Hepatocellular carcinoma: evaluation with biphasic, contrast-enhanced, helical CT

Area of Science:

• Radiology
• Oncology
• Medical Imaging

Background:

• Hepatocellular carcinoma (HCC) is a primary liver malignancy.
• Accurate detection and staging of HCC are crucial for effective patient management.
• Contrast-enhanced computed tomography (CT) is a key imaging modality for HCC evaluation.

Purpose of the Study:

• To assess the incremental value of hepatic arterial-dominant phase (HAP) imaging when combined with portal venous-dominant phase (PVP) imaging.
• To determine if HAP imaging improves the detection of hepatocellular carcinoma (HCC) foci compared to PVP imaging alone.
• To evaluate the utility of biphasic contrast-enhanced CT in HCC assessment.

Main Methods:

• Sixty-six patients with confirmed HCC underwent biphasic contrast-enhanced CT.
• Hepatic arterial-dominant phase (HAP) images were acquired between 20-50 seconds post-contrast.
• Portal venous-dominant phase (PVP) images were acquired between 60-100 seconds post-contrast.

Main Results:

• A total of 326 tumor foci were identified.
• HAP imaging visualized 95% (309/326) of foci, while PVP imaging visualized 82% (268/326).
• In 11% (7/66) of patients, HCC was detected exclusively on HAP images.
• HAP imaging also improved the detection of malignant portal vein thrombosis.

Conclusions:

• Combining HAP and PVP contrast-enhanced CT optimizes the detection and evaluation of HCC.
• Biphasic CT imaging provides a more comprehensive assessment of HCC burden.
• This approach is recommended for patients with or at risk for hepatocellular carcinoma.