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Hepatocellular carcinoma: evaluation with biphasic, contrast-enhanced, helical CT
R L Baron1, J H Oliver, G D Dodd
1Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
Insights
Adding hepatic arterial-dominant phase (HAP) imaging to portal venous-dominant phase (PVP) computed tomography (CT) enhances hepatocellular carcinoma (HCC) detection. This biphasic approach optimizes HCC evaluation in at-risk patients.
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.
Purpose:
To evaluate the added value of hepatic arterial-dominant phase (HAP) imaging to portal venous-dominant phase (PVP) imaging in patients with hepatocellular carcinoma (HCC) at computed tomography (CT).
Materials And Methods:
Sixty-six patients with proved HCC underwent biphasic contrast-enhanced CT. HAP and PVP images were obtained at 20-50 and 60-100 seconds, respectively. PVP images were evaluated for the number of HCC foci. Then, HAP images were reviewed to determine whether any additional HCCs were seen.
Results:
Three hundred twenty-six tumor foci were seen. HAP images depicted 309 foci (95%) and PVP images 268 (82%). In seven patients (11%), tumor was visible only on HAP images. During the HAP, tumors were hyperattenuating compared with liver in 26 patients, of mixed attenuation in 26, and hypoattenuating in 14 without correlation with histologic appearance. Portal vein thrombosis was identified in 17 of 21 patients on HAP images; in 12 patients, the thrombosis was diagnosed as malignant with neovascularity within the thrombus or diffuse thrombus enhancement.
Conclusion:
Use of both HAP and PVP contrast-enhanced CT optimizes the evaluation of patients with or at risk for HCC.