The Identification Of The Nature Of Portal Vein Thrombosis In Contrast-enhanced Ultrasound And The Study Of Untypical Hepatic Carcinoma In CEUS

Part One：The Value of Color Doppler Flow Imaging and Contrast-enhanced Ultrasound inthe Identification of the Nature of Portal Vein ThrombosisObjective To evaluate the value of Color Doppler Flow Imaging(CDFI) andContrast-enhanced Ultrasound(CEUS) in the identification of the nature of portal veinthrombosis.Methods The images of Color Doppler Flow Imaging and Contrast-enhancedUltrasonud of33patients (25men and8women) with portal vein thrombosis (PVT)were retrospectively analyzed. There were20complete embolizations and13partialembolizations of CDFI in33PVTs and there were all no flow signal. CEUS displayedenhancement of23PVTs in the arterial phase, followed by “washout” in the portaland delayed phases, and no enhancement of the other10PVTs was represented in allthree phases in CEUS.Results The33PVTs included23portal vein tumor thromboses (17complete embolizations and6partial embolizations) and10portal vein blood thromboses (3complete embolizations and7partial embolizations). The rate of the completeembolization in the portal vein tumor thromboses was higher than in the portal veinblood thromboses,which was significantly different.It indicated that completeembolizations were more usual in the tumor thromboses and more partialembolizations happened in the blood thromboses. Moreover CDFI found that moretumor thromboses located in the branches of portal vein with higher and uneven echo,while blood thromboses were opposite and occurred secondary to splenectomy andliver cirrhosis. CEUS mainly showed the “wash-in” and “wash-out” of the tumorthromboses and no enhancement of the blood thromboses. There was a relationship ofthe enhancement patterns between23portal vein tumor thromboses and hepaticprimary tumors:typical enhancement was displayed in13hepatic primary tumors(12portal vein tumor thromboses were entirely increasing and1was locallyincreasing);untypical enhancement was seen in other10hepatic primary tumors(4portal vein tumor thromboses were entirely increasing and6were locallyincreasing).The difference was statistically significant.Conclusion CDFI can help to diagnosis the nature of the PVTs and CEUS is moresignificant in the differential diagnosis of the nature of the PVTs. Part Two:The Study of Untypical Hepatic Carcinoma in CEUS and the EnhancementPattern of Uncommon Hepatic Focal LesionsObjective To explore the differential diagnosis of untypical hepatic carcinoma incontrast-enhanced ultrasound(CEUS) and the enhancement pattern of uncommon hepatic focal lesions.Methods View the mode of the contrast-enhanced ultrasound of89hepatic focallesions.Record the enhancement,vanishment and the echo change of the lesions.Analyse the differential diagnosis of untypical performance of hepatic carcinoma inCEUS and the enhancement patterns of uncommon hepatic focal lesions.Results①Hepatocellular carcinomas(HCC) of high or moderate pathologic gradingdegraded lately,moreover the difference was statistically significant with the lowpathologic grading ones.Delayed vanishment could be seen in the portal and latephases in the small and massive hepatocellular carcinomas.②The number of thevessels around the Intrahepatic cholangiocarcinoma(ICC) increased and the vesselsstretched inwardly.③Metastatic hepatic cancinoma(MLC) displayed annularenhancement in the poorly vascularized ones and entirely increased in the richlyvascularized ones.④Hepatic hemangioma(HCH) showed peripherally nodularlyannular enhancement, stretching inwardly and vanishing slowly.No enhancementhappened in HCH where blood thromboses or fatty degenerationexisted.⑤Inflammatory pseudotumor of the liver(IPL) could be similar to HCC inCEUS while IPL had several kinds of enhancement patterns.⑥Hepaticangiomyolipoma(HAML) tended to be highly increased in the portal and delayedphases and degraded slowly.⑦The echo of the solid portion in the liver cystadenomaincreased in the arterial phase and reduced in the portal and delayed phases. Noenhancement was noticed in the liver cysts with old hemorrhage in sac in the threephases.⑧Hepatic lymphoma(HL) showed hypoperfusion compared with surroundingliver tissue.⑨Focal nodular hyperplasia(FNH) was enhanced from the central part ofthe lesion typically,while sometimes it displayed an integral enhancement untypically.Conclusion CEUS can efficiently differentiate the untypical performance of hepatictumors and the uncommon hepatic local lesions.