Dual-Energy Multidetector Computed Tomography With Iodine Quantification in the Evaluation of Portal Vein Thrombosis: Is It Possible to Discard the Unenhanced Phase?

Several imaging techniques can be employed for PVT characterization. Despite the fact that contrast-enhanced and colour Doppler ultrasonography and magnetic resonance with diffusion-weighted imaging are reported as highly accurate techniques, multislice computed tomography (MSCT) is the most used imaging technique for characterization of PVT and its underlying causes. Conventional MSCT study protocol includes an unenhanced study for baseline density measurements in Hounsfield units (HU) and contrast-enhanced acquisition, in the arterial or venous phase, to evaluate the presence of intrathrombus enhancement, which is one of the most reliable imaging features in distinguishing between bland and neoplastic thrombus (HUcontrast phase e HUunenhanced phase). Dual-energy CT (DECT) with iodine quantification offers an alternative approach independent from attenuation measurements, based on the presence of iodine in tissues, providing a more direct measure of lesion vascularization.