Role of computed tomography in screening for hepatocellular carcinoma in patients with cirrhosis

Hepatocellular carcinoma: detection with triple-phase multi-detector row helical CT in patients with chronic hepatitis

PURPOSE

To evaluate whether the use of two arterial phase image acquisition series, when combined with portal venous phase imaging at multi-detector row helical computed tomography (CT), would be superior enough to use of a single arterial phase image acquisition series to warrant the increased radiation dose.

MATERIALS AND METHODS

Multi-detector row CT was performed in 77 patients with 140 foci of hepatocellular carcinoma (HCC). A triple-phase protocol that included an early arterial phase, a late arterial phase, and a portal venous phase was performed. Images were analyzed separately by three radiologists to document the presence and number of HCC nodules. Separate reading sessions were performed for images from the early arterial phase, images from the late arterial phase, images from both arterial phases combined, and images from all three phases. Sensitivity and positive predictive values were calculated for each reading session.

RESULTS

The average sensitivity and positive predictive values, respectively, for the detection of HCC were 48.5% and 96.4% for early arterial phase images, 87.1% and 94.0% for late arterial phase images, 87.1% and 94.0% for images from both arterial phases, and 88.5% and 93.4% for images from all three phases. Analysis of images from both arterial phases together yielded no improvement in either sensitivity or positive predictive value compared with analysis of late arterial phase images alone. Analysis of the combination of late arterial and portal venous phase images resulted in the highest sensitivity value.

CONCLUSION

The acquisition of images during two arterial contrast phases does not provide additional benefit over timed conventional biphasic CT technique.

MR imaging of the liver: effect of portal hypertension on hepatic parenchymal enhancement using a gadolinium chelate

The purpose of this study was to prospectively investigate the extent to which reduced portal blood flow in patients with hepatic cirrhosis and portal hypertension affects hepatic parenchymal enhancement during gadolinium-chelate-enhanced dynamic MR imaging. Breath-hold three-dimensional (3D) spoiled gradient-recalled echo (GRE) MR imaging technique obtained after intravenous administration of a gadolinium chelate was used to measure hepatic parenchymal enhancement and time to peak enhancement in 20 patients with hepatic cirrhosis and clinical evidence of portal hypertension (group 1) and in 20 control subjects without portal hypertension (group 2) who were matched for age, sex, and body weight. Mean peak hepatic enhancement values +/- SD and times to peak enhancement +/- SD were determined for both groups of patients. Mean peak enhancement value (+/-SD) was 78.7% +/- 36.2 in group 1 and 91.6% +/- 46.2 in group 2 (not significant). However, in the nine patients in group 1 with splenomegaly, mean peak enhancement value was 61.3% +/- 14.4, whereas it was 93.0% +/- 42.7 in the 11 patients without splenomegaly (P < .05). Mean time to peak enhancement was 84 seconds +/- 23 in group 1 and 54.0 sec +/- 25.0 in group 2 (P < .01). Our results show that mean peak enhancement value of hepatic parenchyma after intravenous administration of a gadolinium chelate is significantly altered for patients with portal hypertension and splenomegaly. In addition, the time to peak enhancement is delayed significantly when portal hypertension is present. Thus, it is possible that the optimal time for imaging the liver during the portal phase must be tailored to the status of the portal system of the patient.

Focal ultrasound lesions in liver cirrhosis diagnosed as regenerating nodules by fine-needle biopsy. Follow-up of 12 cases

In the period 1985-1988, 62 focal liver lesions in 58 cirrhotic patients were studied by ultrasonography; 12 of these focal lesions were documented to be regenerating lesions by echo-guided fine-needle biopsy. During an average follow-up period of 10.2 months (range 3-22 months), hepatocellular carcinoma was subsequently found in 10 of the cases of regenerating nodules, whereas the initial diagnosis of regenerating nodule was confirmed in the remaining two cases. Based upon this finding, it is suggested that every focal mass visualized by ultrasonography in a cirrhotic liver should either be considered to be a neoplastic lesion or at least a preneoplastic lesion if the possibility of either a metastatic or benign lesion (eg, hemangiomas, focal fatty liver change areas) can be excluded. Therefore either fine-needle aspiration or biopsy of all ultrasonographically revealed mass lesions within a cirrhotic liver is advised, such that early appropriate treatment for hepatocellular carcinoma can be instituted.