Diagnostic Role of Contrast-enhanced Ultrasound in the Discrimination of Malignant Portal Vein Thrombosis in Patients With Hepatocellular Carcinoma.

Background/Aim: To investigate the accuracy of contrast-enhanced ultrasound (CEUS) in differentiating benign and malignant portal vein thrombosis (PVT) complicating hepatocellular carcinoma (HCC), compared to diffusion-weighted magnetic resonance imaging (DWI). Patients and Methods: Forty-nine patients with HCC who had PVT were enrolled. The quantitative and qualitative parameters of CEUS were analysed. We examined the diagnostic performance of CEUS compared with DWI. The relationships between CEUS parameters and biomarkers were also assessed. Results: All qualitative CEUS parameters (e.g., arterial-phase enhancement, washout in the venous phase, vessel occlusion, and expansion) were significantly more common in malignant thrombosis than in benign thrombosis (p<0.05). Among the quantitative CEUS parameters, increased area under the time-intensity curve, prolonged time for full width at half maximum, and prolonged rise time were observed in malignant thrombosis, compared to benign thrombosis (p<0.05). CEUS and DWI performed similarly in discriminating between malignant and benign thrombi (p>0.05). Several CEUS parameters exhibited significant correlations with the tumour marker and stage (p<0.05). Conclusion: CEUS was useful for characterisation of PVT and showed a consistent high diagnostic accuracy, compared to DWI.