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Optimal Arterial Phase Imaging for Detection of Hypervascular Hepatocellular Carcinoma Determined by Continuous Image Capture on 16-MDCT

¹ All authors: Department of Abdominal Imaging and Interventional Radiology, Massachusetts General Hospital and Harvard Medical School, WHT 2-270, 55 Fruit St., Boston, MA 02114.

OBJECTIVE. The purpose of this study is to estimate the optimal time delay before the initiation of arterial phase scanning for detection of hypervascular hepatocellular carcinoma (HCC) on 16-MDCT when a rapid bolus injection of contrast medium is administered.

SUBJECTS AND METHODS. In this prospective study, 25 patients (19 men and six women; mean age, 63.5 years; age range, 50–81 years) with pathologically confirmed HCC were included. Dynamic 16-MDCT imaging was performed in cine mode using 70 mL of nonionic iodinated contrast medium (300 mg I/mL) at an injection rate of 7 mL/s. Four consecutive 5-mm-thick slices at the maximum diameter of the HCC were selected as the region of interest. Time–attenuation curves were generated by region of interest drawn on the aorta, tumor, and liver. Qualitative assessments of conspicuity for contrast medium wash-in, peak, and wash-out of aorta and tumor were performed.

RESULTS. There were 108 arterial phase enhancing lesions (mean [±SD], 4.9 ± 2.4 cm; range, 0.7–12.9 cm) in the 25 patients. The maximum Hounsfield value of aorta, tumor, and background liver parenchyma were 463.8 ± 98 HU, 106.5 ± 19 HU, and 98.3 ± 14 HU, respectively. At the time of onset of peak tumor enhancement, the difference between tumor density and background liver density was 38.2 ± 19 HU. The time–attenuation curve showed that the mean times of contrast enhancement start, peak, and end were 9.2 ± 2.7 seconds, 19.4 ± 2.1 seconds, and 38 ± 13.5 seconds, respectively, for the aorta, and 15.5 ± 2.6 seconds, 26.3 ± 2.9 seconds, and 57.7 ± 14.4 seconds, respectively, for 25 pathologically confirmed hepatocellular carcinomas. Qualitatively, the mean times of contrast enhancement wash-in, peak, and washout were 10.2 ± 2.8 seconds, 19.9 ± 3 seconds, and 39.9 ± 9.2 seconds, respectively for the aorta, and 18 ± 4.2 seconds, 27 ± 3 seconds, and 55.7 ± 21 seconds, respectively, for tumor. There were no differences between quantitative and qualitative measurements of wash-in and peak time for the aorta (p = 0.00017, p = 0.00016) and tumor (p = 0.00163, p = 0.00040).

CONCLUSION. When using 70 mL of 300 mg I/mL of contrast medium with an injection rate of 7 mL/s in 16-MDCT scanning, the optimal time to initiate scanning for HCC is 26.3 ± 2.9 seconds (range, 24.0–34.5 seconds) after contrast medium administration.

Keywords: hepatocellular carcinoma • liver • MDCT • MRI • peak enhancement • rapid bolus injection

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