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Quadruple-Phase MDCT of the Liver in Patients with Suspected Hepatocellular Carcinoma: Effect of Contrast Material Flow Rate

Wolfgang Schima1, Renate Hammerstingl2, Carlo Catalano3, Luis Marti-Bonmati4, Ernst J. Rummeny5, Francisco Tardáguila Montero6, Albert Dirisamer1, Bernd Westermayer7, Massimo Bellomi8, Denis Brisbois9, Patrick Chevallier10, Martin Dobritz5, Jacques Drouillard11, Francesco Fraioli3, Maria Jesus Martinez4, Sandro Morassut12 and Thomas J. Vogl2

1 Department of Radiology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
2 Department of Radiology, Klinikum der Johann Wolfgang Goethe-Universitaet Frankfurt, Germany.
3 Unita Operativa di Radiologia, Universita La Sapienza, Roma, Italy.
4 Servicio de Radiologia, Hospital Universitario Doctor Peset, Valencia, Spain.
5 Department of Radiology, Klinikum rechts der Isar, Muenchen, Germany.
6 Departamento de Radiologia, Centro Medico, Policlinico Vigo, Priegue, Spain.
7 Amersham Buchler GmbH & Co KG, Ismaning, Germany.
8 Istituto Europeo di Oncologia, Milano, Italy.
9 Les Cliniques St. Joseph, Liege, Belgium.
10 CHU Hopital de lArchet II, Nice, France.
11 CHU Hopital Haut Leveque, Bordeaux, France.
12 Centro di Riferimento Oncologico, Aviano, Italy.


Figure 1
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  		Fig. 1A —60-year-old woman with multicentric hepatocellular carcinoma (HCC). Early arterial phase MDCT (performed at flow rate of 5 mL/sec) image shows minimally hyperattenuating HCC in the right lobe in segment 6 (arrow). Qualitatively, lesion visualization was classified as adequate.

 

Figure 2
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  		Fig. 1B —60-year-old woman with multicentric hepatocellular carcinoma (HCC). Late arterial phase image reveals the lesion with much better tumor-liver contrast (arrow). Lesion visualization was classified as excellent.

 

Figure 3
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  		Fig. 1C —60-year-old woman with multicentric hepatocellular carcinoma (HCC). Rapid washout of contrast material renders lesion invisible on portal venous phase image.

 

Figure 4
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  		Fig. 1D —60-year-old woman with multicentric hepatocellular carcinoma (HCC). Lesion is not seen on delayed phase image.

 

Figure 5
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  		Fig. 1E —60-year-old woman with multicentric hepatocellular carcinoma (HCC). Late arterial phase MDCT reveals small satellite HCC (arrow), which was not seen in other phases.

 

Figure 6
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  		Fig. 1F —60-year-old woman with multicentric hepatocellular carcinoma (HCC). Late arterial phase MDCT reveals two more small lesions (arrows) in dome of liver (segment 8) that were not visible during other scans. Both lesions showed interval growth at 6-month follow-up indicative of HCC (not shown).

 

Figure 7
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  		Fig. 2A —57-year-old man with infiltrative hepatocellular carcinoma (HCC) with tumor thrombus in portal vein. Early arterial MDCT scan (performed with flow rate of 3 mL/sec) shows tumor vessels in portal vein (arrow). Infiltrative HCC in adjacent part of segment 4 is not well depicted (subjective assessment, adequate).

 

Figure 8
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  		Fig. 2B —57-year-old man with infiltrative hepatocellular carcinoma (HCC) with tumor thrombus in portal vein. Late arterial phase scan shows tumor thrombus (black arrows). There is only moderate enhancement of HCC (arrowheads) with low contrast material flow rate. Another lesion in right lobe (segment 8/5) is depicted (white arrow). Visualization of both lesions was classified as good.

 

Figure 9
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  		Fig. 2C —57-year-old man with infiltrative hepatocellular carcinoma (HCC) with tumor thrombus in portal vein. Portal venous phase shows tumor thrombus (black arrows), but not infiltrative HCC, which grows into portal vein (subjective assessment, poor visualization). HCC in right lobe (white arrow) is well depicted (subjective assessment, good visualization).

 

Figure 10
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  		Fig. 2D —57-year-old man with infiltrative hepatocellular carcinoma (HCC) with tumor thrombus in portal vein. Delayed phase scan reveals only thrombosis of portal vein (arrows).

 

Figure 11
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  		Fig. 3 —Mean time-attenuation curves of HCC lesion and hepatic parenchyma during early arterial, late arterial, portal venous, and delayed phase imaging. HCC = hepatocellular carcinoma, EAP = early arterial phase, LAP = late arterial phase, PVP = portal venous phase, DP = delayed phase.

 

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