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Contrast-Enhanced CT of Small Hypovascular Hepatic Tumors

Effect of Lesion Enhancement on Conspicuity in Rabbits

Brian S. Kuszyk1, David A. Bluemke1, Michael A. Choti2, Karen M. Horton1, Carolyn A. Magee1 and Elliot K. Fishman1

1 The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Medical Institutions, 600 N. Wolfe St., Baltimore, MD 21287.
2 Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD 21287.



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  		Fig. 1A. —New Zealand White rabbit with liver containing two small VX2 carcinomas measuring 6 mm (right lobe) and 7 mm (left lobe). Unenhanced CT scan shows two subtle lesions within liver.

 


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  		Fig. 1B. —New Zealand White rabbit with liver containing two small VX2 carcinomas measuring 6 mm (right lobe) and 7 mm (left lobe). Arterial phase CT scan obtained 24 sec after start of contrast material injection shows ring enhancement surrounding lesions.

 


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  		Fig. 1C. —New Zealand White rabbit with liver containing two small VX2 carcinomas measuring 6 mm (right lobe) and 7 mm (left lobe). Portal phase CT scan obtained 54 sec after start of contrast material injection shows peak lesion conspicuity. Both lesions are of low attenuation relative to enhancing normal liver.

 


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  		Fig. 2. —Graph shows conspicuity (•) and attenuation of tumor (*), liver ({square}), aorta ({triangleup}), inferior vena cava (x), and portal vein ({blacksquare}) plotted against time after initiation of contrast material injection. Peak aortic attenuation of 910 H at 19 sec is not included on graph. Peak conspicuity occurs when attenuation of aorta and portal vein are equal.

 


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  		Fig. 3. —Graph shows relationship of conspicuity (•) and attenuation of tumor (*), liver ({square}), aorta ({triangleup}), and portal vein ({blacksquare}) versus phases of hepatic enhancement. Tumors progressively enhance during arterial and early portal phases of hepatic enhancement, plateauing in late portal phase and equilibrium phase. Conspicuity is substantially decreased by onset of equilibrium phase.

 


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  		Fig. 4. —Graph shows relative tumor conspicuity ({square}) and liver enhancement ([UNK]) as percentage of maximum values versus time after contrast material injection. Although peak conspicuity occurs slightly before peak hepatic enhancement, conspicuity curve parallels liver enhancement curve throughout imaging.

 

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