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Hypervascular Hepatocellular Carcinoma: Can Double Arterial Phase Imaging with Multidetector CT Improve Tumor Depiction in the Cirrhotic Liver?

Tomoaki Ichikawa1, Takatoshi Kitamura1,2, Hiroto Nakajima1, Hironobu Sou1, Tatsuaki Tsukamoto1, Satoshi Ikenaga1 and Tsutomu Araki1

1 Department of Radiology, Yamanashi Medical University, 1110 Shimokato, Tamaho, Nakakoma, Yamanashi 409-3815, Japan.
2 First Department of Internal Medicine, Yamanashi Medical University, Yamanashi 409-3815, Japan.



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  		Fig. 1. —Scatterplot shows attenuation conspicuity of hypervascular hepatocellular carcinomas with single-detector helical CT. Attenuation conspicuity equals tumor attenuation minus liver attenuation.

 


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  		Fig. 2. —Scatterplot shows attenuation conspicuity of hypervascular hepatocellular carcinomas in double arterial phase CT with multidetector CT. Attenuation conspicuity is tumor attenuation minus liver attenuation.

 


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  		Fig. 3. —Plot shows receiver operating characteristic curves for detecting hypervascular hepatocellular carcinomas with double arterial phase ({Delta}) CT scans. Note that curve of late arterial phase (+) CT scans is superimposed on that of combined arterial phase CT scans because of their equivalent area under the curve values. {circ} = early arterial phase.

 


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  		Fig. 4A. —55-year-old man with hypervascular hepatocellular carcinoma in posterior segment of right lobe of liver. Transverse early arterial phase CT scan shows mass (arrow) with faint contrast enhancement in posterior segment of right lobe. Note that portal vessels show no contrast enhancement, which means that scanning timing may be too early.

 


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  		Fig. 4B. —55-year-old man with hypervascular hepatocellular carcinoma in posterior segment of right lobe of liver. Transverse late arterial phase CT scan clearly shows contrast-enhanced mass (arrow) with hyperattenuation. Degree of contrast enhancement of mass is greater on this late arterial phase scan than on early arterial phase scan (A). As a result, mass can be more easily identified.

 


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  		Fig. 5A. —77-year-old man with hypervascular hepatocellular carcinoma in posterior segment of right lobe of liver. Transverse early arterial phase CT scan shows contrast-enhanced mass (arrow) with hyperattenuation in posterior segment of right lobe of liver.

 


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  		Fig. 5B. —77-year-old man with hypervascular hepatocellular carcinoma in posterior segment of right lobe of liver. Mass shows washout of contrast material and isoattenuation compared with peripheral liver parenchyma on transverse late arterial phase CT scan. Note that right hepatic vein (arrow) is clearly enhanced; scanning may be too late. Hyperattenuating tumor capsule (arrowheads), which is enhancing during process of washout of contrast material from mass to peripheral liver parenchyma, may be retrospectively identified.

 

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