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Sturm L, Bettinger D, Klinger C, Krauss T, Engel H, Huber JP, Schmidt A, Caca K, Thimme R, Schultheiss M. Validation of color Doppler ultrasound and computed tomography in the radiologic assessment of non-malignant acute splanchnic vein thrombosis. PLoS One 2021; 16:e0261499. [PMID: 34929009 PMCID: PMC8687587 DOI: 10.1371/journal.pone.0261499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 12/05/2021] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION International guidelines propose color Doppler ultrasound (CDUS) and contrast-enhanced computed tomography (CT) as primary imaging techniques in the diagnosis of acute splanchnic vein thrombosis. However, their reliability in this context is poorly investigated. Therefore, the aim of our study was to validate CDUS and CT in the radiologic assessment of acute splanchnic vein thrombosis, using direct transjugular spleno-portography as gold standard. MATERIALS AND METHODS 49 patients with non-malignant acute splanchnic vein thrombosis were included in a retrospective, multicenter analysis. The thrombosis' extent in five regions of the splanchnic venous system (right and left intrahepatic portal vein, main trunk of the portal vein, splenic vein, superior mesenteric vein) and the degree of thrombosis (patent, partial thrombosis, complete thrombosis) were assessed by portography, CDUS and CT in a blinded manner. Reliability of CDUS and CT with regard to portography as gold standard was analyzed by calculating Cohen's kappa. RESULTS Results of CDUS and CT were consistent with portography in 76.6% and 78.4% of examinations, respectively. Cohen's kappa demonstrated that CDUS and CT delivered almost equally reliable results with regard to the portographic gold standard (k = 0.634 [p < 0.001] vs. k = 0.644 [p < 0.001]). In case of findings non-consistent with portography there was no clear trend to over- or underestimation of the degree of thrombosis in both CDUS (60.0% vs. 40.0%) and CT (59.5% vs. 40.5%). CONCLUSIONS CDUS and CT are equally reliable tools in the radiologic assessment of non-malignant acute splanchnic vein thrombosis.
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Affiliation(s)
- Lukas Sturm
- Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Berta-Ottenstein-Programme, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dominik Bettinger
- Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Berta-Ottenstein-Programme, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christoph Klinger
- Department of Medicine, RKH Hospital Ludwigsburg, Ludwigsburg, Germany
| | - Tobias Krauss
- Department of Radiology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Hannes Engel
- Department of Radiology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jan Patrick Huber
- Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Arthur Schmidt
- Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Karel Caca
- Department of Medicine, RKH Hospital Ludwigsburg, Ludwigsburg, Germany
| | - Robert Thimme
- Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michael Schultheiss
- Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Abstract
Rapid advances in imaging technology have improved the detection, characterization and staging of colorectal liver metastases. Multi-modality imaging approach is usually the more useful in staging colorectal liver metastases. Multi-detector computed tomography (MDCT) remains the main imaging modality for preoperative planning, lesion detection and tumour surveillance. Magnetic resonance imaging (MRI) and contrast enhanced ultrasonography (US) are invaluable in problem solving for characterization indeterminate lesions, while contrast enhanced intra-operative ultrasound (CE-IOUS) may be the new gold standard staging tool prior to liver resection. Ultimately, the imaging strategy has to be tailored to the clinical situation to obtain the most relevant information for optimal use of available imaging resources.
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Affiliation(s)
- Keh Oon Ong
- Radiology Department, Royal Infirmary, Glasgow, UK
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Kutlu R, Akbulut A, Sigirci A, Alkan A, Karaman I, Baysal T, Sarac K. Lower prevalence of non-tumoral perfusion defects in left hepatic lobe during CT arterial portography with splenic artery injection. Eur J Radiol 2004; 49:262-7. [PMID: 14962657 DOI: 10.1016/s0720-048x(03)00087-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2002] [Revised: 03/07/2003] [Accepted: 03/10/2003] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To determine whether there is a difference in the prevalence of non-tumoral perfusion defects (NTPD) in left hepatic lobe during CT arterial portography (CTAP) through splenic (SA) and superior mesenteric artery (SMA) injection. METHODS AND PATIENTS For the preoperative evaluation, 59 patients (20 females, 39 males) who either have colorectal carcinoma metastasis (n: 42) or hepatocellular carcinoma (n: 17) underwent CTAP examination. Patients were divided into two groups (SA and SMA) according to the injection artery. The presence and type of NTPD in the left hepatic lobe were determined and compared. RESULTS There were significant differences in peripherally located wedge shaped, perihilar-periligamentous and pericholecystic NTPD, but no significant difference was found in lobar/segmental defects between the groups. CONCLUSIONS Our study demonstrated lower prevalence of NTPD in the left hepatic lobe in CTAPs performed through SA injection and we think that this could be explained by the streamlining of portal blood flow.
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Affiliation(s)
- Ramazan Kutlu
- Department of Radiology, Turgut Ozal Medical Center, Inonu University School of Medicine, 44069 Malatya, Turkey.
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