Value of Diffusion-Weighted Imaging in Differentiating Benign from Malignant Portal Vein Thrombosis: A cross-sectional prospective study | ||||
| International Journal of Medical Arts | ||||
| Articles in Press, Accepted Manuscript, Available Online from 30 June 2025 | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/ijma.2025.382092.2177 | ||||
 View on SCiNiTO | ||||
| Authors | ||||
Hadeer Elsayed Elazab Elsayed  1; Rasha Abdelhafiz Aly2; Mohamed Saied Abdel-Gawad3; Muhammad Ahmed Magdy1
| ||||
| 1Diagnostic and Intervention Radiology medical imaging National liver institute - Menoufia University, Egypt | ||||
| 2Radiology Department - National Liver institute - Menoufia University - Shebin Elkom - Menoufia - Egypt | ||||
| 3Department of Diagnostic and Interventional Radiology, National Liver Institute, Menoufia University, Shebin El-Kom, Egypt | ||||
| Abstract | ||||
| Background: It is still difficult to make the noninvasive distinction between tumour invasion and bland clot in portal vein thrombosis (PVT). The histopathologic examination is the gold standard for assessing PVT. However, open laparotomy or percutaneous biopsy have been supplanted by imaging diagnostics in clinical practice to characterise PVT. Aim of the study: to validate diffusion weighted magnetic resonance imaging (MRI) for distinguishing benign from malignant portal vein thrombi. Patients and Methods: a prospective single-center research Diffusion weighted sequences and dynamic liver MRI were performed on 159 adult patients (mean age 60 ± 10 years) with imaging-confirmed PVT. To determine ADC values and signal intensity ratios, regions of interest were positioned in each thrombus and within the adjacent spinal cord. Results: Malignant PVT (n = 129) occurred in older patients than benign PVT (n = 30) (mean age 62.1 ± 7.3 vs 50 ± 13.3 years; p < 0.001). Mean thrombus ADC was significantly lower in malignant PVT (1.2 ± 0.14 × 10⁻³ mm²/s) than benign PVT (1.4 ± 0.05 × 10⁻³ mm²/s; p < 0.001). ROC analysis for ADC yielded an area under the curve (AUC) of 0.677 (p = 0.02) with a cutoff ≤ 1.2 × 10⁻³ mm²/s, achieving 73.2% sensitivity and 56.7% specificity. The ADC ratio (PVT/cord) was also lower in malignant cases (1.6 ± 0.3 vs 1.9 ± 0.36; p < 0.001) but demonstrated poor discriminatory performance (AUC = 0.60; p = 0.453). Conclusions: When combined with mean ADC values, DW MRI is a valuable noninvasive imaging method that is highly effective at characterizing tissue and can be used to distinguish between benign and malignant PVT. The arterial enhancement is strongly correlated with both the ADC value of PVT and the ADC ratio (PVT/cord). | ||||
| Keywords | ||||
| Apparent diffusion coefficient; Benign; Portal vein thrombosis; weighted imaging | ||||
|
Statistics Article View: 34 |
||||
