Malign ile benign portal ven trombozunun ayrımında 3 Tesla manyetik rezonans görüntülemede difüzyon ağırlıklı görüntülemenin rolü

Abstract

Background and Aims: The purpose of this study was to evaluate the use of diffusion-weighted imaging at 3 Tesla magnetic resonance imaging in differentiating malignant from benign portal vein thrombo- sis. Materials and Method: Abdominal magnetic resonance imaging examinations obtained at 3 Tesla magnetic resonance imaging unit be- tween January 2011 and December 2016 were reviewed retrospective-ly to identify the cases with portal vein thrombosis. Portal vein thrombosis was considered malignant if it enhanced ≥15% on arterial phase contrast-enhanced images relative to precontrast images. Moreover, the diameter of the portal vein involved with the thrombus was mea-sured, and the signal intensity of the portal vein thrombosis on diffu- sion-weighted images was recorded. The apparent diffusion coefficient values for malignant and benign portal vein thrombosis were calculated by two independent readers. Results: In this study, 23 patients with malignant portal vein thrombosis [19 men, 4 women; median age 63 years (52–83)] and 14 patients with benign portal vein thrombosis (5 men, 9 women; median age 65 years 47–82)] were identified. Statis-tically significant difference was observed in signal intensity on diffu-sion-weighted images (p < 0.05) between malignant and benign portal vein thrombosis. The mean apparent diffusion coefficient values for malignant portal vein thrombosis were significantly lower than those for benign portal vein thrombosis (p < 0.05). Furthermore, there was a high agreement on the calculation of apparent diffusion coefficient values (R 1 : 0.948) between the two readers. Sensitivity and specifici- ty values were both 100% for the diagnosis of malignant portal vein thrombosis when the apparent diffusion coefficient value was ≤1.4 x 10 –3 mm 2 /s. Conclusion: Thus, diffusion-weighted imaging at 3 Tesla magnetic resonance imaging is beneficial for the differentiation of malignant and benign portal vein thrombosis. Characterization of portal vein thrombosis using its signal intensity on diffusion-weighted images and apparent diffusion coefficient values is important in patients in whom the use of contrast media is contraindicated.