The Role of Shear Wave Elastography in Characterization of Portal Vein Thrombosis

Document Type : Original Article

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Interventional and Diagnostic Radiology Department, National Liver Institute, Menoufia University, Shebin Elkom, Menoufia, Egypt

Abstract

Background: Portal vein thrombosis [PVT] is a significant complication in patients with liver disease, particularly in those with hepatocellular carcinoma [HCC]. The aim of our study is to evaluate the diagnostic performance of shear wave elastography in characterizing benign versus malignant portal vein thrombosis compared to triphasic computed tomography [CT] as the reference standard.  
Patients and methods: This cross-sectional study included 110 adult patients with radiologically diagnosed PVT who attended the National Liver Institute, Menoufia University, between July 2024 and March 2025. All patients underwent SWE and triphasic CT imaging. SWE was performed using a C1–5 MHz curved array probe to assess stiffness values [in kilopascals, kPa] of the thrombus. CT enhancement characteristics were used to classify thrombi as benign or malignant. Diagnostic performance metrics including sensitivity, specificity, predictive values, accuracy, and area under the curve [AUC] were calculated.
Results: The mean SWE stiffness was significantly higher in malignant thrombi [9.81 ± 1.65 kPa] compared to benign thrombi [5.55 ± 0.10 kPa] [P < 0.001]. Using a stiffness cut-off of >6.2 kPa, SWE demonstrated 100% sensitivity, 100% NPV, 42.11% specificity, 89.22% PPV & 90% accuracy, with an AUC of 1.00 [P < 0.001]. The agreement between SWE and CT diagnosis was moderate [kappa = 0.546].
Conclusion: Shear wave elastography is a highly accurate, non-invasive imaging modality for distinguishing malignant from benign PVT. Its diagnostic performance shows high sensitivity, NPV and overall accuracy, supporting its potential utility in clinical decision-making for patients with liver malignancies and suspected malignant PVT.

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