Combination of CT during arterial portography and double-phase CT hepatic arteriography with multi-detector row helical CT for evaluation of hypervascular hepatocellular carcinoma

AIM: To evaluate the diagnostic accuracy of the combination of computed tomography (CT) during arterial portography (CTAP) and double-phase CT hepatic arteriography (CTHA) with multidetector-row CT (MDCT) for the evaluation of hepatocellular carcinomas (HCCs) in patients with cirrhosis. MATERIALS AND METHODS: The combination of CTAP and double-phase CTHA was performed on 46 patients with 54 nodular HCCs. Three readers reviewed the images obtained with CTAP alone, first-phase CTHA alone, double-phase CTHA, and the combination of CTAP and double-phase CTHA. The review of the images was conducted on a segment-by-segment basis, with 368 hepatic segments, including 50 segments with 54 HCCs, reviewed for detection of HCCs with the aid of a five-point confidence scale. Diagnostic accuracy was evaluated by comparing the receiver-operating characteristic (ROC) analysis results. RESULTS: The sensitivity for detecting HCCs was significantly higher with either double-phase CTHA or the combination of CTAP and double-phase CTHA than with first-phase CTHA alone (90 and 93 versus 85%, respectively, p<0.01). The specificity for detecting HCCs was significantly higher with the combination of CTAP and double-phase CTHA than with CTAP alone (97 and 94%, respectively, p<0.01). The positive predictive values for detecting HCCs were significantly higher with double-phase CTHA than with first-phase CTHA alone (86 and 82%, respectively, p<0.05). The area under the ROC curve (Az) values were significantly higher with the combination of CTAP and double-phase CTHA (0.983) than with first-phase CTHA alone (0.959; p<0.05). CONCLUSION: The combination of CTAP and double-phase CTHA with MDCT significantly enhances the detection of HCC.     

Diagnostic accuracy of helical CT arterial portography and CT hepatic arteriography for hypervascular hepatocellular carcinoma in chronic liver damage. An ROC analysis

PURPOSE: To evaluate the detectability of hypervascular hepatocellular carcinomas (HCCs) in chronic liver damage with helical CT arterial portography (CTAP) and CT hepatic arteriography (CTHA). MATERIAL AND METHODS: Thirty-nine HCC patients who underwent CTAP and CTHA were studied. Diagnostic abilities of CTAP alone, CTHA alone, or combined CTAP and CTHA were evaluated by receiver operating characteristic (ROC) analysis. Fifty-three images with 53 HCC nodules were evaluated. Tumor size ranged from 5 to 90 mm (mean 22.8 mm). Sensitivities and specificities for all techniques were calculated. RESULTS: ROC analysis showed the diagnostic ability significantly better with combined CTAP and CTHA (mean area under the ROC curve (Az)=0.95), or CTHA alone (Az=0.93) than CTAP alone (Az=0.87) (p<0.01). Combined CTAP and CTHA showed the best sensitivity (95.0%), followed by CTHA alone (88.1%) and CTAP alone (85.5%). The specificities of all three imaging techniques were relatively low (54.1% for combined CTAP and CTHA, 71.1% for CTHA alone, and 54.1% for CTAP alone) because of perfusion abnormalities of the liver parenchyma. CONCLUSION: The combination of CTAP and CTHA is superior to CTAP alone for detection of hypervascular HCCs. However, its specificity was relatively low in chronic liver damage.     

Hepatic arterioportal shunts not directly related to hepatocellular carcinoma: findings on CT during hepatic arteriography, CT arterial portography and dual phase spiral CT

AIM: To evaluate findings of arterioportal shunts not directly related to hepatocellular carcinoma (HCC) which were seen within third-order portal branches on computed tomography (CT) during hepatic arteriography (CTHA), arterial portography (CTAP), and dual phase spiral CT.MATERIALS AND METHODS: At CTHA in 112 patients, we examined third-order portal vein branches to find arterioportal shunts not directly related to HCC. Six cases were found. We evaluated the findings of these shunts on CTHA and investigated whether CTAP (n = 6) and dual phase spiral CT (n = 5) showed perfusion defects in the corresponding areas on arterioportal shunts. RESULTS: Five of six cases showed abrupt visualization of portal branches without visualization of the proximal portion of CTHA. Five of six cases showed no perfusion defect on CTAP and no hyperattenuating area on CTHA. Four of five cases showed no hyperattenuating area on hepatic arterial phase spiral CT. CONCLUSION: Arterioportal shunts not directly related to HCC and occuring within third-order portal branches mainly showed abrupt visualization of portal branches on CTHA. These occurred frequently without perfusion defects on CTAP and without a hyperattenuating area on CTHA and hepatic arterial phase spiral CT.Park, C. M. (2000). Clinical Radiology55, 465-470.     

CT during hepatic arteriography and portography: an illustrative review.

The combination of computed tomography (CT) during arterial portography (CTAP) and CT during hepatic arteriography (CTHA) has been used for evaluation of hepatic neoplasms before partial hepatic resection. Focal hepatic lesions that can be demonstrated with CTAP and CTHA include regenerative nodules, dysplastic nodules, dysplastic nodules with malignant foci, hepatocellular carcinoma, cholangiocarcinoma, hemangioma, and metastases. CTAP is considered the most sensitive modality for detection of small hepatic lesions, particularly small hepatic tumors such as hepatocellular carcinoma and metastatic tumors. CTHA can demonstrate not only hypervascular tumors but also hypovascular tumors and can help differentiate malignant from benign lesions. However, various types of nontumorous hemodynamic changes are frequently encountered at CTAP or CTHA and appear as focal lesions that mimic true hepatic lesions. Such hemodynamic changes include several types of arterioportal shunts, liver cirrhosis, Budd-Chiari syndrome, inflammatory changes, pseudolesions due to an aberrant blood supply, and laminar flow in the portal vein. Familiarity with the CTAP and CTHA appearances of various hepatic lesions and nontumorous hemodynamic changes allows the radiologist to improve the diagnostic accuracy.     

Focal eosinophilic infiltration of the liver mimicking hepatocellular carcinoma: case reports

Focal eosinophilic infiltration is a rare disease entity that in patients with malignancies may mimic malignant hepatic nodules. We describe two cases in which focal eosinophilic infiltration of the liver, as well as primary liver cancer, occurred. In these patients, imaging findings similar to those observed in hepatocellular carcinoma (HCC) were noted: Enhancement at dynamic magnetic resonance (MR) imaging substantially increased perfusion at computed tomography during hepatic arteriography (CTHA) and a perfusion defect at computed tomography during arterial portography (CTAP).     

Preoperative detection of malignant hepatic tumors: comparison of combined methods of MR imaging with combined methods of CT

OBJECTIVE: We compared radiologists' performance on combined unenhanced, gadolinium-enhanced, and ferumoxides-enhanced MR imaging with their performance on helical CT during arterial portography (CTAP) and biphasic CT during hepatic arteriography (CTHA) for the preoperative detection of malignant hepatic tumors. SUBJECTS AND METHODS: MR images and CT scans obtained in 33 patients were retrospectively analyzed. Images of the liver were reviewed on a segment-by-segment basis; a total of 261 segments with 39 hepatocellular carcinomas and 21 metastases were independently reviewed by three radiologists who were invited from outside institutions. Unenhanced and gadolinium-enhanced MR images were reviewed first, then ferumoxides-enhanced MR images were added for combined review. CTAP images and biphasic CTHA images were reviewed together. RESULTS: Sensitivity for the detection of hepatic tumors was analogous for combined unenhanced, gadolinium-enhanced, and ferumoxides-enhanced MR images (86%) and for combined CTAP images and biphasic CTHA images (87%). Specificity was higher with MR images (95%, p < 0.01) than with CT images (91%). Radiologists' performances were improved (Az = 0.962, p = 0.0502) by combining ferumoxides-enhanced MR images with unenhanced and gadolinium-enhanced MR images (Az = 0.950), and were analogous for combined unenhanced, gadolinium-enhanced, and ferumoxides-enhanced MR images and for combined CTAP images and biphasic CTHA images (Az = 0.959). CONCLUSION: Radiologists' performances on combined unenhanced, gadolinium-enhanced, and ferumoxides-enhanced MR imaging compared with their performances on combined helical CTAP and biphasic CTHA are analogous for the preoperative detection of malignant hepatic tumors. Such a dedicated combination of MR imaging may obviate the need for more invasive angiographically assisted helical CT for the preoperative detection of malignant hepatic tumors.     

Hypervascular hepatocellular carcinoma: detection with double arterial phase multi-detector row helical CT

PURPOSE: To assess whether double arterial phase imaging with multi-detector row helical computed tomography improves detection of hypervascular hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Fifty-one patients with 96 hypervascular HCCs underwent double arterial phase imaging of the entire liver. At measured delay after intravenous administration of 2 mL/kg of contrast medium at a rate of 5 mL/sec, the early and late arterial phase images were obtained serially during a single breath hold with interscan delay of 5.0 seconds. Detector row configuration of 2.5 x 4 mm, pitch of 6, and scanning time of 10.5 seconds for each phase were used. Forty 5-mm-thick reconstruction images were obtained for each phase. Each image set was interpreted separately by three observers, who were unaware of tumor burden in the liver, to detect hypervascular HCC. Sensitivity, positive predictive value, and area below the receiver operating characteristic curve (A(z)) for early and late arterial phases separately and together were calculated. RESULTS: Mean sensitivity and positive predictive value for hypervascular HCC were 54% and 85% for the early arterial phase, 78% and 83% for the late arterial phase, and 86% and 92% for the double arterial phase, respectively. Double arterial phase imaging showed significantly superior sensitivity compared with early or late arterial phase imaging alone for detecting HCC (P <.05). The mean A(z) value for double arterial phase was significantly higher than that for early or late arterial phase imaging alone (P <.05). Double arterial phase imaging showed the lowest number of false-positive lesions. CONCLUSION: Double arterial phase imaging is recommended to improve detection of hypervascular HCCs and reduce false-positive lesions.     

Cirrhotic nodules: association between MR imaging signal intensity and intranodular blood supply

PURPOSE: To retrospectively determine whether there is a relationship between the intranodular blood supply evaluated at computed tomography (CT) during arterial portography (CTAP) and CT during hepatic arteriography (CTHA) and the magnetic resonance (MR) imaging signal intensity of nodules associated with cirrhosis. MATERIALS AND METHODS: Neither institutional review board approval nor informed consent was required for retrospective reviews of medical records and images. One hundred fourteen hepatocellular nodules 10 mm or greater in largest diameter in 58 patients (39 men, 19 women; mean age, 61 years) with cirrhosis were evaluated at CTAP, CTHA, and MR imaging. The CTAP and CTHA nodule findings were divided into three main types: Type A nodules were isoattenuating at CTAP and hypoattenuating at CTHA; type B nodules, slightly hypoattenuating at CTAP and hypoattenuating at CTHA; and type C nodules, strongly hypoattenuating at CTAP and hyperattenuating at CTHA. The relationships between the CTAP and CTHA findings and the MR imaging signal intensity among these nodules were analyzed by using the chi(2) test. RESULTS: On T1-weighted MR images, 27 (63%) of 43 type A nodules were hyperintense, nine (39%) of 23 type B nodules were isointense, and 19 (48%) of 40 type C nodules were hypointense; differences were not significant. On T2-weighted MR images, 31 (72%) of 43 type A nodules were hypointense (P < .05), 12 (52%) of 23 type B nodules were isointense, and 34 (85%) of 40 type C nodules were hyperintense (P < .05). CONCLUSION: There was a significant association between intranodular blood supply and nodule signal intensity on T2-weighted MR images. However, study findings did not show whether the blood itself (ie, blood volume or blood flow amount) directly influenced the signal intensity.     

Efficacy of double arterial phase dynamic magnetic resonance imaging with the sensitivity encoding technique versus dynamic multidetector-row helical computed tomography for detecting hypervascular hepatocellular carcinoma

Purpose  The aim of this study was to evaluate the efficacy of double arterial phase dynamic magnetic resonance imaging (MRI) with the sensitivity encoding technique (SENSE dynamic MRI) for detection of hypervascular hepatocellular carcinoma (HCC) in comparison with double arterial phase dynamic multidetector-row helical computed tomography (dynamic MDCT). Materials and methods  A total of 28 patients with 66 hypervascular HCCs underwent both double arterial SENSE dynamic MRI and dynamic MDCT. The diagnosis of HCC was based on surgical resection (n = 7), biopsy (n = 10), or a combination of CT during arterial portography (CTAP), CT during hepatic arteriography (CTA), and/or the 6-month follow-up CT (n = 49). Based on alternative-free response receiving operating characteristic (ROC) analysis, the diagnostic performance for detecting HCC was compared between double arterial phase SENSE dynamic MRI and double arterial phase dynamic MDCT. Results  The mean sensitivity, positive predictive value, and mean Az values for hypervascular HCCs were 72%, 80%, and 0.79, respectively, for SENSE dynamic MRI and 66%, 92%, and 0.78, respectively, for dynamic MDCT. The mean sensitivity for double arterial phase SENSE dynamic MRI was higher than that for double arterial phase dynamic MDCT, but the difference was not statistically significant. Conclusion  Double arterial phase SENSE dynamic MRI is as valuable as double arterial phase dynamic MDCT for detecting hypervascular HCCs.     

Regenerative nodules in liver cirrhosis: findings at CT during arterial portography and CT hepatic arteriography with histopathologic correlation

PURPOSE: To determine the appearance of regenerative nodules in patients with liver cirrhosis at computed tomography (CT) during arterial portography (CTAP) and CT hepatic arteriography (CTHA). MATERIALS AND METHODS: CTAP and CTHA of the liver were performed in 28 consecutive patients with hepatocellular carcinoma (HCC) who were scheduled to undergo partial resection of the liver. Helical CTAP was performed after contrast material injection into the superior mesenteric artery followed by helical CTHA after contrast material injection into the hepatic artery. CT scans were analyzed for the presence of identifiable nodules and their size; results were correlated with gross and microscopic findings. RESULTS: Resected livers showed cirrhosis in 20 patients, chronic hepatitis in four, and normal liver in four. Among the 20 patients with cirrhosis, regenerative nodules were demonstrated as enhancing 3-10 mm nodules surrounded by lower attenuation fibrous septa 0.8-1.5 mm thick at CTAP in seven patients and nonenhancing nodules of the same size surrounded by enhancing fibrous septa at CTHA in 15 patients. The degree of fibrosis determined the conspicuity of nodules. CONCLUSION: Regenerative nodules in cirrhotic liver are visualized as enhancing nodules surrounded by lower attenuation thin septa at CTAP and nonenhancing nodules surrounded by enhancing fibrous septa at CTHA. CTHA is more sensitive than CTAP in depicting regenerative nodules (P < .005).     

Non-tumorous enhancement caused by cholecystic venous inflow shown on biphasic CT hepatic arteriography: comparison with hepatocellular carcinoma

The haemodynamics in non-tumorous abnormalities on CT arterial portography (CTAP) owing to cholecystic venous direct inflow to the liver were compared with the haemodynamics in hepatocellular carcinoma. 53 patients who simultaneously underwent CTAP and CT during hepatic arteriography (CTHA) to detect hepatocellular carcinoma had the late phase added to CTHA. Changes in size, shape and pattern of 47 non-tumorous enhancement abnormalities on the liver around the gall bladder or in the dorsum of segment IV between the early and late phases on biphasic CTHA as well as of 60 tumorous lesions were determined. Enhancement on biphasic CTHA was seen in all 47 lesions with a non-tumorous portal defect (early phase alone, n=8; late phase alone, n = 3; both, n = 36). In these 47 lesions, the size and the shape of enhancement changed in 63.8% and 51.1%, respectively, between the early and late phases on CTHA; the pattern of enhancement did not change in 72.3%. On the other hand, the size of enhancement on biphasic CTHA changed in only 16.7% of 60 tumours, and the shape in only 5%, although the enhancement pattern changed in a large proportion (80%). In conclusion, owing to the difference in haemodynamics, non-tumorous abnormalities caused by cholecystic venous inflow and tumours are clearly delineated on biphasic CTHA. Thus, adding the late phase to previous single phase CTHA (i.e. performing biphasic CTHA) is useful in differentiating the two entities.     

Optimal scan timing for coronal enhancement of hypervascular hepatocellular carcinomas and correlation with tumor size: evaluation with four-phase CT hepatic arteriography

PURPOSE: Our aim was to evaluate coronal enhancement of hypervascular hepatocellular carcinomas (HCCs) on four-phase CT hepatic arteriography (CTHA). MATERIALS AND METHODS: This study included a total of 86 hypervascular HCCs. Four-phase CTHA images were acquired at 10 sec, 35 sec, 60 sec, and 85 sec after the initiation of contrast medium injection. The rate of coronal enhancement on each phase of CTHA of HCCs was analyzed. The rate of coronal enhancement on each phase of CTHA of HCC was also compared with nodule size. RESULTS: All HCCs showed tumor enhancement on phase-one CTHA. The appearance rates of coronal enhancement on phases-two, -three, and -four CTHA were 87.2%, 67.4%, and 53.4%, respectively. The appearance rates of coronal enhancement of small HCCs on phases-two, -three, and -four CTHA were 91.1%, 53.6%, and 30.5%, respectively; those of non-small HCCs were 80.0%, 93.3%, and 96.7%, respectively. On phase-two CTHA, the presence of coronal enhancement was higher in small HCCs than in non-small HCCs. On phases-three and -four CTHA, the presence of coronal enhancement was significantly higher in non-small HCCs than in small HCCs. CONCLUSION: The optimal phase for achieving coronal enhancement depended on tumor size.     

Pre-operative detection of malignant hepatic tumours: value of combined helical CT during arterial portography and biphasic CT during hepatic arteriography

AIMS: The purpose of our study was to evaluate the observer performance with combined helical CT during arterial portography (CTAP) and biphasic CT hepatic arteriography (CTHA) in the pre-operative detection of malignant hepatic tumours. METHODS: Computed tomography images obtained in 41 patients with suspected hepatic tumours were retrospectively reviewed. In a blind fashion, three off-site, independent radiologists reviewed CTAP and early-phase CTHA combined for the first review, then late-phase CTHA was added for the second review. Statistical analysis was conducted on lesion-by-lesion and segment-by-segment bases; a total of 328 liver segments including 65 segments with 74 malignant hepatic tumours ranging in size from 5 to 100 mm (mean, 21.4 mm) were analysed. RESULTS: Sensitivity for detection of liver segments harbouring tumours of CTAP and biphasic CTHA combined (82%) was identical to that of CTAP and early-phase CTHA combined (82%). Specificity of CTAP and biphasic CTHA combined (93%) was greater than that of CTAP and early-phase CTHA combined (90%, P < 0.005). The mean confidence level for the 74 tumours significantly increased by adding late-phase CTHA (P < 0.0005). The mean confidence level for 100-142 benign perfusion abnormalities detected with CTAP and early-phase CTHA combined significantly decreased by adding late-phase CTHA (P < 0.0005). CONCLUSION: By combining late-phase CTHA with CTAP and early-phase CTHA information, the specificity for the detection of malignant hepatic tumours rises significantly, allowing more accurate preoperative tumour detection.     

Diagnosis of hepatic neoplasms using CT arterial portography and CT hepatic arteriography

Both computed tomography arterial portography (CTAP) and CT hepatic arteriography (CTHA) are CT techniques with angiographic assistance. The detection sensitivity of these techniques is high because marked lesion contrast can be obtained using direct delivery of contrast materials to the liver parenchyma or the tumors. The use of CTAP and CTHA may improve therapeutic results after transarterial embolization therapy for hepatocellular carcinomas because of their high diagnostic accuracy. Findings on CTAP or CTHA can sometimes help characterize the hepatic focal lesions. Thus, CTAP and CTHA are frequently performed as pretreatment examinations, although they are invasive compared to intravenous (IV) contrast-enhanced CT or magnetic resonance imaging. However, there are some potential pitfalls, such as nontumorous perfusion abnormalities. CTAP and CTHA are less effective for evaluation of patients with cirrhosis and portal hypertension. This article presents a current overview of CTAP and CTHA technique for diagnosis of hepatic neoplasms.     

Preoperative detection of hepatocellular carcinoma: comparison of combined contrast-enhanced MR imaging and combined CT during arterial portography and CT hepatic arteriography

The aim of this study was to compare Gd-DTPA-enhanced dynamic MR images, superparamagnetic iron oxide (SPIO)-enhanced MR images, combined Gd-DTPA-enhanced dynamic and SPIO-enhanced MR images, vs combined CT arterial portography (CTAP) and CT hepatic arteriography (CTHA), in the detection of hepatocellular carcinoma (HCC) using receiver operating characteristic (ROC) analysis. Twenty-four patients with 38 nodular HCCs (5–60 mm, mean 23.0 mm) were retrospectively analyzed. Image reviews were conducted on a liver segment-by-segment basis. A total of 192 segments, including 36 segments with 38 HCC, were reviewed independently by three radiologists. Each radiologist read four sets of images (set 1, unenhanced and Gd-DTPA-enhanced dynamic MR images; set 2, unenhanced and SPIO-enhanced MR images; set 3, combined Gd-DTPA-enhanced dynamic and SPIO-enhanced MR images; set 4, combined CTAP and CTHA). To minimize any possible learning bias, the reviewing order was randomized and the reviewing procedure was performed in four sessions at 2-week intervals. The diagnostic accuracy (A_z values) for HCCs of combined CTAP and CTHA, combined Gd-DTPA-enhanced dynamic and SPIO-enhanced MR images, Gd-DTPA-enhanced dynamic MR images, and SPIO-enhanced MR images for all observers were 0.934, 0.963, 0.878, and 0.869, respectively. The diagnostic accuracy of combined CTAP and CTHA and combined Gd-DTPA-enhanced dynamic and SPIO-enhanced MR images was significantly higher than Gd-DTPA-enhanced dynamic MR images or SPIO-enhanced MR images (p<0.005). The mean specificity of combined CTAP and CTHA (93%) and combined Gd-DTPA-enhanced dynamic and SPIO-enhanced MR images (95%) was significantly higher than Gd-DTPA-enhanced dynamic MR images (87%) or SPIO-enhanced MR images (88%; p<0.05). Combined Gd-DTPA-enhanced dynamic and SPIO-enhanced MR images may obviate the need for more invasive combined CTAP and CTHA for the preoperative evaluation of patients with HCC.     

肝动脉和经动脉门脉造影螺旋CT联合应用对肝癌的诊断价值

目的　探讨螺旋CT扫描在肝动脉造影CT(CTHA)和经动脉门脉造影CT(CTAP)对肝癌的诊断价值。方法　分析 2 1例肝癌病人CTAP和CTHA图像 ,并与螺旋CT三期增强扫描进行对照。结果　三期增强扫描病灶检出率为 72 .4% (5 5 /76) ;CTAP病灶检出率为 96.1% (73 /76) ;CTHA病灶检出率为 88.2 % (67/76) ;CTAP和CTHA联合应用病灶检出率为 98.7% (75 /76) ,可检出 0 .5cm的微小癌灶。CTAP和CTHA均可出现非病理性表现 ,CTAP灌注异常出现率为 2 2 .3 % ,CTHA非病理性强化灶出现率为 3 0 .2 %。结论　螺旋CT动脉造影能显著减少造影剂用量 ,提高图像质量 ,CTAP和CTHA联合应用肝癌病灶检出率明显高于CT三期增强扫描。CTAP和CTHA结合分析可减少假阳性率。     

Dysplastic nodules in liver cirrhosis: evaluation of hemodynamics with CT during arterial portography and CT hepatic arteriography

PURPOSE: To evaluate the portal and arterial blood supplies to dysplastic nodules in the cirrhotic liver with computed tomography (CT) during arterial portography (CTAP) and CT hepatic arteriography (CTHA). MATERIALS AND METHODS: Nineteen histopathologically proved low-grade dysplastic nodules and 13 high-grade dysplastic nodules in 17 patients with liver cirrhosis were evaluated with CTAP and CTHA for the presence of portal and arterial blood supplies to the nodules. The nodules ranged from 0.4 to 4.5 cm in diameter (mean, 1.6 cm). RESULTS: The portal supply was present in 14 of the 19 (74%) low-grade dysplastic nodules and in seven of the 13 (54%) high-grade dysplastic nodules. The hepatic arterial supply was increased in four of the 19 (21%) low-grade dysplastic nodules, present in nine (47%), and absent in six (32%). The arterial supply was increased in four of the 13 (31%) high-grade dysplastic nodules, present in four (31%), and absent in five (38%). CONCLUSION: The portal and arterial supplies to the low- and high-grade dysplastic nodules were variable and inconsistent. Therefore, it is difficult to detect and characterize the dysplastic nodules on the radiologic images on the basis of the blood supply.     

Multidetector helical CT plus superparamagnetic iron oxide-enhanced MR imaging for focal hepatic lesions in cirrhotic liver: a comparison with multi-phase CT during hepatic arteriography

The aim of this study was to evaluate multidetector helical computed tomography (MDCT), superparamagnetic iron oxide (SPIO)-enhanced magnetic resonance (MR) imaging, and CT arterial portography (CTAP) and CT during hepatic arteriography (CTHA) for the detection and diagnosis of hepatocellular carcinomas (HCC). This included visual correlations of MDCT and SPIO-MR imaging in the detection of HCC using receiver operating characteristic (ROC) analysis. Twenty-five patients with 57 nodular HCCs were retrospectively analyzed. A total of 200 segments, including 49 segments with 57 HCCs, were reviewed independently by three observers. Each observer read four sets of images (set 1, MDCT; set 2, unenhanced and SPIO-enhanced MR images; set 3, combined MDCT and SPIO-enhanced MR images; set 4, combined CTAP and CTHA). The mean Az values representing the diagnostic accuracy for HCCs of sets 1, 2, 3, and 4 were 0.777, 0.814, 0.849, and 0.911, respectively, and there was no significant difference between sets 3 and 4. The sensitivity of set 4 was significantly higher than those of set 3 for all the lesions and for lesions 10 mm or smaller (p<0.05); however, for lesions larger than 10mm, the sensitivities of the two sets were similar. No significant difference in positive predictive value and specificity was observed between set 3 and set 4. Combined MDCT and SPIO-enhanced MR imaging may obviate the need for more invasive CTAP and CTHA for the pre-therapeutic evaluation of patients with HCC more than 10mm.     

Progression to hypervascular hepatocellular carcinoma: correlation with intranodular blood supply evaluated with CT during intraarterial injection of contrast material

PURPOSE: To analyze the correlation between intranodular blood supply of borderline lesions (ie, dysplastic nodules or hypovascular well-differentiated hepatocellular carcinoma [HCC] nodules) and their progression to hypervascular classic HCC in cirrhotic livers. MATERIALS AND METHODS: One hundred seventy-six borderline lesions seen at computed tomography (CT) during arterial portography (CTAP) and CT during hepatic arteriography (CTHA) were evaluated in 49 patients with cirrhosis who underwent repeated CTAP and/or CTHA but no therapy. On the basis of CTAP findings, nodules were categorized as group A (showing almost the same portal venous supply as the surrounding liver), group B (showing decreased portal venous supply) or group C (showing partially absent portal venous supply); on the basis of CTHA findings, nodules were categorized as group I (showing almost the same arterial supply as the liver), group II (showing decreased arterial supply), or group III (showing partially increased arterial supply). RESULTS: Progression to classic HCC was observed in 29.4% of group A nodules, 53.9% of group B nodules, and 87.9% of group C nodules within 1,000 days; in 58.6% of group I nodules, 12.9% of group II nodules, and 92.2% of group III nodules within 730 days; and in 0% of nodules in group A and I, 28% of nodules in group B and/or II, and 88.7% of nodules in group C and/or III within 730 days. CONCLUSION: Evaluation of intranodular blood supply was valuable in predicting the prognosis in borderline lesions, except when only arterial blood supply was evaluated.     

Hypervascular hepatocellular carcinoma: can double arterial phase imaging with multidetector CT improve tumor depiction in the cirrhotic liver?

OBJECTIVE: We assessed the efficacy of double arterial phase CT with multidetector CT for the detection of hypervascular hepatocellular carcinoma in the cirrhotic liver. MATERIALS AND METHODS: Double arterial phase images with multidetector CT were evaluated using quantitative, qualitative, and receiver operating characteristic analyses for 59 patients with 78 hepatocellular carcinomas. Early and late arterial phase (double arterial phase) CT scans were obtained at a fixed time of 25 and 40 sec, respectively, after administration of contrast material. Total dose and injection rate of contrast material were 100 mL and 3 mL/sec, respectively. RESULTS: On the basis of the receiver operating characteristic curves, the mean area under the curve values of the late (0.98) and combined arterial phase CT scans (0.98) were equivalent, and both were significantly greater than the mean of the early arterial phase CT scans (0.842) for detecting hepatocellular carcinoma (p < 0.05). The mean relative sensitivity values obtained with the late (69/78, 88%) and combined arterial phase CT scans (70/78, 90%) were also equivalent and were significantly greater than those obtained with the early arterial phase CT scans (52/78, 67%; p < 0.001). CONCLUSION: Double arterial phase CT with multidetector CT showed no significant improvement in effectiveness compared with single late arterial phase CT used alone for detecting hypervascular hepatocellular carcinoma in the cirrhotic liver.