Small Hypervascular Hepatocellular Carcinoma Revealed by Double Arterial Phase CT Performed with Single Breath-Hold Scanning and Automatic Bolus Tracking
Tonsok Kim1,
Takamichi Murakami1,
Masatoshi Hori1,
Manabu Takamura1,
Satoru Takahashi1,
Atsuya Okada1,
Shuji Kawata1,
Modesto Cruz1,
Michael P. Federle2 and
Hironobu Nakamura1
1
Department of Radiology, D1 Osaka University Medical School, 2-2 Yamadaoka,
Suita City, Osaka 565-0871, Japan.
2
Department of Radiology, Division of Abdominal Imaging, University of
Pittsburgh Medical Center, 200 Lothrop St., Pittsburgh, PA 15213.
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Fig. 1. —Time chart for automatic bolus-tracking technique. Real-time
low-dose serial monitor scans were automatically initiated 10 sec after start
of injection of contrast material. CT values of region of interest specified
in abdominal aorta were automatically calculated. Trigger for start of
diagnostic scan was set at increase in aortic enhancement of 50H, and first
arterial phase helical CT scan started automatically 10 sec after trigger
level had been reached.
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Fig. 2. —Bar graph shows distribution of time elapsed until
triggering. Time from initiation of contrast injection until trigger value had
been reached varied from 10 to 23 sec. Mean time until triggering was 13 sec,
but interval of 10 sec occurred in largest number of patients.
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Fig. 3A. —Hypervascular hepatocellular carcinoma lesion in 59-year-old
woman. Rate of contrast injection was 5 mL/sec, and time elapsed until
triggering was 10 sec. First arterial phase CT scan, started 20 sec after
start of injection, shows hepatocellular carcinoma nodule (arrow) as
hyperenhanced lesion.
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Fig. 3B. —Hypervascular hepatocellular carcinoma lesion in 59-year-old
woman. Rate of contrast injection was 5 mL/sec, and time elapsed until
triggering was 10 sec. Second arterial phase CT scan, started 38 sec after
start of injection, fails to show hepatocellular carcinoma nodule.
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Fig. 3C. —Hypervascular hepatocellular carcinoma lesion in 59-year-old
woman. Rate of contrast injection was 5 mL/sec, and time elapsed until
triggering was 10 sec. Late phase CT scan fails to show hepatocellular
carcinoma nodule.
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Fig. 3D. —Hypervascular hepatocellular carcinoma lesion in 59-year-old
woman. Rate of contrast injection was 5 mL/sec, and time elapsed until
triggering was 10 sec. CT during arterial portography image obtained at time
of angiography performed after IV contrast-enhanced CT shows hepatocellular
carcinoma (arrow) as area of decreased perfusion.
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Fig. 3E. —Hypervascular hepatocellular carcinoma lesion in 59-year-old
woman. Rate of contrast injection was 5 mL/sec, and time elapsed until
triggering was 10 sec. CT hepatic arteriogram shows hepatocellular carcinoma
(arrow) as hyperenhanced lesion, proving that hepatocellular
carcinoma was hypervascular.
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Fig. 4A. —80-year-old man with hypervascular hepatocellular carcinoma.
Rate of contrast injection was 5 mL/sec, and time until triggering was 18 sec.
First arterial phase CT scan, started 28 sec after start of contrast
injection, shows hepatocellular carcinoma nodule (arrow) as slightly
hyperenhanced lesion.
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Fig. 4B. —80-year-old man with hypervascular hepatocellular carcinoma.
Rate of contrast injection was 5 mL/sec, and time until triggering was 18 sec.
Second arterial phase CT scan, started 46 sec after start of contrast
injection, shows hepatocellular carcinoma as more prominently hyperenhanced
lesion (arrow) than did first arterial phase CT.
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Fig. 4C. —80-year-old man with hypervascular hepatocellular carcinoma.
Rate of contrast injection was 5 mL/sec, and time until triggering was 18 sec.
Late phase CT scan shows hepatocellular carcinoma (arrow) as slightly
hypoenhanced lesion.
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Fig. 4D. —80-year-old man with hypervascular hepatocellular carcinoma.
Rate of contrast injection was 5 mL/sec, and time until triggering was 18 sec.
CT during arterial portography scan obtained during angiography performed
after IV contrast-enhanced CT shows hepatocellular carcinoma (arrow)
as area of decreased perfusion.
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Fig. 4E. —80-year-old man with hypervascular hepatocellular carcinoma.
Rate of contrast injection was 5 mL/sec, and time until triggering was 18 sec.
CT scan after intraarterial iodized oil injection shows hepatocellular
carcinoma (arrow) as hyperenhanced lesion, proving hepatocellular
carcinoma to be hypervascular.
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Copyright © 2002 by the American Roentgen Ray Society.
