Dynamic CT of hepatic masses using intraarterial enhancement: advantages and pitfalls

Accuracy of CT Arterial Portography of the Liver Compared with Findings at Laparotomy

To evaluate the accuracy of CT arterial portography (CTAP) of the liver, CTAP examinations from 111 patients were retrospectively reviewed and compared with the findings at laparotomy. Laparotomy had been performed within 3 weeks after the CTAP examination. In cases of resectable liver tumor, the result from the pathologic examination report was used to calculate the accuracy of CTAP. In cases of nonresectable liver tumor or liver without tumor, CTAP findings were compared with the result of a thorough inspection and palpation of the liver. The right liver lobe and the medial and lateral segments of the left lobe were separately evaluated. Thus, a total of 333 lobes/segments were evaluated. Tumor was found at laparotomy in 80 of 333 lobes or segments. At CTAP a total of 94 lobes were evaluated as positive for tumor growth, 23 of these were falsely interpreted as positive and 9 were falsely interpreted as negative when compared with the findings at laparotomy. However, 3 patients called false-positives later turned out to be true-positives since the lesions were overlooked at operation. A sensitivity of 89%, a specificity of 91%, and an accuracy of 90% was calculated for CTAP. It is concluded that CTAP has a higher accuracy than other radiologic methods and should be considered suitable for preoperative evaluation of potentially resectable liver tumor.

Solitary hepatic metastasis: comparison of dynamic contrast-enhanced CT and MR imaging with fat-suppressed T2-weighted, breath-hold T1-weighted FLASH, and dynamic gadolinium-enhanced FLASH sequences

Twenty consecutive cancer patients with a solitary hepatic metastasis detected with dynamic contrast-material-enhanced computed tomography (CT) who were considered for hepatic resection underwent magnetic resonance (MR) imaging within 18 days after CT. Histologic confirmation was obtained in all lesions. CT depicted 20 solitary lesions. MR imaging showed a solitary lesion in 14 patients, two lesions in three patients, and more than two lesions in three patients, for a total of 37 lesions. Twenty-three lesions less than 2 cm in diameter were missed with CT, and six lesions less than 1.3 cm in diameter were missed with MR imaging. MR imaging was superior to CT in the detection of hepatic metastases on a patient-by-patient basis (P < .01). The results suggest that MR imaging is superior to dynamic contrast-enhanced CT for the detection of hepatic metastases.