Benign and malignant portal venous thrombosis: Multi-modality

Objective: To evaluate the value of color Doppler, tri-phasic CT and Diffusion weighted magnetic resonance imaging in differentiating benign from malignant portal vein thrombosis. Patients and methods: This study included 50 patients presented ultrasonically with PVT referred for discriminating the benign from malignant PVT. The color Doppler US, tri-phasic CT and MR DWI results were compared and correlated with available histopathological results. Results: Those 50 patients were classified on the bases of imaging criteria and histopathology into two groups: G.(I) included 17 patients with benign PVT and G.(II) included 33 patients with malignant PVT. Intrathrombus pulsatile flow was depicted in 25 patients with malignant PVT (25/33). On tri-phasic CT, neovascularity and early arterial enhancement of PVT were depicted in 28/33 and 29/33 of malignant cases and non-depicted in benign cases with 100% specificity. ADC values for group I was mean + SD (1.1 ± 0.1), median (1.2), and the ADC values for group II was mean + SD (0.7 ± 0.1), median (0.8) with significant P value (0.001). ROC curve revealed cutoff value (⩽1), sensitivity (100%), specificity (82.5%). Conclusion: Distinguishing benign from malignant PVT is required to determine the management plane. The combination of color Doppler US, tri-phasic CT and MR DWI is essential for more accurate evaluation and can obviate FNAC.