Nontumorous Perfusion Abnormalities of Liver Parenchyma Adjacent to the Falciform Ligament As Revealed by Angiographic Helical Ct and Angiography

Purpose: To investigate nontumorous abnormalities in the liver around the falciform ligament as revealed by arteriography and helical CT arterial portography (CTAP) and helical CT during hepatic arteriography (CTHA).Material and Methods: One hundred and seventeen patients simultaneously underwent hepatic arteriography and CTAP and CTHA of the common hepatic artery. The number, size, and shape of nontumorous defects of portal perfusion in the liver adjacent to the falciform ligament on CTAP as well as the nontumorous contrast enhancement in the same area on CTHA were determined. In 1 case, in which nontumorous enhancement was observed on CTHA, selective arteriography from the gastric arteries was performed.Results: On CTAP a nontumorous area of decreased portal perfusion of the liver around the falciform ligament was detected in 18 (15.4%) of the 117 patients, while nontumorous enhancement on CTHA was seen in 7 (6.0%). In 4 patients, both of these nontumorous abnormalities were observed. In the patient undergoing selective gastric arteriography, nonportal venous inflow to the liver in the direction to the liver adjacent to the falciform ligament was seen.Conclusion: One cause of nontumorous vascular abnormalities adjacent to the falciform ligament as shown on angiographic helical CT is aberrant gastric venous inflow to this region.     

Embolization of the hepatic falciform artery to prevent supraumbilical skin rash during transcatheter arterial chemoembolization for hepatocellular carcinoma

A dilated hepatic falciform artery (HFA) arising from the left hepatic artery was demonstrated on arteriography prior to chemoembolization of an unresectable hepatocellular carcinoma (HCC) located predominantly in the left lobe of the liver. The HFA was occluded by microcoils to prevent a possible toxic supraumbilical skin rash following chemoembolization of the HCC via the left hepatic artery. There were no postprocedure complications. We consider this procedure useful for improving the safety of chemoembolization.     

Computed tomography hepatic arteriography has a hepatic falciform artery detection rate that is much higher than that of digital subtraction angiography and 99mTc-MAA SPECT/CT: Implications for planning 90Y radioembolization?

Purpose

To compare the hepatic falciform artery (HFA) detection rates of digital subtraction angiography (DSA), computed tomography hepatic arteriography (CTHA) and 99mTc-macroaggregated albumin (99mTc-MAA) single photon emission computed tomography with integrated CT (SPECT/CT) and to correlate HFA patency with complication rates of yttrium-90 (90Y) radioembolization.

Material and methods

From August 2008 to November 2010, 79 patients (range 23–83 years, mean 62.3 years; 67 male) underwent pre-treatment DSA, CTHA and 99mTc-MAA scintigraphy (planar/SPECT/CT) to assess suitability for radioembolization with 90Y resin microspheres. Thirty-seven patients were excluded from the study, because CTHA was performed with a catheter position that did not result in opacification of the liver parenchyma adjacent to the falciform ligament. DSA, CTHA and 99mTc-MAA SPECT/CT images and medical records were retrospectively reviewed.

Results

A patent HFA was detected in 22 of 42 patients (52.3%). The HFA detection rates of DSA, CTHA and 99mTc-MAA SPECT/CT were 11.9%, 52.3% and 13.3%, respectively (p < 0.0001). An origin from the segment 4 artery was seen in 51.7% of HFAs. Prophylactic HFA coil-embolization prior to 90Y microspheres infusion was performed in 2 patients. Of the patients who underwent radioembolization with a patent HFA, none developed supra-umbilical radiation dermatitis. One patient experienced epigastric pain attributed to post-embolization syndrome and was managed conservatively.

Conclusion

The HFA detection rate of CTHA is superior to that of DSA and 99mTc-MAA SPECT/CT. Complications related to non-target radiation of the HFA vascular territory rarely occur, even in patients undergoing radioembolization with a patent HFA.     

Arteries of the falciform ligament on C-arm CT hepatic arteriography: The hepatic falciform artery and the Sappey’s superior artery

Background and aim

To investigate the prevalence, anatomy and distribution of the hepatic falciform artery (HFA) and Sappey’s superior artery (SSA) using C-arm CT hepatic arteriography (C-arm CTHA).

Materials and methods

From January 2011 to December 2012, 220 patients who underwent C-arm CTHA during initial transarterial treatment for hepatocellular carcinoma were included in this retrospective study. The HFAs and SSAs prevalence and origin were evaluated using axial images of C-arm CTHA. A 5-point scale for HFAs and a 4-point scale for SSAs were used to designate the radiologically conspicuous arteries.

Results

The prevalences of the total HFAs and SSAs were 95 % (n=209) and 22 % (n=49), while those of radiologically conspicuous HFAs and SSAs were 62 % (n=137) and 10 % (n=22), respectively. Thirty HFAs (22 % of radiologically conspicuous HFAs and 14 % of the total study population) were distributed in the subcutaneous layer of the anterior abdominal wall, while the majority of SSAs ran through the superior part of the falciform ligament in the left-anterior direction and anastomosed with left inferior phrenic artery.

Conclusion

Our study using C-arm CTHA revealed that the prevalence of the HFA is higher than the existing knowledge and proved the existence of the SSA radiologically for the first time.

Key Points

? Prevalence of hepatic falciform artery is 95 %, higher than previously known. ? 22 % of conspicious hepatic falciform arteries distributed in subcutaneous tissue around umbilicus. ? The existence of Sappey’s superior artery was proved with a radiological method.

     

Reexamination of hepatic falciform artery: angiographic study]

Supraumbilical skin complication during hepatic artery infusion chemotherapy or transcatheter arterial chemoembolization (TACE) for liver tumor has been reported by some authors. This complication is thought to be caused by the flow of chemotherapeutic, agent and embolus into the hepatic falciform artery (HFA). It is important for angiographers to be aware of the presence of HFA to prevent possible supraumbilical skin complication. The rate of visualization of the HFA on angiography has been considered to be only about 2%. In a retrospective study of celiac angiograms performed in 200 patients, we found an incidence of 32/200 (16%). The proximal side of this artery may be tortuous. In all cases, the flow of the HFA is slower than that of the hepatic artery. The paraumbilical vein was visualized with the HFA in 18 cases. Chemotherapy or transcatheter arterial chemoembolization was performed in 10 patients, and there was no postprocedure supraumbilical skin complication.     

Chemoembolization for Hepatocellular Carcinoma Supplied Exclusively by the Hepatic Falciform Artery

Purpose

The purpose of this study was to describe imaging appearances of hepatocellular carcinoma (HCC) supplied exclusively by the hepatic falciform artery (HFA) and safety of chemoembolization via the HFA.

Methods

During the past 6?years, we have performed chemoembolization for the treatment of 12 patients with HCCs supplied exclusively by the HFA. Computed tomography (CT) scans, digital subtraction angiograms, and medical records were retrospectively reviewed by consensus.

Results

Tumors were located in Couinaud segments IV (n?=?7) and III (n?=?5) and in subcapsular areas around the falciform ligaments. Tumor size ranged from 1.0 to 1.8?cm (mean, 1.3?cm; median, 1.3?cm). HFAs originated from A4 (n?=?7), A3 (n?=?4), and the left hepatic artery near the umbilical point (n?=?1). All tumors were supplied exclusively by the HFA. Prophylactic embolization of the distal HFA before chemoembolization was performed using gelatin sponge particles in only one patient, and selective chemoembolization via the HFA was achieved in all patients. One patient suffered from a skin rash after chemoembolization and recovered after conservative management. Individual responses of tumors supplied exclusively by the HFA were complete response (n?=?8), partial response (n?=?1), and stable disease (n?=?2) at the first follow-up enhanced CT scan.

Conclusions

The HFA can supply HCC located in subcapsular areas around the falciform ligament, and the tumors can be safely chemoembolized without significant complications.     

Nonhepatic arteries originating from the hepatic arteries: angiographic analysis in 250 patients

PURPOSE: To investigate the prevalence and patterns of origin of nonhepatic arteries originating from the proper hepatic artery (PHA) or its distal branches and to assess their relation to anatomic variations. MATERIALS AND METHODS: Digital subtraction celiac arteriography and selective left hepatic arteriography was performed in 250 patients with hepatocellular carcinoma. Three interventional radiologists interpreted the angiograms on the monitor by consensus. If necessary, further superselective arteriography was performed. The prevalence of nonhepatic arteries, their sites of origin, and the influence of underlying anatomic variants were analyzed. RESULTS: Nonhepatic arteries were found in 205 patients. The most common nonhepatic artery was the right gastric artery (RGA; n = 196), followed by the hepatic falciform artery (HFA; n = 129), accessory left gastric artery (LGA; n = 43), posterior superior pancreaticoduodenal artery (PSPDA; n = 18), and left inferior phrenic artery (LIPA; n = 5). The left hepatic artery (LHA) was the most frequent origin of nonhepatic arteries (170 of 250). Regardless of anatomic variation, the most common origins of the RGA and HFA were the PHA and the segment IV hepatic artery, respectively. In patients with an aberrant LHA from the LGA, no accessory LGAs or LIPAs were found. PSPDAs preferentially arose from variant hepatic arteries arising from the gastroduodenal artery. CONCLUSIONS: Nonhepatic arteries commonly arise from the hepatic arteries, especially the LHA and PHA. Moreover, variants of the celiac and hepatic arteries influence the prevalence and sites of origin of nonhepatic arteries.     

Is prophylactic embolization of the hepatic falciform artery needed before radioembolization in patients with <Superscript>99m</Superscript>Tc-MAA accumulation in the anterior abdominal wall?

Purpose  

While influx of chemoembolic agents into the hepatic falciform artery (HFA) from the hepatic artery can cause supraumbilical skin rash, epigastric pain and even skin necrosis, the significance of a patent HFA in patients undergoing radioembolization is not completely clear. Furthermore, the presence of tracer in the anterior abdominal wall seen in ^99mTc-macroaggregated albumin (^99mTc-MAA) images, which is generally performed prior to radioembolization, has been described as a sign of a patent HFA. The aim of this retrospective study was to evaluate the incidence and consequences of ^99mTc-MAA accumulation in the anterior abdominal wall, indicating a patent HFA, in patients undergoing radioembolization of liver tumours.     

CTHA和CTAP在肝癌介入治疗中的应用

目的:研究肝动脉造影CT和经动脉门脉造影CT在肝癌介入治疗中的应用价值和意义。方法:10例原发性肝癌介入治疗前行肝动脉造影CT(CTHA)和经动脉门脉造影CT(CTAP)检查;术中行数字减影肝动脉造影(DSA)。结果:CTHA、CTAP联合检查与常规CT、DSA比较,分别多发现新癌灶11个(26/37)和12个(25/37)。准确判断非复发癌灶2个和1个坏死灶。结论:CTHA、CTAP是肝癌介入治疗前准确判断肿瘤数量和存活度最敏感和准确的方法,对于介入治疗方案的实施、疗效评价有很重要的作用。     

Double phase CT during hepatic arteriography for diagnosis of hepatocellular carcinoma

RATIONALE AND OBJECTIVES: The purpose of this study is to assess the diagnostic impact of double phase computed tomography during hepatic arteriography for hepatocellular carcinoma. MATERIALS AND METHODS: 118 hepatocellular carcinomas in 73 cirrhotic patients who underwent double phase computed tomography during hepatic arteriography were enrolled in this study. Double phase computed tomography during hepatic arteriography consisted of computed tomography images obtained at 5-10 s (first phase) and 40-50 s (second phase) after the initiation of an intraarterial administration of 40-60 ml of contrast medium through the hepatic artery. Diagnostic accuracy of the first phase computed tomography during hepatic arteriography alone and double phase computed tomography during hepatic arteriography images for hepatocellular carcinoma were separately analyzed by three blinded readers independently. Alternative-free response receiver operating characteristic curves were constructed to compare each set of computed tomography during hepatic arteriography images. RESULTS: The detection sensitivity of the double phase CTHA for HCC (mean, 83.1%) was significantly higher than that of the first phase CTHA alone (mean, 73.4%) (P < 0.01). Moreover, the positive predictive value of the double phase CTHA (mean, 93.7%) was higher than that of the first phase CTHA alone (87.4%). The area under the AFROC curve (Az value) of the double phase CTHA (mean, 0.88) was significantly higher than that of the first phase CTHA alone (mean, 0.77) (P < 0.05). CONCLUSIONS: Double phase computed tomography during hepatic arteriography can improve the diagnostic accuracy of hepatocellular carcinoma.     

Hepatic falciform artery: is prophylactic embolization needed before short-term hepatic arterial chemoinfusion?

OBJECTIVE: The purpose of this study was to assess the need for prophylactic embolization of the hepatic falciform artery (HFA) to prevent supraumbilical skin rash before short-term hepatic arterial chemoinfusion with or without subsequent embolization. MATERIALS AND METHODS: Transcatheter arterial chemoinfusions or chemoembolizations were performed on 127 consecutive patients with hepatocellular carcinoma between August 1997 and September 1997. Hepatic angiography findings regarding the anatomic variations of the hepatic artery and the presence and origin of the HFA were analyzed. The patients were followed up for 35-143 days (mean, 78 days). The incidence of supraumbilical skin rash was assessed for two groups of patients, those with an HFA and those without. We also evaluated other factors that seemed closely related to the presence of an HFA. RESULTS: An HFA was identified in 16 (13%) of 127 patients. Each HFA originated either in the left hepatic artery (n = 14) or the middle hepatic artery (n = 2). In the 16 patients with an HFA, serum bilirubin levels were significantly higher than in patients without one (p < .05), whereas serum albumin levels and prothrombin times were significantly lower (p < .05) and more prolonged (p = .02) than in patients without one. Portal venous collateral vessels were more frequently seen in patients with an HFA (50%) than in those without one (31%), but the frequency was not significant (p = .157). However, supraumbilical skin rash was not seen in any patient. CONCLUSION: We found no need for prophylactic embolization of the HFA to prevent supraumbilical skin rash before short-term hepatic arterial chemoinfusion with or without subsequent embolization.     

肝癌合并腹腔动脉与肠系膜上动脉侧支循环通路假性闭塞(附12例报告)

目的：探讨肝癌合并腹腔动脉与肠系膜上动脉侧支循环通路假性闭塞的血管造影表现及其在介入治疗中的价值。方法：回顾性分析12例该类患者的肠系膜上动脉造影，腹腔动脉造影及介入治疗资料。结果：12例假性闭塞中，位于肝总动脉与腹腔动脉分叉处6例，肝总动脉分出胃十二指肠动脉支处5例，1例右肝动脉直接起源于腹腔动脉，并在其分叉处发生假性闭塞。在这12处假性闭塞中，于腹腔动脉造影时呈闭塞状态，而肠系膜上动脉造影却完全通畅，似静脉瓣样。并且导丝、导管能顺利通过该闭塞处。10例患者完成了肝动脉化疗栓塞术。结论：这一少见现象可能与其血液动力学改变和解剖学变异有关，了解此征象对于指导介入治疗有一定价值。     

Communicating arcade between the right and left hepatic arteries: evaluation with CT and angiography during temporary balloon occlusion of the right or left hepatic artery

PURPOSE: To evaluate prospectively the relationship between the arterial collateral system at the hepatic hilum and the blood supply to the hilar bile duct by using computed tomography (CT) and angiography during temporary balloon occlusion of the right or left hepatic artery. MATERIALS AND METHODS: Institutional review board approval and informed consent were obtained. The study included 13 patients with no lesions at the hepatic hilum (eight men and five women; age range, 41-78 years; mean, 65.8 years). After serial angiographic studies were performed for preoperative evaluation or transcatheter arterial chemoembolization, a 5.5-F catheter with an occlusion balloon was positioned in the right or left hepatic artery. Eleven patients underwent angiography of the left hepatic artery with temporary occlusion of the right hepatic artery, and two patients underwent angiography of the right hepatic artery with temporary occlusion of the left hepatic artery. In addition, 11 patients underwent single-level dynamic CT during hepatic arteriography (CTHA) with temporary occlusion of the right or left hepatic artery. The images from angiography and CTHA were interpreted by two authors who assessed the existence of the arterial communication and its branching points, location, and relationship to the hilar bile duct and caudate lobe. RESULTS: During temporary occlusion of the right or left hepatic artery, the communicating arcade (CA) between the right and left hepatic arteries was immediately evident in all patients. On the left side, the CA originated from the segment IV artery in eight patients (62%) and from the left hepatic artery in five (38%). On the right side, the CA originated from the right anterior hepatic artery in six patients (46%), the right hepatic artery in two (15%), and both arteries in five (38%). The CA was extrahepatically located close to the hilar bile duct and forked into a few branches to the caudate lobe. CONCLUSION: The CA may play an important role not only in the interlobar arterial collateral system but also in the blood supplies to the caudate lobe and hilar bile duct.     

肝动脉正常解剖及变异的DSA研究

目的 研究数字减影血管造影（DSA）下肝动脉正常解剖及变异。方法 回顾分析我院从1994年11月至2003年6月的1200份,常规腹腔动脉干造影和（或）选择性肝动脉造影DSA片,部分病例同时作肠系膜上动脉、胃左动脉等处的造影。结果 873例（72．8％）患者具有正常的肝血管起源,156例（13．0％）患者存在变异的肝左动脉,120例（10．0％）患者存在变异的肝右动脉,而21例（1．8％）肝左及肝右动脉同时存在变异。1200例患者中肝总动脉起源于腹腔动脉干者1170例（97．5％）;肝固有动脉有92．0％系肝总动脉的直接延续;肝右动脉大多数发自肝固有动脉（89．8％）;肝中动脉的变异较大,发自肝左动脉较多（62．2％）;肝左动脉可直接发自肝固有动脉（44．6％）,也可来源于肝右动脉（30．2％）或其他动脉（25．2％）。结论 DSA了解肝动脉的解剖变异对指导肝脏疾病的介入治疗以及肝脏外科临床具有重要的意义。     

Transcatheter arterial chemoembolization for hepatocellular carcinomas in patients with celiac axis occlusion

PURPOSE: To verify the hypothesis that most instances of celiac axis occlusion in patients with hepatocellular carcinoma (HCC) are caused by diaphragmatic compression and, therefore, transcatheter arterial chemoembolization (TACE) can be performed through the compressed lumen of the celiac axis. MATERIALS AND METHODS: The authors attempted to perform TACE in 36 consecutive patients with HCC and celiac axis occlusion. Spiral computed tomographic (CT) images were available in 26 patients. Initially, catheterization of the hepatic arteries was attempted through the occluded celiac axis. If it failed, catheterization was performed through the pancreaticoduodenal arcades. The causes of celiac axis occlusion were evaluated based on spiral CT and angiographic findings, access routes, technical success rates, and related complications in superselective catheterization of hepatic arteries. RESULTS: Among the 26 patients who underwent spiral CT, diaphragmatic compression of the celiac axis was demonstrated in 23. Selective catheterization of hepatic arteries was possible through the occluded celiac axis in 23 patients (64%). In nine (25%) of the remaining 13 patients, TACE was performed through the dilated pancreaticoduodenal arcades from the superior mesenteric artery. As a procedure-related complication, celiac axis dissection occurred in one patient (3%). CONCLUSION: Most patients with celiac axis occlusion had arcuate ligament compression. In TACE, the celiac artery occlusion could be traversed directly and this should be the initial approach.     

Impact of multidetector CT hepatic arteriography on the planning of chemoembolization treatment of hepatocellular carcinoma.

OBJECTIVES: We examined the impact of the increased sensitivity for hypervascular masses of multidetector CT hepatic arteriography on treatment decisions involving selective chemoembolization of hepatocellular carcinomas. SUBJECTS AND METHODS: Thirty patients were referred for chemoembolization of unresectable hepatocellular carcinoma. Initial selective chemoembolization plans were formulated on the basis of diagnostic biphasic CT or MR imaging. Ultrafast CT hepatic arteriography was performed using a multidetector CT scanner and selective contrast material injection into the hepatic artery. The entire liver was scanned in a single breath-hold of approximately 20 sec with a slice thickness of 1 mm. Lesions and their arterial supplies were identified, and these data were immediately used to formulate a final plan for chemoembolization. RESULTS: Hypervascular masses were detected in 29 patients. In 16 (53%) of the patients, preprocedural CT or MR imaging underestimated the number of lesions. In nine (30%) of these 16 patients, the additional lesions were detected only on CT hepatic arteriography, not on conventional angiography. CT hepatic arteriography findings had a major impact on planning the way in which chemoembolization treatment was performed. In three of the nine patients, the previously undetected lesions were treated with additional superselective chemoembolization. In the other six patients, chemoembolization was performed less selectively than originally planned. CONCLUSION: Primarily because of the high sensitivity of multidetector CT hepatic arteriography in revealing small and multifocal hepatomas, findings of this modality frequently alter treatment plans involving selective administration of chemoembolic material.     

Hepatic falciform ligament Tc-99m-macroaggregated albumin activity on SPECT/CT prior to Yttrium-90 microsphere radioembolization: prophylactic measures to prevent non-target microsphere localization via patent hepatic falciform arteries

Yttrium-90 (Y-90) selective internal radiation therapy (SIRT) is increasingly used to treat inoperable hepatocellular carcinoma. We describe two patients where hepatic falciform ligament Technetium-99m-macroaggregated albumin (Tc-99m-MAA) activity was identified on single photon emission computed tomography with integrated low-dose CT (SPECT/CT) scan during pre-therapy planning, and the steps taken to prevent radiation dermatitis. The first patient underwent prophylactic coil embolization of the patent hepatic falciform artery; the second patient underwent super-selective infusion of Y-90 resin microspheres to avoid the patent hepatic falciform artery. The incidence of falciform ligament Tc-99m-MAA activity detected on SPECT/CT at our institution is 10%. Tc-99m-MAA SPECT/CT scan provides valuable diagnostic information for treatment planning prior to Y-90 SIRT.     

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).     

Hepatic falciform artery: anatomy, angiographic appearance, and clinical significance

Three patients developed supraumbilical skin rashes during hepatic artery infusion chemotherapy by a surgically placed perfusion catheter and drug-infusion pump. In one patient, hepatic arterial scintigraphy with technetium-99m macroaggregated serum albumin showed increased uptake corresponding to the rash, and a hepatic arteriogram showed a dilated falciform branch of the left hepatic artery. Surgical ligation of the falciform artery permitted further treatment without recurrent rash. Based on a review of 100 celiac arteriograms, the incidence of the falciform artery on angiographic studies is approximately 2%. The angiographic appearance of this artery is presented, and its potential clinical significance in hepatic artery perfusion chemotherapy is discussed.     

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.