Differentiation of neoplastic from bland macroscopic portal vein thrombi using dual-energy spectral CT imaging: A pilot study

Objectives To assess the feasibility and value of dual-energy spectral computed tomography (DESCT) imaging for differentiating neoplastic from bland macroscopic portal vein (PV) thrombi. Methods Computed tomography (CT) images of 44 patients with macroscopic PV thrombus (bland group, n016; neoplastic group, n028) were reviewed. Iodine-based material decomposition images in the portal venous phase were reconstructed to compare the iodine indices between groups, including thrombus iodine density (I_T), thrombus-aorta iodine density ratio (I_T/I_A), and thrombus-PV iodine density ratio (I_T/I_P). Differential diagnostic performances of DESCT were calculated in the subgroup of 21 patients with histopathological evidence (bland group, n012; neoplastic group, n09). Results The iodine indices of the neoplastic group were significantly higher than those in the bland group (Plt;0.001). A threshold I_T of 1.14 mg/mL, I_T/I _A of 0.17, and IT/IP of 0.17 in the portal venous phase yielded 100 %, 88.9 %, and 100 % sensitivity, and 91.7 %, 91.7 %, and 83.3 % specificity, respectively, in differentiating neoplastic from bland PV thrombi.