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Detection of Early Enhancement of Hypervascular Hepatocellular Carcinoma Using Single Breath-Hold 3D Pixel Shift Dynamic Subtraction MDCT

¹ All authors: Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjyo, Kumamoto 860-8556, Japan.

View larger version (9K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1 —Mean receiver operating characteristic (ROC) curves for all observers who detected enhancement during hepatic arterial phase. Mean area under ROC curve (Az) increased from 0.86 ± 0.05 (original images, dashed line) to 0.91 ± 0.03 (subtracted images, solid line); this difference was statistically significant (p <0.01).

View larger version (152K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —29-year-old man with undetected liver tumor. Unenhanced MDCT image depicts iso- or hypoattenuated area in left lobe (arrow).

View larger version (153K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —29-year-old man with undetected liver tumor. Tumor (arrow) is not clearly depicted on contrast-enhanced original image. Only one of eight radiologists assigned confidence level of more than 50% with respect to presence of focal enhancement.

View larger version (110K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2C —29-year-old man with undetected liver tumor. Subtracted image clearly depicts hyperenhanced area (arrow), confirming presence of hypervascular hepatocellular carcinoma (HCC). Tumor-to-liver contrast is increased from 1 to 17 H by our subtraction method.

View larger version (147K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2D —29-year-old man with undetected liver tumor. CT image obtained during hepatic arteriography clearly depicts hypervascular HCC (arrow).

View larger version (142K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —72-year-old man with detected liver tumor. Unenhanced MDCT image depicts iso- or hypoattenuated area (arrow) in right lobe.

View larger version (132K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —72-year-old man with detected liver tumor. Contrast-enhanced original image depicts slightly hyperenhanced area (arrow), confirming presence of hypervascular tumor.

View larger version (116K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C —72-year-old man with detected liver tumor. This subtracted image depicts hyperenhanced area (arrow) more clearly than B. Subtraction method increased tumor-to-liver contrast from 28 to 40 H.

View larger version (135K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3D —72-year-old man with detected liver tumor. CT image obtained during hepatic arteriography clearly depicts hypervascular hepatocellular carcinoma (arrow).

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