Thread and Streak Sign at Microvascular Flow Imaging and Contrast-enhanced US

HomeRadiologyVol. 308, No. 3 PreviousNext Reviews and CommentaryFree AccessImages in RadiologyThread and Streak Sign at Microvascular Flow Imaging and Contrast-enhanced USMasashi Hirooka , Yoichi HiasaMasashi Hirooka , Yoichi HiasaAuthor AffiliationsFrom the Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitsukawa 454, Toon, Ehime 791-0295, Japan.Address correspondence to M.H. (email: [email protected]).Masashi Hirooka Yoichi HiasaPublished Online:Sep 12 2023https://doi.org/10.1148/radiol.230961MoreSectionsPDF ToolsAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Supplemental material is available for this article.A 48-year-old woman with advanced hepatocellular carcinoma underwent contrast-enhanced US with microvascular flow imaging (MVFI), which showed tumor invasion of the inferior vena cava and filling of the right hepatic vein (Figure, A, B). The thread and streak sign, which represents the bundle of tumor threads along the long axis of the right hepatic vein (1,2), was seen only subtly at contrast-enhanced US (Figure, C). Reduced noise and improved sensitivity to slower flow Doppler signals were achieved using MVFI (3). MVFI enabled the delineation of the microvasculature in the tumors. Moreover, vessel imaging was remarkably enhanced after injecting the contrast medium (microbubbles) during MVFI (Movie).US images in a 48-year-old woman with advanced hepatocellular carcinoma show tumor invasion (black arrowheads) of the inferior vena cava (IVC in A) and the thread and streak sign filling the right hepatic vein (white arrowheads). (A) This image was acquired by using microvascular flow imaging and accumulating the raw movie data. MHV = middle hepatic vein. (B) The raw movie data from A were rearranged in the order with the least motion artifact and accumulated. (C) Contrast-enhanced US image.Download as PowerPoint Movie: Microvascular imaging is shown in the movie. The thread and streaks sign is clearly visible in the right hepatic vein.Download Original Video (17.3 MB)Disclosures of conflicts of interest: M.H. No relevant relationships. Y.H. No relevant relationships.References1. Matsumoto N, Ogawa M, Abe M, et al. The thread and streaks sign. J Med Ultrason (2001) 2009;36(2):99–100. Crossref, Medline, Google Scholar2. Kirikoshi H, Saito S, Ueno N, et al. Evaluation of hepatocellular carcinoma with portal vein tumor thrombosis by CEUS before and after hepatic arterial infusion chemotherapy. J Med Ultrason (2001) 2010;37(3):137–141. Crossref, Medline, Google Scholar3. Aziz MU, Eisenbrey JR, Deganello A, et al. Microvascular flow imaging: A state-of-the-art review of clinical use and promise. Radiology 2022;305(2):250–264. Link, Google ScholarArticle HistoryReceived: Apr 25 2023Revision requested: May 2 2023Revision received: May 23 2023Accepted: June 7 2023Published online: Sept 12 2023 FiguresReferencesRelatedDetailsRecommended Articles Imaging Evaluation of Living Liver Donor Candidates: Techniques, Protocols, and AnatomyRadioGraphics2021Volume: 41Issue: 6pp. 1572-1591Venous Thrombosis and Hypercoagulability in the Abdomen and Pelvis: Causes and Imaging FindingsRadioGraphics2020Volume: 40Issue: 3A Comprehensive Approach to Hepatic Vascular DiseaseRadioGraphics2017Volume: 37Issue: 3pp. 813-836Multimodality Imaging of Abdominopelvic Tumors with Venous InvasionRadioGraphics2020Volume: 40Issue: 7pp. 2098-2116Liver Surgery: Important Considerations for Pre- and Postoperative ImagingRadioGraphics2022Volume: 42Issue: 3pp. 722-740See More RSNA Education Exhibits Imaging of Pathology Involving the Hepatic Veins and Inferior Vena CavaDigital Posters2019Ins and Outs of Budd-Chiari Syndrome (BCS): A Pictorial Review of Vascular Derangements in BCSDigital Posters2019Imaging Assessment after Partial Hepatectomies: Surgical Technique and Type of Parenchymal Transection Performed: Normal Findings and ComplicationsDigital Posters2022 RSNA Case Collection Intravenous LeiomyomatosisRSNA Case Collection2020Transhepatic Portosystemic Shunt (TIPS) for Variceal BleedingRSNA Case Collection2020Duplicated Inferior Vena CavaRSNA Case Collection2021 Vol. 308, No. 3 Metrics Altmetric Score PDF download