Analysis on misdiagnosis of ultrasonography in portal vein tumor thrombosis
超声诊断门静脉瘤栓漏诊原因分析

Objective To explore the misdiagnosis of ultrasonography （US） in portal vein tumor thrombosis （PVTT）. Methods The routine liver US was used to examine 61 cases of pathologically diagnosed primary hepatic carcinoma （PHC） with PVTT. The location, range, characteristics of periphery, internal blood flow and contrast-enhanced ultrasonic characteristics of PVTT were observed. The PVTT was classified into 5 types （ Ⅰ0 -Ⅳ types）. The incidence rate of gross pVTT was calculated. The detection rate, misdiagnosis rate and number of misdiagnosis of US in PVTT were calculated. The relationship between gross PVTT location and tumor location was analyzed. Results In these 61 cases, 54 （ 54/61,88.5% ） were gross PVTT and 7 （7/61,11.5%）were microscopic PVTr. The detection and misdiagnosis rate of US in PVTF were 62.3% （ 38/61 ） and 37.7% （ 23/61 ）, respectively. The detection rates of US in each-type PVTT were 0（0/7, Ⅰ0）, 30.8% （4/13, Ⅰ） ,72.2% （ 13/18, Ⅱ ） ,88.2% （ 15/17, Ⅲ ） and 100% （6/6, Ⅳ） , respectively. The PVTT was easy for misdiagnosis by low-level ultrasonograph and ultrasound investigator, small PVTT and hepatic cirrhosis. The PVTT were in the same locations of PHC tumor in 97.7% （42/43） cases of gross PVTr. Conclusions The reasons of misdiagnosis in PVTT were complicated. By using high resolution ultrasonic equipments, routinely applying intraoperative ultrasound, being familiar with portal system ultrasonic anatomy and sufficiently recognizing the characteristics of PVTT are the important factors for improving the detection of PVTT.