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DOI:10.2214/AJR.06.0801
AJR 2007; 188:1337-1342
© American Roentgen Ray Society

Original Research

Detection of Hepatocellular Carcinoma on CT in Liver Transplant Candidates: Comparison of PACS Tile and Multisynchronized Stack Modes

Se Hyung Kim1,2, Jeong Min Lee1,2, Young Jun Kim3, Jin Young Choi1, Gi Hyeon Kim4, Ho Yun Lee1 and Byung Ihn Choi1,2

1 Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, 28, Yongon-dong, Chongno-gu, Seoul, 110-744 Korea.
2 Institute of Radiation Medicine, Seoul National University Hospital, Seoul, Korea.
3 Department of Radiology, Konkuk University Hospital, Seoul, Korea.
4 Department of Radiology, Chung Ang University Hospital, Seoul, Korea.

OBJECTIVE. The objective of our study was to compare CT image interpretation using PACS tile and multisynchronized stack modes with respect to speed and observer performance for the detection of hepatocellular carcinoma (HCC) in liver transplant candidates.

MATERIALS AND METHODS. Institutional review board approval was obtained, but informed consent was not required for this retrospective study. Sixty-seven patients underwent dynamic multiphasic CT within 3 months before liver transplantation. Interval reviews using tile and multisynchronized stack modes were performed independently by four reviewers with various levels of experience to determine the presence of HCC using a five-point confidence scale. Observer performance was compared using jackknife free-response receiver operating characteristic (ROC) analysis. The time required to interpret the CT scans using each mode was recorded and compared using the paired Student's t test.

RESULTS. Twenty-seven patients had 48 HCC nodules. The mean free-response ROC figures of merit for detecting HCC were significantly higher using the multisynchronized stack mode (0.731) than using the tile mode (0.662) (F-statistic = 6.603, p = 0.012). The 95% CIs for the task were -0.125 - -0.016. The time used for image analysis was also significantly shorter with the stack mode (63 {approx} 75 seconds) than with the tile mode (94 {approx} 191 seconds) for all four reviewers (p < 0.0001).

CONCLUSION. Multisynchronized stack viewing of multiphasic dynamic CT scans significantly increases the detection rate of HCC in liver transplant candidates. It also significantly shortens the interpretation time compared with tile viewing.

Keywords: CT • diagnostic radiology • liver neoplasms • observer performance • PACS


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