Portal Vein Thrombosis Diagnosis in Hepatocellular Carcinoma
Summary
Portal vein thrombosis (PVT) is a frequent and clinically significant complication of hepatocellular carcinoma (HCC), arising either from bland clot formation or direct tumour invasion known as tumour-in-vein (TIV). Distinction between benign and neoplastic thrombi is crucial for accurate staging, prognostication and selection of appropriate therapies, including surgical resection, locoregional treatments or systemic agents. Conventional cross-sectional imaging techniques such as contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) remain the mainstays of detection, relying on patterns of enhancement and washout to characterise intravascular lesions. However, limitations arise in patients with impaired renal function or indeterminate enhancement profiles. Emerging modalities and combined diagnostic algorithms now incorporate advanced ultrasound techniques, molecular imaging and quantitative biomarkers to improve sensitivity and specificity. Integration of serum markers, notably alpha-fetoprotein levels, with dynamic imaging scores has yielded composite tools that refine diagnostic confidence. Recent advances have also explored tissue stiffness measurement and metabolic activity assessment to further distinguish malignant from benign PVT. Ongoing developments aim to streamline non-invasive workflows, reduce reliance on ionising radiation and expedite clinical decision-making, ultimately enhancing patient outcomes in a condition with historically poor prognosis.
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Portal Vein Thrombosis Diagnosis in Hepatocellular Carcinoma publication trend
The graph below shows the total number of articles in portal vein thrombosis diagnosis in hepatocellular carcinoma across all publications each year (not limited to Nature Index journals).
Technical terms
Portal vein thrombosis (PVT): Obstruction of the portal vein by blood clot, which may be benign or invade from a tumour.
Tumour-in-vein (TIV): Neoplastic extension of hepatocellular carcinoma into the lumen of the portal vein.
Contrast-enhanced ultrasound (CEUS): Ultrasound imaging performed with microbubble contrast agents to characterise vascular patterns in real time.
18F-FDG PET/CT: Hybrid imaging combining positron emission tomography with 18F-fluorodeoxyglucose and CT to evaluate metabolic activity in tissues.
Shear wave elastography (SWE): Ultrasound-based technique measuring tissue stiffness by assessing the speed of mechanically generated shear waves.
Alpha-fetoprotein (AFP): Serum biomarker often elevated in hepatocellular carcinoma, used in conjunction with imaging for risk stratification.
SUVmax: Maximum standard uptake value, a semi-quantitative PET metric reflecting the highest regional metabolic activity within a lesion.
References
- Contrast-enhanced ultrasound for the characterization of portal vein thrombosis vs tumor-in-vein in HCC patients: a systematic review and meta-analysis. European Radiology (2020).
- The role of 18F-FDG PET/CT in distinguishing benign from malignant portal vein thrombosis. Egyptian Journal of Radiology and Nuclear Medicine (2023).
- The role of shear wave elastography in differentiation between benign and malignant portal vein thrombosis in hepatocellular carcinoma. Egyptian Journal of Radiology and Nuclear Medicine (2022).
- Usefulness of Imaging and Biological Tools for the Characterization of Portal Vein Thrombosis in Hepatocellular Carcinoma. Diagnostics (2022).
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