Abstract
Objective
To examine whether intra-thrombus enhancement on contrast-enhanced sonograms can predict the recanalization by anticoagulation for recent portal thrombosis.
Methods
This prospective study included 10 patients with a recent portal thrombosis and 20 controls (10 cirrhosis patients and 10 healthy subjects, all without thrombosis). The diagnosis of thrombosis was based on clinical and ultrasound findings. Pre-anticoagulation intra-thrombus enhancement on the contrast-enhanced sonogram was examined with respect to the post-anticoagulation results or portal enhancement in controls.
Results
Complete recanalization was obtained in 4 patients with positive intra-thrombus enhancement. However, in 4 other patients who had a thrombosis showing positive enhancement concurrent with one showing negative enhancement, anticoagulation recanalized the former and failed to recanalize the latter. Mean onset time of contrast enhancement measured from the beginning of hepatic arterial enhancement was significantly longer in the thrombus (6.6 ± 4.3 s, 3–16 s) than in the portal vein of controls (cirrhosis, 4.3 ± 1.4 s, 2–8 s, P = 0.0035; healthy subjects, 2.4 ± 0.6 s, 1–3 s, P < 0.0001). Anticoagulation failed to achieve recanalization in 2 patients with negative intra-thrombus enhancement. Sensitivity and specificity of contrast enhancement for the prediction of post-treatment recanalization was 100%.
Conclusions
Intra-thrombus positive enhancement demonstrated on contrast-enhanced sonograms has promise as a successful predictor of recanalization for the recent portal thrombosis.
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References
Kumar S, Sarr MG, Kamath PS (2001) Mesenteric venous thrombosis. N Engl J Med 45:1683–1688
Chawla Y, Duseja A, Dhiman RK (2009) Review article: the modern management of portal vein thrombosis. Aliment Pharmacol Ther 30:881–894
de Franchis R, on behalf of the Baveno V Faculty (2010) Revising consensus in portal hypertension: report of the Baveno V consensus workshop on methodology of diagnosis and therapy in portal hypertension. J Hepatol 53:762–768
Plessier A, Darwish-Murad S, Hernandez-Guerra M, et al. (2009) Acute portal vein thrombosis unrelated to cirrhosis: a prospective multicenter follow-up study. Hepatology 50:1–9
Condat B, Pessione F, Denninger MH, et al. (2000) Recent portal or mesenteric venous thrombosis: increased recognition and frequent recanalization on anticoagulant therapy. Hepatology 32:466–470
Condat B, Pessione F, Hillaire S, et al. (2001) Current outcome of portal vein thrombosis in adults: risk and benefit of anticoagulant therapy. Gastroenterology 120:490–497
Amitrano L, Guardascione MA, Brancaccio V, et al. (2004) Risk factors and clinical presentation of portal vein thrombosis in patients with liver cirrhosis. J Hepatol 40:736–741
Francoz C, Belghiti J, Vilgrain V, et al. (2005) Splanchnic vein thrombosis in candidates for liver transplantation: usefulness of screening and anticoagulation. Gut 54:691–697
Lencioni R, Piscaglia F, Bolondi L (2008) Contrast-enhanced ultrasound in the diagnosis of hepatocellular carcinoma. J Hepatol 48:848–857
Rossi S, Rosa L, Ravetta V, et al. (2006) Contrast-enhanced versus conventional and color Doppler sonography for the detection of thrombosis of the portal and hepatic venous systems. AJR Am J Roentgenol 186:763–773
Rossi S, Ghittoni G, Ravetta V, et al. (2008) Contrast-enhanced ultrasonography and spiral computed tomography in the detection and characterization of portal vein thrombosis complicating hepatocellular carcinoma. Eur Radiol 18:1749–1756
Maruyama H, Ishibashi H, Takahashi M, et al. (2009) Effect of signal intensity from the accumulated microbubbles in the liver for differentiation of idiopathic portal hypertension from liver cirrhosis. Radiology 252:587–594
Takahashi M, Maruyama H, Ishibashi H, et al. (2011) Contrast-enhanced ultrasound with perflubutane microbubble agent: evaluation of differentiation of hepatocellular carcinoma. AJR Am J Roentgenol 196:W123–W131
Mitchell DG (1990) Color Doppler imaging: principles, limitations, and artifacts. Radiology 177:1–10
Foley WD, Erickson SJ (1991) Color Doppler flow imaging. AJR Am J Roentgenol 156:3–13
Aytekin C, Boyvat F, Kurt A, et al. (2001) Catheter directed thrombolysis with transjugular access in portal vein thrombosis secondary to pancreatitis. Eur J Radiol 39:80–82
Lopera JE, Correa G, Brazzini A, et al. (2002) Percutaneous, transhepatic treatment of symptomatic mesenteric venous thrombosis. J Vasc Surg 36:1058–1067
Hollingshead M, Burke CT, Mauro MA, et al. (2005) Transcatheter thrombolytic therapy for acute mesenteric and portal vein thrombosis. J Vasc Inter Radiol 6:651–661
Lautt WW, Legare DJ, Ezzat WR (1990) Quantitation of the hepatic arterial buffer response to graded changes in portal blood flow. Gastroenterology 98:1024–1028
Dodd GD III, Memel DS, Baron RL, et al. (1995) Portal vein thrombosis in patients with cirrhosis: does sonographic detection of intrathrombus flow allow differentiation of benign and malignant thrombus? AJR Am J Roentgenol 165:573–577
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Maruyama, H., Ishibashi, H., Takahashi, M. et al. Prediction of the therapeutic effects of anticoagulation for recent portal vein thrombosis: a novel approach with contrast-enhanced ultrasound. Abdom Imaging 37, 431–438 (2012). https://doi.org/10.1007/s00261-011-9795-9
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DOI: https://doi.org/10.1007/s00261-011-9795-9