Differentiation of neoplastic from bland macroscopic portal vein thrombi using dual-energy spectral CT imaging: a pilot study

Objectives

To assess the feasibility and value of dual-energy spectral computed tomography (DESCT) imaging for differentiating neoplastic from bland macroscopic portal vein (PV) thrombi.

Methods

Computed tomography (CT) images of 44 patients with macroscopic PV thrombus (bland group, n?=?16; neoplastic group, n?=?28) were reviewed. Iodine-based material decomposition images in the portal venous phase were reconstructed to compare the iodine indices between groups, including thrombus iodine density (I _T), thrombus–aorta iodine density ratio (I _T/I _A), and thrombus–PV iodine density ratio (I _T/I _P). Differential diagnostic performances of DESCT were calculated in the subgroup of 21 patients with histopathological evidence (bland group, n?=?12; neoplastic group, n?=?9).

Results

The iodine indices of the neoplastic group were significantly higher than those in the bland group (P?I _T of 1.14?mg/mL, I _T/I _A of 0.17, and I _T/I _P of 0.17 in the portal venous phase yielded 100?%, 88.9?%, and 100?% sensitivity, and 91.7?%, 91.7?%, and 83.3?% specificity, respectively, in differentiating neoplastic from bland PV thrombi.

Conclusions

DESCT imaging with quantification of thrombus iodine density in the portal venous phase appears to be a promising new method for distinguishing neoplastic from bland macroscopic PV thrombi.

Key Points

? Differentiating the nature of portal vein thrombus is of great clinical significance. ? Iodine-based material decomposition imaging reflects iodine distribution after contrast media administration. ? Dual-energy CT with iodine quantification can distinguish bland from neoplastic PV thrombi.