal vein thrombosis detection and characterization.
- Discussion of limitations of conventional ultrasound and contrast-enhanced imaging.
- Exploration of advanced functional and quantitative imaging approaches.
Main Results:
- Ultrasound and Color-Doppler ultrasound are initial diagnostic tools but have operator-dependent limitations.
- Contrast-enhanced imaging identifies PVT as a filling defect, aiding differentiation of thrombus types but not always malignancy.
- Functional and quantitative imaging techniques show greater accuracy in PVT assessment.
Conclusions:
- Imaging is essential for diagnosing portal vein thrombosis in liver disease patients.
- While conventional methods have limitations, advanced imaging techniques improve diagnostic accuracy.
- Further research into functional and quantitative imaging is warranted for optimal PVT characterization.
Abstract:
Portal vein thrombosis is a pathological condition characterized by the lumen occlusion of the portal vein and its intrahepatic branches, commonly associated to chronic liver diseases. Portal vein thrombosis is often asymptomatic and discovered as an incidental finding in the follow-up of chronic hepatopathy. Imaging plays a pivotal role in the detection and characterization of portal vein thrombosis in patients with hepatocellular carcinoma. Ultrasound and Color-Doppler ultrasound are usually the first-line imaging modalities for its detection, but they have limits related to operator-experience, patient size, meteorism and the restrained field-of view. Unenhanced cross-sectional imaging doesn't provide specific signs of portal vein thrombosis except under certain specific circumstances. Conventional contrast-enhanced imaging can depict portal vein thrombosis as an endoluminal filling defect best detected in venous phase and can differentiate between non-neoplastic and neoplastic thrombus based on the contrast enhanced uptake, but not always rule-out the malignant nature. Functional and quantitative imaging techniques and software seem to be more accurate. The purpose of this work is to provide the reader with an accurate overview focused on the main imaging features of portal vein thrombosis.
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