الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Differentiation between benign and malignant portal vein
thrombosis may be required not only to determine its cause but also to
detect patients with hepatocellular carcinoma for liver transplantation,
because tumoral vascular invasion is an exclusion criterion for this
procedure.
HCC invasion into the portal vein renders a patient unsuitable
for aggressive treatment approaches such as surgical resection, liver
transplantation, or chemo-embolization, due to the unusually high
incidence of tumor recurrence and survival associated with this
finding. Embolic forms of liver-directed therapy for HCC such as
TAE or TACE are relatively contraindicated in HCC patients with
PVT Our study was done on thirty patients with suspected Portal
vein thrombosis by ultrasound and confirmed by triphasic CT,
according to our results, PVT was divided into the following
categories : malignant thrombus (14 cases ),benign thrombus (13 cases
) and cavernous transformation(chronic portal venous thrombosis)(3
cases). 24 patients were males(80%) and 6 were females (20%) with a
mean age of 52.2 years.
The studied groups were processed in the work station of CT
to measure Hounsfield unit of the portal vein thrombus and these data
are acquired to compare with the diagnosis.
Sensitivity of thrombus density in arterial phase 100%,
specificity 93% and accuracy 100%, Sensitivity of thrombus density
in porto-venous phase 100%, specificity 93% and accuracy 100%. The
best cut off value to diagnose malignant thrombus in arterial phase is 47 HU and in porto-venous phase is 50 HU. AUC is more than 0.7 in
arterial and poto-venous phases(significant)
In the current study, All patients with malignant PVT(100%)
showed enhancement of the thrombus in arterial phase and washout in
portovenous phase while all patients with benign PVT and cavernous
transformation showed no enhancement,
from the present study we can conclude that:
Differentiation between benign and malignant portal vein thrombi is
very important in planning strategy of treatment especially liver
transplantation.
Tri-phasic computed tomography (CT) is considered a fundamental
tool for the detection of portal vein thrombosis.It is used worldwide
for the non-invasive assessment of the portal vein
CT attenuation values allow reliable differentiation between
neoplastic and bland thrombi on arterial and portal venous phases.
Sensitivity of thrombus density in arterial phase is 100%, specificity is
93% , Sensitivity of thrombus density in the porto-venous phase is
100%, specificity is 93%