{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T09:33:27Z","timestamp":1792748007375,"version":"4.5.0"},"reference-count":24,"publisher":"Springer Science and Business Media LLC","issue":"7","license":[{"start":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T00:00:00Z","timestamp":1772755200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T00:00:00Z","timestamp":1772755200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Radiol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Neoplastic portal vein thrombosis (PVT) is a critical prognostic factor in hepatocellular carcinoma (HCC); however, differentiation from bland PVT remains challenging using conventional imaging criteria. Photon-counting detector CT (PCD-CT) enables quantitative iodine density (ID) assessment in every contrast-enhanced acquisition. This study evaluated the diagnostic performance of ID for distinguishing bland from neoplastic PVT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>\n                      In this retrospective single-center study, 104 patients with suspected PVT who underwent PCD-CT between 09\/2022 and 08\/2024 were included. Based on imaging, follow-up data, and multidisciplinary consensus, patients were classified into four groups: HCC with neoplastic PVT (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200918), HCC with bland PVT (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200929), bland PVT without malignancy (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200931), and neoplastic PVT in non-HCC malignancies (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200926). ID was measured in the late arterial phase (LAP) and portal venous phase (PVP) by two independent radiologists and compared with a CT feature-based score including vessel infiltration, thrombus extension, and arterial hyperenhancement.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>ID measurements demonstrated excellent inter- and intra-rater agreement (ICC\u2009\u2265\u20090.99). ID was significantly higher in neoplastic PVT in both phases. Diagnostic performance was high, with sensitivities and specificities of 100% and 95.9% in LAP and 93.1% and 100% in PVP (AUC 0.98 (95% CI: 0.95\u20131.00) and 0.97 (95% CI: 0.92\u20131.00)). The feature-based score showed lower accuracy. In non-HCC malignancies, ID achieved high diagnostic accuracy in PVP.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>ID derived from PCD-CT reliably differentiates neoplastic from bland PVT in HCC and outperforms conventional CT features. In non-HCC malignancies, ID is particularly accurate in the portal venous phase, supporting its broader clinical utility as an imaging biomarker in this contrast media phase.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Points<\/jats:title>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Question<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>Can iodine density measured by photon-counting detector CT improve the differentiation between bland and neoplastic portal vein thrombosis?<\/jats:italic>\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Findings<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>Iodine density measurements obtained with photon-counting CT accurately differentiated neoplastic from bland portal vein thrombosis and outperformed established morphologic CT features<\/jats:italic>\n                      .\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Clinical relevance<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>Photon-counting CT-derived iodine density enables reliable, noninvasive identification of neoplastic portal vein thrombosis, thereby improving diagnostic confidence and treatment planning in patients with hepatocellular carcinoma and other malignancies<\/jats:italic>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00330-026-12416-8","type":"journal-article","created":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T17:21:02Z","timestamp":1772817662000},"page":"5380-5391","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Photon-counting detector CT with iodine quantification: improved distinction between bland and neoplastic portal vein thrombosis"],"prefix":"10.1007","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8626-4044","authenticated-orcid":false,"given":"Lukas","family":"M\u00fcller","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Jorg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan-Peter","family":"Grunz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dirk","family":"Graafen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aline","family":"M\u00e4hringer-Kunz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maximilian","family":"Moos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Friedrich","family":"Foerster","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henner","family":"Huflage","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Pinto dos Santos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Ligorio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Constantin","family":"Scholz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"B\u00e4uerle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tilman","family":"Emrich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roman","family":"Kloeckner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,6]]},"reference":[{"key":"12416_CR1","first-page":"229","volume":"74","author":"F Bray","year":"2024","unstructured":"Bray F, Laversanne M, Sung H et al (2024) Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 74:229\u2013263","journal-title":"CA Cancer J Clin"},{"key":"12416_CR2","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1055\/s-2007-1007122","volume":"19","author":"JM Llovet","year":"1999","unstructured":"Llovet JM, Bru C, Bruix J (1999) Prognosis of hepatocellular carcinoma: the BCLC staging classification. Semin Liver Dis 19:329\u2013338","journal-title":"Semin Liver Dis"},{"key":"12416_CR3","doi-asserted-by":"publisher","first-page":"681","DOI":"10.1016\/j.jhep.2021.11.018","volume":"76","author":"M Reig","year":"2022","unstructured":"Reig M, Forner A, Rimola J et al (2022) BCLC strategy for prognosis prediction and treatment recommendation: the 2022 update. J Hepatol 76:681\u2013693","journal-title":"J Hepatol"},{"key":"12416_CR4","doi-asserted-by":"publisher","first-page":"315","DOI":"10.1016\/j.jhep.2024.08.028","volume":"82","author":"B Sangro","year":"2025","unstructured":"Sangro B, Argemi J, Ronot M et al (2025) EASL clinical practice guidelines on the management of hepatocellular carcinoma. J Hepatol 82:315\u2013374","journal-title":"J Hepatol"},{"key":"12416_CR5","doi-asserted-by":"publisher","first-page":"938.e1","DOI":"10.1016\/j.crad.2016.05.002","volume":"71","author":"G Ascenti","year":"2016","unstructured":"Ascenti G, Sofia C, Mazziotti S et al (2016) Dual-energy CT with iodine quantification in distinguishing between bland and neoplastic portal vein thrombosis in patients with hepatocellular carcinoma. Clin Radiol 71:938.e1\u2013938.e9","journal-title":"Clin Radiol"},{"key":"12416_CR6","doi-asserted-by":"publisher","first-page":"324","DOI":"10.1111\/liv.13988","volume":"39","author":"A M\u00e4hringer-Kunz","year":"2019","unstructured":"M\u00e4hringer-Kunz A, Steinle V, D\u00fcber C et al (2019) Extent of portal vein tumour thrombosis in patients with hepatocellular carcinoma: the more, the worse? Liver Int 39:324\u2013331","journal-title":"Liver Int"},{"key":"12416_CR7","doi-asserted-by":"publisher","first-page":"154","DOI":"10.1148\/radiol.09090304","volume":"254","author":"OA Catalano","year":"2010","unstructured":"Catalano OA, Choy G, Zhu A, Hahn PF, Sahani DV (2010) Differentiation of malignant thrombus from bland thrombus of the portal vein in patients with hepatocellular carcinoma: application of diffusion-weighted MR imaging. Radiology 254:154\u2013162","journal-title":"Radiology"},{"key":"12416_CR8","doi-asserted-by":"publisher","first-page":"531","DOI":"10.5152\/dir.2020.19569","volume":"26","author":"R Cannella","year":"2020","unstructured":"Cannella R, Taibbi A, Porrello G, Dioguardi Burgio M, Cabibbo G, Bartolotta TV (2020) Hepatocellular carcinoma with macrovascular invasion: multimodality imaging features for the diagnosis. Diagn Interv Radiol 26:531\u2013540","journal-title":"Diagn Interv Radiol"},{"key":"12416_CR9","doi-asserted-by":"publisher","first-page":"658","DOI":"10.1002\/lt.22044","volume":"16","author":"F Piscaglia","year":"2010","unstructured":"Piscaglia F, Gianstefani A, Ravaioli M et al (2010) Criteria for diagnosing benign portal vein thrombosis in the assessment of patients with cirrhosis and hepatocellular carcinoma for liver transplantation. Liver Transpl 16:658\u2013667","journal-title":"Liver Transpl"},{"key":"12416_CR10","doi-asserted-by":"publisher","first-page":"2557","DOI":"10.1007\/s00261-023-03964-4","volume":"48","author":"S Ichikawa","year":"2023","unstructured":"Ichikawa S, Sirlin CB, Cunha GM et al (2023) Inter-observer agreement and accuracy of LI-RADS v2018 for differentiating tumor in vein from bland thrombus using gadoxetic acid-enhanced magnetic resonance imaging. Abdom Radiol 48:2557\u20132569","journal-title":"Abdom Radiol"},{"key":"12416_CR11","doi-asserted-by":"publisher","first-page":"293","DOI":"10.1159\/000505191","volume":"9","author":"JS Bae","year":"2020","unstructured":"Bae JS, Lee JM, Yoon JH et al (2020) How to best detect portal vein tumor thrombosis in patients with hepatocellular carcinoma meeting the Milan criteria: gadoxetic acid-enhanced MRI versus contrast-enhanced CT. Liver Cancer 9:293\u2013307","journal-title":"Liver Cancer"},{"key":"12416_CR12","doi-asserted-by":"publisher","first-page":"719","DOI":"10.2214\/ajr.168.3.9057522","volume":"168","author":"ME Tublin","year":"1997","unstructured":"Tublin ME, Dodd GD 3rd, Baron RL (1997) Benign and malignant portal vein thrombosis: differentiation by CT characteristics. AJR Am J Roentgenol 168:719\u2013723","journal-title":"AJR Am J Roentgenol"},{"key":"12416_CR13","doi-asserted-by":"publisher","first-page":"1947","DOI":"10.1007\/s00261-017-1298-x","volume":"43","author":"SM Thompson","year":"2018","unstructured":"Thompson SM, Wells ML, Andrews JC et al (2018) Venous invasion by hepatic tumors: imaging appearance and implications for management. Abdom Radiol (NY) 43:1947\u20131967","journal-title":"Abdom Radiol (NY)"},{"key":"12416_CR14","doi-asserted-by":"publisher","first-page":"2178","DOI":"10.1007\/s00330-012-2477-3","volume":"22","author":"LJ Qian","year":"2012","unstructured":"Qian LJ, Zhu J, Zhuang ZG et al (2012) Differentiation of neoplastic from bland macroscopic portal vein thrombi using dual-energy spectral CT imaging: a pilot study. Eur Radiol 22:2178\u20132185","journal-title":"Eur Radiol"},{"key":"12416_CR15","doi-asserted-by":"crossref","unstructured":"Trauernicht CJ (2023) Dual-energy CT and photon counting CT. In: Bortz JH, Ramlaul A, Munro L (eds) CT colonography for radiographers: a guide to performance and image interpretation. Springer, Cham, 345\u2013351","DOI":"10.1007\/978-3-031-30866-6_26"},{"key":"12416_CR16","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1016\/j.diii.2022.11.003","volume":"104","author":"J Greffier","year":"2023","unstructured":"Greffier J, Villani N, Defez D, Dabli D, Si-Mohamed S (2023) Spectral CT imaging: technical principles of dual-energy CT and multi-energy photon-counting CT. Diagn Interv Imaging 104:167\u2013177","journal-title":"Diagn Interv Imaging"},{"key":"12416_CR17","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1016\/j.thromres.2023.09.004","volume":"230","author":"H Tathireddy","year":"2023","unstructured":"Tathireddy H, Rice D, Martens K, Shivakumar S, Shatzel J (2023) Breaking down tumor thrombus: current strategies for medical management. Thromb Res 230:144\u2013151","journal-title":"Thromb Res"},{"key":"12416_CR18","doi-asserted-by":"publisher","first-page":"372","DOI":"10.1111\/hepr.12697","volume":"46","author":"M Kudo","year":"2016","unstructured":"Kudo M, Izumi N, Ichida T et al (2016) Report of the 19th follow-up survey of primary liver cancer in Japan. Hepatol Res 46:372\u2013390","journal-title":"Hepatol Res"},{"key":"12416_CR19","doi-asserted-by":"crossref","unstructured":"Singal AG, Llovet JM, Yarchoan M et al (2023) AASLD Practice Guidance on prevention, diagnosis, and treatment of hepatocellular carcinoma. Hepatology. 78:1922\u20131965","DOI":"10.1097\/HEP.0000000000000466"},{"key":"12416_CR20","doi-asserted-by":"publisher","first-page":"110514","DOI":"10.1016\/j.ejrad.2022.110514","volume":"156","author":"D Graafen","year":"2022","unstructured":"Graafen D, M\u00fcller L, Halfmann M et al (2022) Photon-counting detector CT improves quality of arterial phase abdominal scans: a head-to-head comparison with energy-integrating CT. Eur J Radiol 156:110514","journal-title":"Eur J Radiol"},{"key":"12416_CR21","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1186\/s40644-023-00592-5","volume":"23","author":"D Graafen","year":"2023","unstructured":"Graafen D, Stoehr F, Halfmann MC et al (2023) Quantum iterative reconstruction on a photon-counting detector CT improves the quality of hepatocellular carcinoma imaging. Cancer Imaging 23:69","journal-title":"Cancer Imaging"},{"key":"12416_CR22","doi-asserted-by":"publisher","first-page":"S143","DOI":"10.1016\/j.acra.2023.03.026","volume":"30","author":"D Graafen","year":"2023","unstructured":"Graafen D, M\u00fcller L, Halfmann M et al (2023) Soft reconstruction kernels improve HCC imaging on a photon-counting detector CT. Acad Radiol 30:S143\u2013S154","journal-title":"Acad Radiol"},{"key":"12416_CR23","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1016\/j.jcm.2016.02.012","volume":"15","author":"TK Koo","year":"2016","unstructured":"Koo TK, Li MY (2016) A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med 15:155\u2013163","journal-title":"J Chiropr Med"},{"key":"12416_CR24","doi-asserted-by":"publisher","first-page":"293","DOI":"10.1148\/radiol.2018172656","volume":"289","author":"MJ Willemink","year":"2018","unstructured":"Willemink MJ, Persson M, Pourmorteza A, Pelc NJ, Fleischmann D (2018) Photon-counting CT: technical principles and clinical prospects. Radiology 289:293\u2013312","journal-title":"Radiology"}],"container-title":["European Radiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00330-026-12416-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00330-026-12416-8","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00330-026-12416-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T10:17:12Z","timestamp":1781864232000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00330-026-12416-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,6]]},"references-count":24,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["12416"],"URL":"https:\/\/doi.org\/10.1007\/s00330-026-12416-8","relation":{},"ISSN":["1432-1084"],"issn-type":[{"value":"1432-1084","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,6]]},"assertion":[{"value":"12 July 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 January 2026","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 February 2026","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 March 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"The scientific guarantor of this publication is Roman Kloeckner.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Guarantor"}},{"value":"Daniel Pinto dos Santos is Deputy Editor of\n                      European Radiology\n                      . He was not involved in the handling and review of this manuscript. The authors of this manuscript declare relationships with the following companies: T.E.: Institutional research support from Siemens Healthineers; speakers fees from Siemens Healthineers; travel support from Siemens Healthineers; advisory board member for Siemens Healthineers.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"No complex statistical methods were necessary for this paper.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Statistics and biometry"}},{"value":"Written informed consent was waived by the Institutional Review Board.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"Institutional Review Board approval was obtained.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"No overlap.","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Study subjects or cohorts overlap"}},{"order":8,"name":"Ethics","group":{"name":"EthicsHeading","label":"Methodology"}}]}}