Optimal Scan Window for Detection of Hypervascular Hepatocellular Carcinomas During MDCT Examination
Myeong-Jin Kim1,2,3,
Jin Young Choi1,3,
Joon Seok Lim3,
Jin Yong Kim1,3,
Joo Hee Kim3,
Young Taik Oh1,3,
Eun Hye Yoo1,3,
Jae Joon Chung1 and
Ki Whang Kim1
1 Department of Diagnostic Radiology, Severance Hospital, Yonsei University
College of Medicine, Seodaemun-ku Shinchon-dong 134, Seoul, 120-752, South
Korea.
2 Institute of Gastroenterology and Brain Korea 21 Project for Medical Science,
Severance Hospital, Yonsei University College of Medicine, Seoul, South
Korea.
3 Department of Diagnostic Radiology, Institute of Radiological Science,
Severance Hospital, Yonsei University College of Medicine, Seoul, South
Korea.
View larger version (13K):
[in a new window]
|
Fig. 1 —Diagram of scan protocol over time axis in each group. Bolus
tracking was started 10 seconds after start of injection of contrast medium
(CM). The 100-H threshold scan delay time for early scan was 10 seconds in
group (GR) 1 and was increased by 2-second increments in each group. Interscan
delay was fixed at 6 seconds. Number of patients (pts) and number of
hepatocellular carcinomas (HCCs) are displayed in parentheses.
|
|
View larger version (12K):
[in a new window]
|
Fig. 2A —Box-and-whisker plots show median (middle line of each box),
quartiles (top and bottom lines of each box), and upper and lower adjacent
(upper and lower whiskers for each box) values for (A) tumor,
(B) liver, and (C) tumor-to-lesion attenuation difference (TLAD)
in each group in first- (light gray) and second- (dark gray)
phase images. Attenuation of tumor gradually increased in first-phase images
in groups 1 through 5; attenuation of tumor gradually increased in
second-phase images in groups 1 through 4, but decreased in groups 5 and
6.
|
|
View larger version (10K):
[in a new window]
|
Fig. 2B —Box-and-whisker plots show median (middle line of each box),
quartiles (top and bottom lines of each box), and upper and lower adjacent
(upper and lower whiskers for each box) values for (A) tumor,
(B) liver, and (C) tumor-to-lesion attenuation difference (TLAD)
in each group in first- (light gray) and second- (dark gray)
phase images. Attenuation value of liver gradually increased from groups 1 to
6 for both phase images.
|
|
View larger version (12K):
[in a new window]
|
Fig. 2C —Box-and-whisker plots show median (middle line of each box),
quartiles (top and bottom lines of each box), and upper and lower adjacent
(upper and lower whiskers for each box) values for (A) tumor,
(B) liver, and (C) tumor-to-lesion attenuation difference (TLAD)
in each group in first- (light gray) and second- (dark gray)
phase images. Mean value for TLAD1 gradually increased in groups 1 through 4
with increasing scan delay time. Mean TLAD1 of groups 4 through 6 and mean
TLAD2 of groups 1 through 4 were not statistically significant.
|
|
View larger version (14K):
[in a new window]
|
Fig. 3A —Bar graphs indicate number of lesions that showed (A)
higher tumor-to-liver attenuation difference (TLAD), (B) visual
conspicuity, and (C) interpreter preference in each phase image in each
group. Gray bars denote number of lesions for which TLAD1 was greater than
TLAD2, and black bars represent number of lesions for which TLAD2 was greater
than TLAD1. In groups 1 to 4, larger number of lesions showed higher contrast
in second arterial phase image than in first arterial phase image. In groups 5
and 6, larger number of lesions showed higher contrast in first arterial phase
images.
|
|
View larger version (20K):
[in a new window]
|
Fig. 3B —Bar graphs indicate number of lesions that showed (A)
higher tumor-to-liver attenuation difference (TLAD), (B) visual
conspicuity, and (C) interpreter preference in each phase image in each
group. Bar graph indicates summation of four interpreters' subjective rating
of conspicuity of each lesion. Gray bars denote total number of lesions that
were subjectively rated as being more conspicuous in first-phase image in each
group by four interpreters. Hatched bars denote total number of lesions that
were rated as having similar conspicuity in first- and second-phase images.
Black bars denote total number of lesions that were rated as being more
conspicuous in second-phase image.
|
|
View larger version (15K):
[in a new window]
|
Fig. 3C —Bar graphs indicate number of lesions that showed (A)
higher tumor-to-liver attenuation difference (TLAD), (B) visual
conspicuity, and (C) interpreter preference in each phase image in each
group. Bar graph indicates total number of lesions preferred by four
interpreters. Gray bars denote total number of lesions in which interpreters
preferred first-phase image, and black bars represent total number of lesions
in which interpreters preferred second-phase image. In groups 1 and 2, more
lesions were preferred at second arterial phase. In groups 3 through 6, more
lesions were preferred at first arterial phase.
|
|
View larger version (92K):
[in a new window]
|
Fig. 4A —64-year-old woman from group 2 with small hepatocellular
carcinoma (HCC) at dome of liver (arrows). Small HCC lesion is barely
visible in first-phase image.
|
|
View larger version (104K):
[in a new window]
|
Fig. 4B —64-year-old woman from group 2 with small hepatocellular
carcinoma (HCC) at dome of liver (arrows). Second-phase image clearly
depicts heterogeneously enhancing hypervascular HCC. Most lesions in groups 1
and 2 showed better contrast in second-phase image.
|
|
View larger version (143K):
[in a new window]
|
Fig. 5A —43-year-old man from group 4 with hepatocellular carcinoma
(HCC) on left lobe of liver (arrows). First-phase image shows
hypervascular tumor.
|
|
View larger version (135K):
[in a new window]
|
Fig. 5B —43-year-old man from group 4 with hepatocellular carcinoma
(HCC) on left lobe of liver (arrows). Lesion is barely discernible in
second-phase image. Patient underwent right hepatectomy previously, and
fluid-filled bowel loops are seen in right hepatic fossa.
|
|
View larger version (128K):
[in a new window]
|
Fig. 6A —65-year-old man from group 6 with small hepatocellular
carcinoma (HCC) on right lobe of liver. First-phase image clearly shows
hypervascular tumor (arrow).
|
|
View larger version (147K):
[in a new window]
|
Fig. 6B —65-year-old man from group 6 with small hepatocellular
carcinoma (HCC) on right lobe of liver. Lesion is not seen in second-phase
image. In this patient, second scan is actually taken at portal venous or
hepatic parenchymal phase. Note substantial enhancement of hepatic parenchyma
and hepatic vein (arrowhead).
|
|
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
Copyright © 2006 by the American Roentgen Ray Society.
