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. 2023 Apr 1;13(4):2688-2696.
doi: 10.21037/qims-22-350. Epub 2022 Oct 25.

Value of susceptibility-weighted imaging in differentiating benign from malignant portal vein thrombosis

Chengling Huang #  1 , Xixi Xiao #  2 , Man Guo  1 , Xianling Hu  3 , Chen Liu  1 , Jian Wang  1 , Huarong Zhang  4 , Xiaoming Li  1 , Ping Cai  1
Affiliations

Value of susceptibility-weighted imaging in differentiating benign from malignant portal vein thrombosis

Chengling Huang et al. Quant Imaging Med Surg. .

Abstract

Background: Many diseases are accompanied by portal vein thrombosis (PVT), and its nature is closely related to its prognosis and treatment. It is important to evaluate magnetic resonance imaging (MRI) parameters, including susceptibility-weighted imaging (SWI) and qualitative diffusion-weighted imaging (DWI), in the differentiation between benign and malignant PVT.

Methods: In this retrospective study, we collected clinical imaging data from 140 patients with PVTs characterized as benign or malignant based on enhanced MRI between January 2011 and April 2016 and retrospectively analyzed PVTs using SWI and DWI. There were 37 benign and 103 malignant PVTs. Image review was performed by 2 radiologists blinded to clinical information. The signal intensity (SI) of PVTs was recorded on SWI. The apparent diffusion coefficient (ADC) and the ratio of signal intensity (SIR) on SWI (SIRSWI) and ADC (SIRADC) between the PVTs and the spinal cord were calculated. Finally, we generated receiver operating characteristic (ROC) curves to evaluate the efficacy of SIRSWI and SIRADC for distinguishing benign and malignant PVTs.

Results: On SWI and DWI, 100.0% (36/36) and 80.5% (29/36) of benign PVTs were hypointense, respectively. For malignant PVTs on SWI and DWI, 99.0% (103/104) and 89.4% (93/104) were hyperintense, respectively. The SIRSWI values of benign and malignant PVTs were 0.58±0.13 and 0.88±0.06, respectively, representing a significant difference (P<0.001). The SIRADC values of benign and malignant PVTs were 0.72±0.32 and 0.62±0.17, respectively, representing a significant difference (P=0.034). The area under the ROC curve (AUROC) for SIRSWI [0.990; 95% confidence interval (CI): 0.971-1.000] was significantly higher than that for SIRADC (0.619; 95% CI: 0.500-0.737; P<0.001). The SIRSWI had a sensitivity of 100.0% and a specificity of 97.3% with a cutoff value of 0.749, while the SIRADC had a sensitivity of 45.9% and specificity of 83.3% with a cutoff value of 0.791.

Conclusions: The diagnostic performance of SWI is superior to that of DWI in the differentiation of benign and malignant PVTs.

Keywords: Benign; diffusion-weighted imaging (DWI); malignant; portal vein thrombosis (PVT); susceptibility-weighted imaging (SWI).

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://qims.amegroups.com/article/view/10.21037/qims-22-350/coif). All authors report that this study was supported by the National Key Research and Development Program of China (Nos. 2016YFC0107101 and 2016YFC0107109) and the General Program of National Natural Science Foundation of Chongqing (No. CSTB2022NSCQ-MSX1371). The authors have no other conflicts of interest to declare.

Figures

Figure 1
Figure 1
(A-C) Benign PVT in a 40-year-old woman. PVT (yellow arrow) appears hyperintense on T2WI (A). PVT is also shown on the portal venous phase (yellow arrow) on enhanced MRI (B) and without enhancement during the arterial phase (not shown). The sample image of the ROI placement over the PVT and spinal cord (red circles) on SWI (C). (D-F) Malignant PVT in a 45-year-old man with HCC. PVT (yellow arrow) appears mildly hyperintense on T2WI (D). PVT is also shown on the portal venous phase (yellow arrow) on enhanced MRI (E) and with enhancement during the arterial phase (not shown). The sample image of the ROI placement over the PVT and spinal cord (red circles) on SWI (F). PVT, portal vein thrombosis; T2WI, T2-weighted imaging; MRI, magnetic resonance imaging; ROI, region of interest; SWI, susceptibility-weighted imaging.
Figure 2
Figure 2
(A-C) Benign PVT in a 59-year-old man. PVT (yellow arrow) appears hypointense on T2WI (A). PVT is also shown on the portal venous phase (yellow arrow) on enhanced MRI (B). The sample image of the ROI placement over the PVT and spinal cord (red circles) on the ADC map (C). (D-F) Malignant PVT in a 40-year-old man with cirrhosis and HCC. PVT (yellow arrow) appears mildly hyperintense on T2WI (D). PVT is also shown on the portal venous phase (yellow arrow) on enhanced MRI (E). The sample image of the ROI placement over the PVT and spinal cord (red circles) on the ADC map (F). PVT, portal vein thrombosis; T2WI, T2-weighted imaging; MRI, magnetic resonance imaging; ROI, region of interest; ADC, apparent diffusion coefficient; HCC, hepatocellular carcinoma.
Figure 3
Figure 3
The flowchart of participants thoughout the study. PVT, portal vein thrombosis; MRI, magnetic resonance imaging; SWI, susceptibility weighted imaging; DWI, diffusion weighted imaging.
Figure 4
Figure 4
The SIRSWI of benign and malignant PVTs. The mean SIRSWI was statistically different between benign and malignant PVTs (P<0.001). SIR, signal intensity ratio; SWI, susceptibility-weighted imaging; PVT, portal vein thrombosis.
Figure 5
Figure 5
The SIRADC of benign and malignant PVTs. The mean SIRADC was statistically different between benign and malignant PVTs (P=0.034). SIR, signal intensity ratio; ADC, apparent diffusion coefficient; PVT, portal vein thrombosis.
Figure 6
Figure 6
ROC curve analysis showing the diagnostic accuracy of SWI and DWI for differentiating benign and malignant PVTs. The area under the ROC curve for SIRSWI (0.990; 95% CI: 0.971–1.000) was significantly higher than that for SIRADC (0.619; 95% CI: 0.500–0.737; P<0.001). ROC, receiver operating characteristic; SWI, susceptibility-weighted imaging; DWI, diffusion-weighted imaging; PVT, portal vein thrombosis; CI, confidence interval; ADC, apparent diffusion coefficient.
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