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Visualization of Hypervascular Liver Lesions During TACE: Comparison of Angiographic C-Arm CT and MDCT

¹ Department of Radiology and Nuclear Medicine, Charité-University Hospital, Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany.
² Department of Biometry and Clinical Epidemiology, Charité-University Hospital, Berlin, Germany.
³ Siemens Medical Solutions AG, Forchheim, Germany.
⁴ Present address: Department of Radiology and Radiological Science, The Johns Hopkins Hospital, Baltimore, MD.

View larger version (138K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —63-year-old woman with multifocal recurrence of hepatocellular carcinoma (HCC) 9 years after hepatic resection. Transverse IV contrast-enhanced MDCT images of liver in arterial (A) and portal venous (B) phases compared with C-arm CT images in arterial (C) and portal venous (D) phases obtained after administration of transarterial contrast material before transarterial chemoembolization. On MDCT, only three lesions (black arrows, A–D) with weak hyperdense arterial enhancement and isodense enhancement in portal venous phase were identified as HCC nodules. In corresponding C-arm CT images, these lesions show strong rim enhancement in arterial phase (C) and slightly hypodense enhancement in portal venous phase (D). An additional lesion with equal enhancement pattern was seen only on C-arm CT (white arrow, C and D) and was counted as false-positive finding on C arm CT.

View larger version (133K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —63-year-old woman with multifocal recurrence of hepatocellular carcinoma (HCC) 9 years after hepatic resection. Transverse IV contrast-enhanced MDCT images of liver in arterial (A) and portal venous (B) phases compared with C-arm CT images in arterial (C) and portal venous (D) phases obtained after administration of transarterial contrast material before transarterial chemoembolization. On MDCT, only three lesions (black arrows, A–D) with weak hyperdense arterial enhancement and isodense enhancement in portal venous phase were identified as HCC nodules. In corresponding C-arm CT images, these lesions show strong rim enhancement in arterial phase (C) and slightly hypodense enhancement in portal venous phase (D). An additional lesion with equal enhancement pattern was seen only on C-arm CT (white arrow, C and D) and was counted as false-positive finding on C arm CT.

View larger version (114K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —63-year-old woman with multifocal recurrence of hepatocellular carcinoma (HCC) 9 years after hepatic resection. Transverse IV contrast-enhanced MDCT images of liver in arterial (A) and portal venous (B) phases compared with C-arm CT images in arterial (C) and portal venous (D) phases obtained after administration of transarterial contrast material before transarterial chemoembolization. On MDCT, only three lesions (black arrows, A–D) with weak hyperdense arterial enhancement and isodense enhancement in portal venous phase were identified as HCC nodules. In corresponding C-arm CT images, these lesions show strong rim enhancement in arterial phase (C) and slightly hypodense enhancement in portal venous phase (D). An additional lesion with equal enhancement pattern was seen only on C-arm CT (white arrow, C and D) and was counted as false-positive finding on C arm CT.

View larger version (159K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1D —63-year-old woman with multifocal recurrence of hepatocellular carcinoma (HCC) 9 years after hepatic resection. Transverse IV contrast-enhanced MDCT images of liver in arterial (A) and portal venous (B) phases compared with C-arm CT images in arterial (C) and portal venous (D) phases obtained after administration of transarterial contrast material before transarterial chemoembolization. On MDCT, only three lesions (black arrows, A–D) with weak hyperdense arterial enhancement and isodense enhancement in portal venous phase were identified as HCC nodules. In corresponding C-arm CT images, these lesions show strong rim enhancement in arterial phase (C) and slightly hypodense enhancement in portal venous phase (D). An additional lesion with equal enhancement pattern was seen only on C-arm CT (white arrow, C and D) and was counted as false-positive finding on C arm CT.

View larger version (127K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —Hepatocellular carcinoma (HCC) in 73-year-old woman. Transverse IV contrast-enhanced MDCT images of liver in arterial (A) and portal venous (B) phases show large HCC (black arrows, A–D) in liver segments IV and VIII with ill-defined tumor margins and peripheral rimlike enhancement in arterial phase (A) and heterogeneous iso– and hypodense enhancement in portal venous phase (B).

View larger version (120K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —Hepatocellular carcinoma (HCC) in 73-year-old woman. Transverse IV contrast-enhanced MDCT images of liver in arterial (A) and portal venous (B) phases show large HCC (black arrows, A–D) in liver segments IV and VIII with ill-defined tumor margins and peripheral rimlike enhancement in arterial phase (A) and heterogeneous iso– and hypodense enhancement in portal venous phase (B).

View larger version (156K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2C —Hepatocellular carcinoma (HCC) in 73-year-old woman. Corresponding transverse C-arm CT images after transarterial contrast media administration in arterial (C) and portal venous (D) phases. Although tumor shows comparable enhancement pattern to MDCT in arterial phase (C), portal venous phase (D) shows large perfusion defect. On C-arm CT, additional nodular lesion was detected in liver segment II (white arrow, C and D); it was rated HCC by both readers. In this case, scan coverage was incomplete because of liver extension.

View larger version (130K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2D —Hepatocellular carcinoma (HCC) in 73-year-old woman. Corresponding transverse C-arm CT images after transarterial contrast media administration in arterial (C) and portal venous (D) phases. Although tumor shows comparable enhancement pattern to MDCT in arterial phase (C), portal venous phase (D) shows large perfusion defect. On C-arm CT, additional nodular lesion was detected in liver segment II (white arrow, C and D); it was rated HCC by both readers. In this case, scan coverage was incomplete because of liver extension.

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