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1 Department of Medical Imaging, University Health Network and Mount Sinai
Hospital, University of Toronto, Toronto, ON, Canada.
2 Department of Medical Imaging, NCSB, 1C558, Toronto General Hospital, 585
University Ave., Toronto M5G 2N2, ON, Canada.
OBJECTIVE. The purpose of this study was to describe the appearances of hepatocellular carcinoma including intralesional contrast washout using a triple-phase liver protocol on an MDCT scanner.
MATERIALS AND METHODS. Fifty-one patients with newly diagnosed
hepatocellular carcinoma underwent standardized triple-phase CT using a
multidetector scanner. Pathologic proof was obtained in 35 patients (69%); in
16 patients (31%), hepatocellular carcinoma was diagnosed on clinical and
laboratory findings. Two radiologists independently reviewed the CT studies
for the appearance and attenuation of the lesions. Intralesional washout of
contrast material was evaluated subjectively and objectively. Statistical
analysis was performed using Fisher's exact test to analyze the relationships
between tumor appearance and 
-fetoprotein level, tumor grade, and risk
factor. Correlation between tumor size and appearance was analyzed using the
Student's t test and Wilcoxon's rank sum test.
RESULTS. The most common enhancement pattern for hepatocellular
carcinoma was hypervascularity on hepatic arterial phase images with a mosaic
pattern on both arterial and portal venous images; this finding was seen in
86% and 78% of lesions by the two observers, respectively. A hypervascular
component was seen in 96% of lesions by both observers, and the observers
recorded 86% and 63% of lesions as showing washout, respectively. Objective
washout was present in 76% of lesions. Both subjective and objective washout
correlated with an elevated -fetoprotein level (p = 0.01).
CONCLUSION. The appearances of hepatocellular carcinoma on images obtained using MDCT scanners are similar to those described for images obtained using single-detector helical scanners. However, the prevalence of hypervascular hepatocellular carcinoma on MDCT images is higher than previously described on single-detector helical images and most lesions showed washout on portal venous MDCT images.
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