The Efficacy of Diffusion MRI in Differentiating Bland and Malignant Portal Vein Thrombosis in Hepatic Patients Using ADC Values

Document Type : Original Article

Authors

1 Radiology department, Faculty of medicine, Ain Shams University, Cairo, Egypt

2 Department of radiology, Faculty of Medicine, Ain Shams University

3 Faculty of Medicine Ain Shams University

Abstract

Background: Portal vein thrombosis may occur because of various hepatic or systemic conditions such as liver cirrhosis,
neoplasms, inflammatory disorders and coagulopathy. Patients having cirrhosis or hepatic focal lesions may develop PVT,
which could be either bland or malignant. Detecting malignant PVT plays a vital role in tumour staging, deciding treatment
options, and predicting patient outcomes.
Aim: This work goals to evaluate the efficacy of diffusion MRI in distinguishing between bland and malignant PVT in hepatic
patients by measuring the ADC value.
Material & method: The present retrospective study was performed on 35 patients confirmed, either pathologically or
radiologically, to have hepatic focal lesions accompanied by visualized PVT based on the accepted radiological criteria.
Patients were divided to benign and malignant PVT groups and the ADC values and ratios were calculated in the focal lesion
and the thrombus.
Results: The ADC value of the portal vein thrombus showed a significant difference between the malignant and benign groups,
scoring a cut off value at 1.3 which is convenient in differentiating between bland and malignant thrombi. The ADC ratio
between the hepatic lesion and the thrombus also was found to have a significant difference at a cut off value at 1.2.
Conclusion: Diffusion MRI is a reliable method that can help in differentiating malignant and bland PVT by measuring the
ADC value and ratio between the ADC of the PV thrombus and the hepatic focal lesion, yet dynamic contrast enhanced MRI
or CT is still the standard used in practice with the aid of LI-RADS.

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