American Journal of Roentgenology, Vol 172, 961-968, Copyright © 1999 by American Roentgen Ray Society

ARTICLES

Comparison of unenhanced, hepatic arterial-dominant, and portal venous- dominant phase helical CT for the detection of liver metastases in women with breast carcinoma

DH Sheafor, MG Frederick, EK Paulson, MT Keogan, DM DeLong and RC Nelson
Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA.

OBJECTIVE: The purpose of this study was to evaluate triple-phase helical CT for detection of hepatic metastases from breast carcinoma. SUBJECTS AND METHODS: Breast cancer patients were studied prospectively with triple-phase helical CT in 300 consecutive examinations. Hepatic arterial-dominant and portal venous-dominant phase scans were initiated at 20 and 65 sec, respectively, after IV injection of 175 ml of iopamidol (30 mg/ml) at 5 ml/sec. Three independent observers each reviewed 200 cases of the portal venous-dominant phase for lesion number, conspicuity, and attenuation. Subsequently, portal venous- dominant phase images were reevaluated in conjunction with hepatic arterial-dominant phase or unenhanced images. RESULTS: Hepatic metastases were identified in 79 (26%) of 300 cases. Lesions detected on portal venous-dominant, hepatic arterial-dominant, and unenhanced images were as follows: observer 1, n = 198, 164, and 171; observer 2, n = 254, 233, and 233; and observer 3, n = 291, 270, and 276 (p > .05). The mean total lesion count was 387, with more lesions detected on portal venous-dominant phase than on either hepatic arterial-dominant phase or unenhanced images (p < .001 and p < .0001, respectively). For individual observers, 10-26% of lesions were hypervascular on hepatic arterial-dominant phase images. Two to 4% of lesions were identified only on hepatic arterial-dominant phase or unenhanced images. However, in these few cases, the lesions either were false-positives or were seen in conjunction with additional metastases on portal venous- dominant images. CONCLUSION: Routine use of triple-phase CT in patients with breast carcinoma may not be warranted: Addition of the hepatic arterial-dominant phase or unenhanced images revealed few additional lesions in our group of 300 patients.
CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				C. H. McCollough, L. Guimaraes, and J. G. Fletcher In Defense of Body CT Am. J. Roentgenol., July 1, 2009; 193(1): 28 - 39. [Abstract] [Full Text] [PDF]

				B. Siewert, J. Sosna, A. McNamara, V. Raptopoulos, and J. B. Kruskal Quality Initiatives: Missed Lesions at Abdominal Oncologic CT: Lessons Learned from Quality Assurance RadioGraphics, May 1, 2008; 28(3): 623 - 638. [Abstract] [Full Text] [PDF]

				P. Soyer, M. Poccard, M. Boudiaf, M. Abitbol, L. Hamzi, Y. Panis, P. Valleur, and R. Rymer Detection of Hypovascular Hepatic Metastases at Triple-Phase Helical CT: Sensitivity of Phases and Comparison with Surgical and Histopathologic Findings Radiology, May 1, 2004; 231(2): 413 - 420. [Abstract] [Full Text] [PDF]

				I.-M. Danet, R. C. Semelka, P. Leonardou, L. Braga, G. Vaidean, J. T. Woosley, and M. Kanematsu Spectrum of MRI Appearances of Untreated Metastases of the Liver Am. J. Roentgenol., September 1, 2003; 181(3): 809 - 817. [Abstract] [Full Text] [PDF]

				I. R. Francis, R. H. Cohan, N. J. McNulty, J. F. Platt, M. Korobkin, A. Gebremariam, and K. Ragupathi Multidetector CT of the Liver and Hepatic Neoplasms: Effect of Multiphasic Imaging on Tumor Conspicuity and Vascular Enhancement Am. J. Roentgenol., May 1, 2003; 180(5): 1217 - 1224. [Abstract] [Full Text] [PDF]

				S. C. Eberhardt, P. H. Choi, A. M. Bach, S. A. Funt, H. E. Felderman, and L. E. Hann Utility of Sonography for Small Hepatic Lesions Found on Computed Tomography in Patients With Cancer J. Ultrasound Med., April 1, 2003; 22(4): 335 - 343. [Abstract] [Full Text] [PDF]

				H.-C. Kim, A. Y. Kim, J. K. Han, J. W. Chung, J. Y. Lee, J. H. Park, and B. I. Choi Hepatic Arterial and Portal Venous Phase Helical CT in Patients Treated with Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma: Added Value of Unenhanced Images Radiology, December 1, 2002; 225(3): 773 - 780. [Abstract] [Full Text] [PDF]

				D. A. Bluemke, E. K. Paulson, M. A. Choti, S. DeSena, and P. A. Clavien Detection of Hepatic Lesions in Candidates for Surgery: Comparison of Ferumoxides-Enhanced MR Imaging and Dual-Phase Helical CT Am. J. Roentgenol., December 1, 2000; 175(6): 1653 - 1658. [Abstract] [Full Text] [PDF]

				M. E. O'Malley, E. Halpern, P. R. Mueller, and G. S. Gazelle Helical CT Protocols for the Abdomen and Pelvis: A Survey Am. J. Roentgenol., July 1, 2000; 175(1): 109 - 113. [Abstract] [Full Text] [PDF]

				A. L. Spielmann, R. C. Nelson, C. R. Lowry, G. A. Johnson, G. Sundaramoothy, D. H. Sheafor, and E. K. Paulson Liver: Single Breath-hold Dynamic Subtraction CT with Multi-Detector Row Helical Technology—Feasibility Study Radiology, January 1, 2002; 222(1): 278 - 283. [Abstract] [Full Text] [PDF]