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1
Department of Radiology, Medical College of Wisconsin, Froedtert Memorial
Lutheran Hospital, 9200 W. Wisconsin Ave., Milwaukee, WI 53226.
2
Diagnostic Imaging Associates, Mercy Hospital, 400 University Ave., Des
Moines, IA 50314.
OBJECTIVE. The aim of this study was to evaluate a new injection-acquisition technique performed using a multirow detector CT scanner for separation of three distinct hepatic circulatory phases (hepatic artery, portal venous inflow, hepatic venous) and to determine which of these phases is optimal for detecting hypervascular neoplasm.
MATERIALS AND METHODS. Two sequential acquisitions were performed during a single breath-hold followed by a third acquisition beginning 60 sec after injection. Injection-to-scan delay for the first acquisition was the individual patient's circulation time, which was determined by a preliminary mini bolus. The mean attenuation of the upper abdominal aorta, portal vein, and hepatic parenchyma were determined for each imaging pass in 20 patients with cirrhosis and 20 patients without cirrhosis. Tumor-to-liver contrast for hypervascular primary and metastatic neoplasm was evaluated in a different set of 16 cirrhotic patients and nine noncirrhotic patients. Three-dimensional CT arteriograms were obtained from first-pass data.
RESULTS. Three distinct circulatory phases (hepatic artery, portal vein inflow or late arterial, and hepatic venous) were seen in cirrhotic and noncirrhotic patients. Maximum tumor-to-liver contrast for hypervascular primary and metastatic neoplasm occurred during the second pass for both cirrhotic (p < 0.006) and noncirrhotic (p < 0.001) patients. A three-dimensional hepatic-mesenteric CT arteriogram of normal or anomalous hepatic vessels without venous overlay was obtained from first-pass data in all patients.
CONCLUSION. Rapid-sequence hepatic helical CT allows selection of the optimal time interval for hypervascular tumor detection. A new paradigm for rapid hepatic CT acquisition—namely, hepatic arterial, portal vein inflow, and hepatic venous phases—is recommended to replace hepatic artery dominant and portal venous phases.
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