Contrast-enhanced color Doppler US in malignant portal vein thrombosis

Purpose: To assess the role of contrast-enhanced color Doppler US in the di fferential diagnosis of benign and malignant portal vein thrombosis. Material and Methods: Fifty-six patients with portal vein thrombosis underw ent color and power Doppler US examination before and after i.v. injection of galactose-palmitic acid suspension. The criterion for diagnosing the pre sence and extension of thrombosis was the lack of visualization of portal v ein flow in a segment of the portal vein. The criterion for diagnosing mali gnant portal vein thrombosis was the detection of pulsatile arterial flow e ither hepatopetal or hepatofugal, in the thrombus. The US data were correla ted with the types of portal vein thrombosis. Results: Among the 56 patients, there were 40 benign and 16 malignant porta l thromboses. Unenhanced Doppler US detected continuous blood flow in 24 be nign thromboses and pulsatile in 3 malignant thromboses. No flow, either co ntinuous or pulsatile, was detected in 16 cases with benign thrombosis and in 13 cases with malignant thrombosis. Contrast-enhanced Doppler US allowed to assess pulsatile flow in 15 cases with malignant thrombosis (94%). The use of pulsatile flow as diagnostic criterion of malignant thrombosis yield ed a sensitivity of 57% and a specificity of 95% with conventional Doppler US, whereas contrast-enhanced US achieved a sensitivity of 94% and a specif icity of 100%. Conclusion: Contrast-enhanced Doppler US is a reliable diagnostic tool for assessing malignant portal vein thrombosis.