Portal vein thrombosis (response to TARE)
Case submitted by Nazim Coskun
75-year-old male
Hepatocellular carcinoma
AFP: 1451 µg/L
Increased FDG uptake in 9x6 cm sized mass with exophytic extension at liver segment 6 (SUVmax: 5.11). Increased FDG uptake was also observed in the right hepatic vein, extending to the inferior vena cava (SUVmax: 4.56), consistent with malignant portal vein thrombosis.
Hepatic perfusion scintigraphy with MAA particles (185 MBq) delivered to the right hepatic artery showed increased perfusion of both primary mass and portal vein thrombosis. Glass microspheres loaded with 3.54 GBq 90Y injected to the same region demonstrated a similar distribution with MAA scan. Post-treatment voxel-based dosimetry showed absorbed doses in the primary mass and the PVT as 300 Gy and 220 Gy, respectively.
18F-FDG PET/CT performed at 12 weeks after TARE showed complete metabolic response in PVT and the primary lesion in segment 6.
Case Notes
Portal vein thrombosis is associated with poor prognosis in hepatocellular carcinoma. Transarterial radioembolization with appropriate interventional and dosimetric approach offers long-term response without severe hepatotoxicity.