The Presence of Portal Vein Thrombosis Alters the Classic Enhancement Associated with Diagnosis of Hepatocellular Carcinoma
The Presence of Portal Vein Thrombosis Alters the Classic Enhancement Associated with Diagnosis of Hepatocellular Carcinoma
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DOI：
10.1007/s10620-015-3587-y
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发表时间：
2015-07-01
影响因子：
3.1
通讯作者：
Kwo, Paul Y.
中科院分区：
文献类型：
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作者：
Umar, Nadia K.;Badshah, Maaz B.;Kwo, Paul Y.
确定门静脉血栓形成（PVT）是否存在，其中肝脏内静脉流动可能被改变，可能延迟HCC的诊断，并与更晚期的疾病相关。我们将诊断为肝细胞癌的PVT患者与未诊断为PVT的患者进行了比较，分析了PVT患者的发病率和影像学特征。这是一项单中心回顾性研究，研究了一组接受动态影像学筛查并发现有PVT的HCC患者，数据包括人口统计学数据、TNM分期、扫描次数/类型、AFP水平、MELD评分和诊断时间。本文回顾了82例经筛查新诊断为HCC的患者，其中37%（30/82）发现有门静脉血栓形成。与没有PVT的患者相比，PVT患者与HCC相关的非典型影像学发生率更高（83%对56%，p = 0.01），门静脉冲洗率更低（23%对50%，p = 0.018）。有PVT和HCC的患者也比没有PVT的患者在TNM晚期被诊断出来（70% vs 23%, p < 0.001），接受原位肝移植的可能性也显著降低（3.6% vs 42%, p < 0.001）。14例患者既往存在无HCC的PV血栓；16例在筛查或诊断时出现PVT。先前存在PVT的患者年龄较大（63岁）。与未存在PVT的患者相比，MRI对HCC的诊断率更高（79% vs 21% CT, p = 0.01）。动态成像发现PVT与诊断时HCC的晚期相关。临床医生应高度怀疑在pvt背景下出现不典型强化的新发肝病变的HCC诊断。在这种情况下，MRI更常与HCC诊断相关。
To determine whether the presence of portal vein thrombosis (PVT) where venous flow within the liver may be altered may delay the diagnosis of HCC and be associated with more advanced disease. We characterized the incidence and imaging characteristics of patients diagnosed with hepatocellular carcinoma in a cohort of patients with PVT compared with those without PVT.This is a single-center retrospective study of a subset of HCC patients who underwent dynamic imaging for HCC screening and were found to have PVT. Data abstracted included demographic data, TNM stage, number/type of scans, AFP level, MELD score, and time to diagnosis.Eighty-two patients newly diagnosed with HCC on screening were reviewed, of which 37 % (30/82) were found to have portal vein thrombosis. Patients with PVT had higher rates of atypical imaging associated with HCC compared with those without PVT (83 vs 56 %, p = 0.01) and had lower rates of portal venous washout (23 % vs 50 %, p = 0.018). Patients with PVT and HCC were also diagnosed at later TNM stage than those without PVT (70 vs 23 %, p < 0.001) and were significantly less likely to receive orthotopic liver transplant (3.6 vs 42 %, p < 0.001). Fourteen patients had preexisting PV clot without HCC; 16 developed PVT during screening or at diagnosis. Those with preexisting PVT were older (63. vs 55 years) and had higher rates of diagnosis of HCC using MRI (79 vs 21 % with CT, p = 0.01), compared with those without preexisting PVT.The presence of PVT found on dynamic imaging was associated with advanced stage of HCC at the time of diagnosis. Clinicians should have a high suspicion for HCC diagnosis in new liver lesions with atypical enhancement in the setting of PVT. In this setting, MRI was more frequently associated with HCC diagnosis.