[Value of triple phase helical CT for the detection of hepatocellular carcinoma in cirrhotic liver]

Abstract

Purpose: Purpose of this study was to determine the value of the delayed-phase (DP) of helical CT in the detection of hepatocellular carcinoma (HCC) in cirrhotic liver in comparison to the arterial phase (AP) and the portal-venous phase (PP).

Material and methods: 51 patients with liver cirrhosis and suspected HCC were examined by triple-phase helical-CT (THCT). Images were standardized and obtained 20 seconds - AP, 60 - 70 seconds - PP, and 300 seconds - DP after injection of 140 ml of intravenous iodinated contrast material. Pictures were reviewed by two experienced radiologists for typical intrahepatic lesions. First, each single phase of contrast distribution were seen separately. Then all contrast phases were reviewed together.

Results: In 17 patients 49 typical lesions were found, histological work-up was performed, whereas in 34 patients clinical follow-up of at least 6 months was obtained. The arterial phase (AP) itself depicted 55 % of these lesions, whereas the portal-venous phase (PP) depicted 57 % and the delayed phase 78 %. DP showed a significantly higher detection rate in comparison to the PP (p = 0.008). By performing a biphasic helical CT 40 lesions would have been detected with AP and PP, whereas all 49 lesions would have been visualised by combining AP and DP. This means a significantly higher detection rate for AP/DP instead of using AP/PP (p = 0.031).

Conclusion: Additionally to the AP and PP, a delayed phase should be performed when cirrhosis is present. Even though AP and DP depicted all HCC's in this study, the PP provides undispensable additional information, so that, in our opinion, a THCT should be given preference when HCC is suspected.