Korean J Radiol.  2016 Aug;17(4):533-540. 10.3348/kjr.2016.17.4.533.

Diffusion-Weighted MRI of Malignant versus Benign Portal Vein Thrombosis

• Ahn JH
• Yu JS
• Cho ES
• Chung JJ
• Kim JH
• Kim KW

• KMID: 2455423
• DOI: http://doi.org/10.3348/kjr.2016.17.4.533

Abstract

OBJECTIVE
To validate the diffusion-weighted MRI (DWI) for differentiation of benign from malignant portal vein thrombosis.
MATERIALS AND METHODS
The Institutional Review Board approved this retrospective study and waived informed consent. A total of 59 consecutive patients (52 men and 7 women, aged 40-85 years) with grossly defined portal vein thrombus (PVT) on hepatic MRI were retrospectively analyzed. Among them, liver cirrhosis was found in 45 patients, and hepatocellular carcinoma in 47 patients. DWI was performed using b values of 50 and 800 sec/mm2 at 1.5-T unit. A thrombus was considered malignant if it enhanced on dynamic CT or MRI; otherwise, it was considered bland. There were 18 bland thrombi and 49 malignant thrombi in 59 patients, including 8 patients with simultaneous benign and malignant PVT. Mean apparent diffusion coefficients (ADCs) of benign and malignant PVTs were compared by using Mann-Whitney U test. Diagnostic accuracy was evaluated using receiver operating characteristic (ROC) curve analysis.
RESULTS
The mean ADC ± standard deviation of bland and malignant PVT were 1.00 ± 0.39 × 10(-3) mm2/sec and 0.92 ± 0.25 × 10(-3) mm2/sec, respectively; without significant difference (p = 0.799). The area under ROC curve for ADC was 0.520. An ADC value of > 1.35 × 10(-3) mm2/sec predicted bland PVT with a specificity of 94.6% (95% confidence interval [CI]: 84.9-98.9%) and a sensitivity of 22.2% (95% CI: 6.4-47.6%), respectively.
CONCLUSION
Due to the wide range and considerable overlap of the ADCs, DWI cannot differentiate the benign from malignant thrombi efficiently.

Keyword

Portal vein thrombosis; MRI; Diffusion weighted MRI; Apparent diffusion coefficient; Diagnosis; Hepatoma; Hepatocellular carcinoma

MeSH Terms

Adult
Aged
Aged, 80 and over
Area Under Curve
Carcinoma, Hepatocellular/*diagnosis/diagnostic imaging
Diagnosis, Differential
*Diffusion Magnetic Resonance Imaging
Female
Humans
Liver Neoplasms/*diagnosis/diagnostic imaging
Male
Middle Aged
Portal Vein/*diagnostic imaging
ROC Curve
Retrospective Studies
Sensitivity and Specificity
Venous Thrombosis/*diagnosis/diagnostic imaging

Figure

• 

  Fig. 1 Patient flow chart. BT = benign thrombosis, HCC = hepatocellular carcinoma, LC = liver cirrhosis, PVT = portal vein thrombosis, TT = tumor thrombosis

• 

  Fig. 2 Box plot showing ADC (× 10-3 mm2/sec) of bland and malignant portal vein thrombi (PVT). There is no significant difference between bland and malignant thrombi (p = 0.799). ADC = apparent diffusion coefficient

• 

  Fig. 3 Bland thrombosis of portal vein in 65-year-old man without underlying disease. Filling defect is noted in right portal vein (arrows) on portal phase (B) contrast-enhanced MRI, which shows no enhancement on subtraction image (A). Portal vein thrombosis exhibits central high SI (arrows) with peripheral low SI (arrowheads) at DWI (b = 800 sec/mm2) (C) and central low ADC value (0.86 × 10-3 mm2/sec) (arrows) with peripheral high ADC value (arrowheads) on corresponding ADC map (D). Peripheral bright region on ADC map representing vessel wall or increased capillary flow by formation of collateral vessels. ADC = apparent diffusion coefficient, DWI = diffusion-weighted MRI, SI = signal intensity

• 

  Fig. 4 Bland and malignant thrombus in 58-year-old man with liver cirrhosis and infiltrative HCC. Arterial phase contrast-enhanced MRI (A) and subtraction image (B) show infiltrative HCC (*) in left hepatic lobe and enhancing thrombus in right portal vein (arrows). HCC and portal vein tumor thrombus display similar high SI on DWI (b = 800 sec/mm2) (C) and low ADC value on corresponding ADC map (D). Non-enhancing bland thrombus (arrowheads) is also seen in main portal vein (E, F). Bland thrombus shows low SI on DWI (b = 800 sec/mm2) (G) and low ADC value on corresponding ADC map (H). Tumor thrombus (1.06 × 10-3 mm2/sec) shows higher ADC value than benign thrombus (0.73 × 10-3 mm2/sec) on ADC map. ADC = apparent diffusion coefficient, DWI = diffusion-weighted MRI, HCC = hepatocellular carcinoma, SI = signal intensity

• 

  Fig. 5 Receiver operating characteristic curve analyses showing diagnostic accuracy of ADC value for differentiating between bland and malignant PVT. Area under curve was 0.520. When threshold ADC value of greater than 1.35 × 10-3 mm2/sec, sensitivity and specificity of diagnosis of bland PVT were 22.2% (95% confidence interval [CI]: 6.4–47.6%) and 94.6% (95% CI: 84.9–98.9%), respectively. ADC = apparent diffusion coefficient, PVT = portal vein thrombosis, ROC = receiver operating characteristic

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